Barriers and Adaptations of a Digital Game for Older Adults
Robyn Schell, Simone Hausknecht and David Kaufman
Faculty of Education, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
Keywords: Digital Games, Videogames, Older Adults, Seniors, Aging, Barriers, Adaptations, Difficulties.
Abstract: The number of older adults playing digital games is increasing. However, there are few studies that focus on
barriers that can limit ageing players from fully participating in these games. This paper describes some key
findings regarding barriers reported by 17 older adults who played Wii bowling in an eight week
tournament and how they adapted their playing style to overcome these barriers. This qualitative study
found that physical issues such as visual impairment, balance, and strength affected the way these older
adults played, but these limitations did not appear to curtail their enjoyment of the game. This may be partly
due to adaptations they implemented in order to play such as using walkers, canes and other aids to support
themselves. Adequate space was an important consideration for those using such aids.
1 INTRODUCTION
1.1 Background
The World Health Organization (WHO) estimates
that worldwide, the proportion of people 60 years of
age and over is growing faster than any other age
group, and there will be a total of about 1.2 billion
people over the age of 60 by 2025 (WHO, 2002).
Aging older adults face difficult conditions as they
experience declining physical and cognitive abilities,
loss of life-long friends and partners, changed living
arrangements, and increasing likelihood of chronic
and debilitating illness (Kaufman, 2013).
As people live longer and the number of older
adults increases in our society, concerns about future
health care and social costs have promoted an
interest in enhancing healthy living and “successful
aging.” Successful aging is associated with an
independent, positive, healthy, and meaningful
quality of life. Achieving these goals can be a
challenge for older individuals, but if encouraged
and supported it may yield significant benefits for
older adults and society at large.
Historically, much of what we know about the
aging process has been oriented to medical or
biological perspectives that tend to medicalize old
age. More contemporary theories also consider
factors such as overall well-being, lifestyle, financial
resources, and the influence of home and
community.
Being active is now thought of as more than the
ability to be physically active or to participate in the
labour force. Being active also includes participation
in social, economic, cultural, spiritual and civic
affairs (WHO, 2002). Through active aging, a
healthy life expectancy and quality of life could be
extended as people age. Within this framework,
policies and programs that promote mental health
and social connections are as significant as those
that improve physical health status.
Technology can offer meaningful and engaging
activities that are stimulating, enjoyable and fun
(Sixsmith, 2006). Research has shown that digital
games have the potential to enhance the social life of
older adults (IJsselsteijn, Nap, de Kort, and Poels,
2007) and to exert a positive influence on an
individual’s sense of well being (Goldstein et al.,
1997). Mature gamers are becoming an expanding
segment of the gaming population in the US. In
1999, ESA reported that 9% of the digital game
audience was over 50 (Entertainment Software
Association, 2005) and by 2011 twenty-nine percent
of those who played games were 50+ (Entertainment
Software Association, 2011).
Gaming is enjoyable because games provide an
opportunity to produce feelings of mastery and a
sense of achievement (Astell, 2013). Games are also
associated with a feeling of immersion that results in
a sense of satisfaction that players find enjoyable
(Csikszentmihalyi, 1997).
Games have a social element when played with
one or more other people that can enhance well-
269
Schell R., Hausknecht S. and Kaufman D..
Barriers and Adaptations of a Digital Game for Older Adults.
DOI: 10.5220/0005524002690275
In Proceedings of the 1st International Conference on Information and Communication Technologies for Ageing Well and e-Health (AGEWELL-2015),
pages 269-275
ISBN: 978-989-758-102-1
Copyright
c
2015 SCITEPRESS (Science and Technology Publications, Lda.)
being. Playing digital games offers a venue for
meeting people, staying connected and coping with
loneliness (De Schutter and Abeele, 2010). Playing
digital games also produces positive feelings about
other participants and their abilities (Whitcomb,
1990). However, to achieve the positive social
outcomes associated with playing digital games, the
design of digital games must be accessible and
appropriate to the needs of older adults.
Inappropriate design can inhibit or diminish the
sense of accomplishment, satisfaction and self
efficacy that make games enjoyable.
Some commercial games offer more accessibility
to older adults than do others. Wii bowling was
selected for our research as a game to study the
social effects of game playing and to learn more
about older adults’ digital gaming experience. This
game was chosen because many older people are
familiar with this game and enjoyed bowling when
they were younger.
This paper describes the barriers to playing Wii
bowling as perceived by older adults, and how they
adapted to play despite disabilities and other issues
associated with ageing. We also offer some
recommendations on how the game could be
successfully implemented with other older adults.
1.2 Purpose of the Study
The purpose of this study was to explore the
opinions and experiences of older adults (aged 60
years and older) who played the digital game Wii
bowling during an eight-week tournament. Our
focus was on the social-emotional aspects of playing
Wii bowling and possible barriers affecting their
gameplay and how they adapted their playing style
to overcome these barriers.
The data collected will help to inform future
studies investigating the use of digital games as a
venue to enhance the lives of older adults. By
understanding more about barriers and how they can
be overcome from the player’s perspective, other
older adults may experience the benefits associated
with playing a digital games such as Wii bowling.
1.3 Research Questions
This research was guided by the following
questions:
1. What do older adults perceive as benefits and
barriers to playing this digital game?
2. What are the key implementation issues for
older adults who play this digital game?
2 LITERATURE REVIEW
2.1 Social Interaction and Successful
Aging
In 1988, after reviewing five large prospective
studies, researchers concluded a lack of social
relationships had a negative impact on the lifespan
of elderly people (House, Landis, and Umberson,
1988). More recent evidence shows that the quantity
and/or quality of social relationships in western
societies is decreasing. For instance, trends reveal
fewer instances of intergenerational living, greater
social mobility, dual-career families that reduce time
available for the elderly, more single-residence
households, and increased age-related disabilities
(McPherson and Smith-Lovin, 2006; Putnam,
2000).
Research has established that social engagement
can positively improve one’s ability to age
successfully (Rowe and Kahn, 1998) and active
engagement in social activities plays a role in the
level of life satisfaction (Bowling and Dieppe,
2005). In Rowe and Kahn’s (1998) report for the
McArthur Foundation, social engagement, defined
earlier as being involved “in activities that are
meaningful and purposeful” and “maintaining close
relationships” (Rowe and Kahn, 1997), was included
as one of the three major elements of successful
aging. Digital games have the potential to support
seniors in creating meaningful and enjoyable ways
to enjoy life and the company of others (Nap, de
Kort, and IJsselsteijn, 2009).
2.2 Digital Games and Older Adults
There are many studies showing that activities
linked to casual leisure are associated with benefits
including development and maintenance of
interpersonal relationships and enhanced well being
(Stebbins, 2007). As the number of older adults
playing games increases (Pew Research Center,
2010), technology is providing them with new
opportunities for casual leisure that promise
significant benefits for enhancing their lives as they
age (IJsselsteijn et al., 2007). Technology can play a
more significant role in helping people at any age to
live a happier and more satisfying life when the
development of these technologies focuses on
addressing more complex, higher level social needs
(Astell, 2013).
Currently digital gaming is a technology
dedicated to enhancing the enjoyment of life,
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whether played alone or in social groups. Digital
games have been oriented to the young, but as
demographics change older adults are becoming
important game consumers (Entertainment Software
Industry, 2011). Digital games are enjoyable
because they offer a venue to develop skills, attain
mastery, and achieve a sense of accomplishment.
These feelings tie into the notion of “flow” which
describes the feelings of satisfaction and lack of
sense of time when someone is completely
immersed in an activity (Csikszentmihalyi, 1997).
The flow effect of digital games has the potential to
create positive experiences for older adults.
Digital games have been found to provide an
environment that offers a culture of fun for older
adults (Whitcomb, 1990). De Schutter and Abeele’s
qualitative study (2010), which included a sample of
35 participants selected from a larger sample of 239
older gamers between 45 and 85, revealed that
participants found digital games a fun way to spend
their time.
Furthermore, when games include social
interaction, there is the possibility of developing
meaningful relationships with fellow players as well
as having fun. Online games have positive impact on
well-being and successful aging because they offer a
venue for interacting with other people and enjoying
leisure activities. An analysis of 50,000 posts
collected from online social games showed that
participants found that online games offered
meaningful play, an opportunity for practice, a
venue to demonstrate their abilities, and a means for
coping with ageing (Nimrod, 2009). Nimrod noted
that “regulars” “knew” one another and had
interpersonal dialogues, mostly relating to the game.
Nimrod also found that play and active
entertainment were important goals for those who
participated in social online games, and those who
played digital social games frequently were often
involved in sociable conversations. Players
identified each other, exchanged personal
information and experiences, and had their own
“group humor.” The main categories of subjects in
the postings — funny stories, jokes or other
comments — fostered connectedness among players
and provided enjoyable interaction and, to a certain
extent, a sense of belonging.
Several studies have demonstrated that the social
interaction that takes place when playing digital
games is very important to older players (De
Schutter and Abeele, 2010; Khoo and Cheok, 2006;
Wollersheim et al., 2010). Playing digital
videogames also promotes positive health outcomes
associated with alleviating depression and reducing
feelings of loneliness and isolation (Wollersheim et
al., 2010). Digital gaming also provides a venue for
developing social capital that strengthens strong
social ties both online and off (Trepte, Reinecke, and
Juechems, 2012).
If digital games and games within online
communities can enhance the quality of lives of
older adults through the effect of flow experience
and the facilitation of social interaction, research
that explores older players’ barriers and adaptations
to the game interface can produce information that
improves gameplay and so enhances the social lives
of older people.
2.3 Barriers and Adaptations
Research that focuses on barriers to older players of
digital games is relatively rare, but it appears that for
technology in general, age-related changes can
influence how well technologies can be used and
how easily they can be learned (Charness and
Holley, 2004; Xie, 2002). We selected the Wii
bowling game for our research because many older
adults are familiar with bowling and the game is
relatively simple to learn and play.
Wii Bowling offers a platform for multiple
players where bowlers can use one or more
controllers, while the game action is displayed on a
large screen. The controller uses a motion sensor to
detect the user’s movement and supports the player’s
interaction with the game environment. The natural
movement of the bowler is facilitated by the hand
held controller, which is swung by the player in a
similar motion to throwing a bowling ball. The
participant faces the screen, which shows a virtual
bowling lane.
Certain design features enhance game play for
older adults playing a digital game such as Wii
Bowling, including content variety, choice and
flexibility (Marston, 2013). But often the game
design industry does not take into consideration the
needs of older adults to produce interface designs
that could help enable mature players to take part in
game play. In a study of ten digital game players,
with a mean age of 67.8, problems were reported
with system and in-game interfaces (Nap et al.,
2009). In some cases, players have even reported
pain when playing (Wollersheim et al., 2010). There
is a correlation between age and optimal length of
playing time for older people. Current knowledge of
the needs of older players of digital games suggests
that today’s commercial games pose usability
challenges for many older adults (Buiza et al, 2009;
De Schutter, 2011). When developing digital games
BarriersandAdaptationsofaDigitalGameforOlderAdults
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for older adults, elements such as display,
navigation, audio, visuals, and rules all affect
players’ ability to effectively engage with the game
and achieve a satisfactory experience (Sauvé,
Renaud, Kaufman, and Duplàa, (2015, in press).
Despite these limitations, the number of older
people playing digital games is growing, and there is
evidence that their gameplay has social benefits..
However, very few studies have been conducted on
the barriers that older players encounter and if and
how they can adapt their playing style to play these
games despite the types of physical limitations often
associated with ageing.
Our research investigates what older players
perceive as barriers and how they cope with these
barriers while playing Wii Bowling.
3 RESEARCH METHOD
3.1 Participants and Recruitment
The participants for our qualitative study included
17 individuals 60 years of age and older, originally
recruited as part of a larger quantitative study of 73
participants who played Wii Bowling in a
tournament for eight weeks. Participants who took
part in our qualitative study lived within an area
comprised of three adjoining municipalities in the
Greater Vancouver region of Canada. Twelve were
recruited from independent living centres and five
from assisted living centres. In these municipalities,
independent living centres offer apartment living for
those over 55, while assisted living centres offer
services to residents such as meals, housekeeping,
laundry, recreational opportunities, 24-hour
emergency response, and personal care services.
3.2 Data Collection
We conducted interviews with participants who
volunteered to take part in the qualitative portion of
our study after participating in a Wii Bowling
tournament at their centre. Each interview was about
30 minutes long and covered topics designed to
elicit perceptions of the game playing experience
and the formation during the tournament of
friendships or social connectedness with their team
members, their family and friends, and others in
their centres. We also asked about their experience
with the equipment and the disadvantages and
advantages of playing Wii Bowling. These
interviews were recorded and transcribed.
3.3 Instruments
The in-person interview was based on a semi-
structured questionnaire that asked about the
perceptions of the participants about the game
experience in the Wii Bowling tournament. Each
person was interviewed in their home and the
conversation recorded on a smart phone. Some
examples of the questions asked were: How would
you describe your Wii Bowling experience?; Were
there things you found difficult to do when playing
Wii Bowling?; Do you think there were any
drawbacks for other people who played in the Wii
Bowling tournament?
3.4 Data Analysis
Seventeen transcripts were imported into MaxQDA
for coding. The coding process encompassed three
basic steps: familiarizing ourselves with the content
of the transcriptions, applying open coding to the
content, and lastly, analyzing codes for emergent
themes. We began by applying preliminary coding
to three transcriptions using pencil and paper to
elicit the possible direction of the emerging codes.
Once transcriptions were imported into MaxQDA,
codes were applied to each statement using a word
or phrase to summarize the basic meaning of each
comment (Saldana, 2009). If more than one
completely different idea was included in a
statement, each idea was coded separately, but this
occurred rarely in the analysis. Words that were
simple affirmatives like, “Yeah” or part of
introductions or other topics not related to the study
were coded as “Irrelevant.”
Codes were then organized to reflect the number
of people whose statements were coded with the
same code as well as how many times a particular
code was applied. In this way, codes that applied to
statements made by more than 50% of the
participants were identified. Those codes identified
were reviewed to determine their overarching
themes. One of these overarching themes was Game
Issues.
4 FINDINGS
4.1 Participants’ Backgrounds (N=17)
Twenty participants were interviewed before the
tournament began. Two dropped out of the
tournament and data for one participant who only 58
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was not included, as she was not in our target
demographic of adults aged 60 years or older. Of the
17 who were interviewed a second time after the
tournament, 11 had not played video games in the
last five years; the remainder had played video
games in the last five years.
1. Sex: Males (n=3); Females (n=14).
2. Age:
65-69 (n=3); 70-74 (n=2); 75-79 (n=6);
89-84 (n=2); 85-89 (n=3); 90+ (n=1).
3. Where do you live?
Assisted-living (n=5);
Independent (n=12).
4.2 Game Issues
Game issues were found to be an overarching theme
that included seemingly contradictory codes. Codes
applied to statements made by more than 50% of the
participants collected under the theme of Game
Issues are shown in Table 1.
Table 1: Number of participants’ statements about game
issues by theme code.
Code Participants (N)
Playing with disabilities 9
Help with setup 10
No problem with equipment 10
Issues with Wii Equipment 11
No disadvantage playing Wii 14
4.3 Participants’ Perceived Barriers
Although ten participants commented that they
found no problems with equipment and 14 reported
that there were no disadvantages to playing Wii
Bowling, nine participants referred to their
perceptions about the experience of playing Wii
Bowling with disabilities and ten participants
commented on help needed with setting up the
game.
When asked about Wii equipment, difficulties
with the controller were mentioned on a number of
occasions. One player over 80 years old, asserted
that some of her acquaintances found the use of the
controller challenging but her statement appears to
illustrate contradictions shown in the major codes
“Well, the ones that I bowl with find it a positive
experience. So, I don’t know—everybody’s
different. I know they try it and get very upset at
trying to master the—what they call...the controller.”
The topic of playing with disabilities was
described frequently and many players described the
controller as an issue. For example, one player
commented: “Well, because I–I had carpal tunnel
surgery on this hand and then I’m numb in the—I
might have to have it in this hand. I found that my
numbness--I really couldn’t feel the buttons too
easily and I would sort of goof up on the buttons.
But I would eventually get it. I mean I think that’s
where a lot of people got hung up with the whole
thing cuz they couldn’t really manage the buttons”
Others were concerned with issues of balance,
chronic injuries, and strength that affected their
game play. One 80+ player referred to balance as a
challenge to playing Wii: “A little bit of balance, but
that was my balance, but I think we all had a
problem with that because you were standing up
without a walker. I don't use a walker, I use a cane
when I go out but ah --- balance is a problem.”
When asked if there were drawbacks to playing Wii,
one respondent who played seated a walker replied,
“Just the standing, because they are used to using
walkers, many of them. They rely on the walker.”
Nevertheless, over 50% of the participants declared
they found no disadvantages to playing Wii
Bowling. This may be because players enjoyed
playing and overcame disabilities by using various
aids.
One player described impaired vision as a
problem although she enjoyed playing. Another
described the sound effects produced by the Wii as
wearing and very distracting, and they ended up
turning the volume off. Equipment set up was often
taken care of by a key person who was comfortable
with the technology. In four of our five centres, there
was a player or a resident who took responsibility
for setup.
4.4 Using Aids to Play Wii Bowling
Despite the challenges older players faced with
playing Wii Bowling and coping with the equipment
particularly the controller and set up, those
interviewed for this research study were able to play
using aids while playing such as using a cane, a
walker, wheelchair, or a learning or sitting on a chair
to adapt to play with disabilities.
5 DISCUSSION
Reviewing the findings, we see that the design of
Wii bowling game created barriers for older players
as described in earlier studies (Charness and Holley,
2004; Nap, 2009; Xie, 2002). As suggested by Sauvé
et al. (2015), game elements such as display,
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273
navigation, audio, visuals, and rules should be
considered when designing digital games for older
adults’ play. Since playing digital games has been
shown to have social benefits (IJsselsteijn et al,
2007: Stebbins, 2007), future research studying how
games could accommodate the needs of ageing
adults would be of value. Furthermore, consideration
of adaptations mentioned by our participants could
be supported and put in place in other Wii game
playing environments to allow physical aids to be
used.
6 CONCLUSIONS
In our research, the design of the Wii game interface
was not completely suitable for those with problems
with dexterity and balance, but it appears that with
even fairly serious disabilities, players can enjoy
playing Wii Bowling. Fourteen of 17 Wii Bowling
participants declared that they found no
disadvantages to playing Wii. This may be due in
part to adaptations they initiated which entail
additional space when playing. One of the most
challenging aspects for players was the set up of the
game including the hookup of the monitor and using
the controller. Perhaps future research exploring
universal design approaches may provide
improvements that are more inclusive.
ACKNOWLEDGEMENTS
We wish to thank the Social Sciences and
Humanities Research Council of Canada (SSHRC)
for their financial support of this project.
REFERENCES
Astell, A. J. (2013). Technology and fund for a happy old
age. Technologies for Active Ageing-International
Perspectives on Ageing, 9, 169-187.
Bowling, A., and Dieppe, P. (2005). What is successful
ageing and who should define it? BMJ: British
Medical Journal (International Edition), 331(7531),
1548-1551.
Buiza, C., Gonzales, M. F., Facal, D., Martinez, V., Diaz,
U., Etxaniz, A., Urdaneta, E., Yanguas, J. (2009).
Efficacy of cognitive training experiences in the
elderly: Can technology help? In C. Stephanidis (Ed.),
Universal access in human-computer interaction:
Addressing diversity (pp. 324-333). Berlin: Springer.
Charness, N., and Holley, P. (2004). The new media and
older adults: Usable and useful? American Behavioral
Scientist, 48(4), 416-433.
Csikszentmihalyi, M. (1997). Flow and education.
NAMTA Journal, 22(2), 2-35.
De Schutter, R. (2011). Never too old to play: The appeal
of digital games to an older audience. Games and
Culture, 6(2), 155-170.
De Schutter, R., and Abeele, V. (2010). Designing
meaningful play within the psycho-social context of
older adults. Fun and Games, (September), 13-15.
Entertainment Software Association (2005). Essential
facts about the computer and video game industry:
Sales, demographics, and usage. Retrieved February
15, 2015 from
http://www.tntg.org/documents/gamefacts.pdf.
Entertainment Software Association (2011). Essential
facts of the computer and video game industry.
Retrieved February 16, 2013, from
http://www.theesa.com/facts/pdfs/ESA_EF_2011.pdf.
Goldstein, J. H., Cajko, L., Oosterbroek, M., Michielsen,
M., van Houten, O., and Salverda, F. (1997). Video
games and the elderly. Social Behavior and
Personality, 25(4), 345-352.
doi:10.2224/sbp.1997.25.4.345.
House, J. S., Landis, K. R., and Umberson, D. (1988).
Social relationships and health. Science, 24(1), 540-
545.
IJsselsteijn, W., Nap, H. H., De Kort, Y., and Poels, K.
(2007). Digital game design for elderly users. In
Future Play ’07: Proceedings of the 2007 conference
on future play (pp. 17-22). New York, NY: ACM
Press. doi: 10.1145/1328202.1328206.
Kaufman, D., (2013, October) Aging well: Can digital
games help? Overview of the project. Paper presented
at the World Social Science Forum 2013, Montreal,
QC.
Khoo, E., and Cheok, A. (2006). Age invaders:
Intergenerational mixed reality family game. The
International Journal of Virtual Reality, 5(2), 45-50.
Marston, H. R. (2013). Design recommendations for
digital game design within an ageing society.
Educational Gerontology, 39(2), 103-118.
doi:10.1080/03601277.2012.689936.
McPherson, M., and Smith-Lovin, L. (2006). Social
isolation in America: Changes in core discussion
networks over two decades. American Sociological
Review, 71, 353-375.
Nap, H. H., de Kort, Y. A. W., and IJsselsteijn, W. A.
(2009). Senior gamers: Preferences, motivations and
needs. Gerontechnology, 8(4), 247-262.
doi:10.4017/gt.2009.08.04.003.00.
Nimrod, G. (2009). Senior's online communities: A
quantitative content analysis. The Gerontologist,
50(3), 382-392. doi:10.1093/geront/gnp141.
Pew Research Center (2010). .Four in ten seniors go
online. Retrieved June 2, 2013 from
http://www.pewinternet.org/Commentary/2010/Januar
y/38-of-adults-age-65-go-online.aspx.
ICT4AgeingWell2015-InternationalConferenceonInformationandCommunicationTechnologiesforAgeingWelland
e-Health
274
Putnam, R. D. (2000). Bowling alone: The collapse and
revival of American community. New York, NY:
Simon and Schuster.
Rowe, J. W., and Kahn, R. L. (1997). Successful aging.
Gerontologist, 37(4), 433-440.
Rowe, J. W., and Kahn, R. L. (1998). Successful aging
Random House, New York, NY.
Saldana, J. (2009). The coding manual for qualitative
research. London: SAGE.
Sauvé, L., Renaud, L., Kaufman, D., and Duplàa, E.
(2015, in press). Validation of educational games for
seniors: Live well, live healthy! Procedia – Social and
Behavioural Sciences.
Sixsmith, A. (2006). New technologies to support
independent living and quality of life for people with
dementia. Alzheimer’s Care Quarterly, 7(3), 194-202.
Stebbins, R. (2007). Serious leisure: A perspective for our
time. New Brunswick, NJ: Transaction Publishers.
Trepte, S., Reinecke, L., and Juechems, K. (2012). The
social side of gaming: How playing online computer
games creates online and offline social support.
Computers in Human Behavior, 28(3), 832-839.
doi:10.1016/j.chb.2011.12.003.
Whitcomb, R. (1990). Computer games for the elderly. In
Proceedings of the Conference on Computers and the
Quality of Life (CQL '90 (pp. 112-115). New York:
ACM. doi:10.1145/97344.97401.
Wollersheim, D., Merkes, M., Shields, N., Liamputtong,
P., Wallis, L., Reynolds, F., and Koh, L. (2010).
Physical and psychosocial effects of wii video game
use among older women. International Journal of
Emerging Technologies and Society, 8(2), 85-98.
World Health Organization (WHO) (2002). Active Ageing:
A Policy Framework. Geneva: World Health
Organization. Retrieved Sept 1, 2014 from.
http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_
02.8.pdf.
Xie, B. (2002). Older adults, computers and the internet:
Future directions. Gerontechnology, 2(4), 289-305.
BarriersandAdaptationsofaDigitalGameforOlderAdults
275
