Designing Digital Games with & for Home-dwelling Older Adults’

Social Interaction under Sheltering Measures

Way Kiat Bong

and Igal Bronshtein

Department of Computer Science, OsloMet, Oslo Metropolitan University, Pilestredet 35, Oslo, Norway

Independent Researcher, Tel Aviv, Israel

Keywords: Gaming, Social Interactions, User-centered Design, Home-dwelling, Sheltering Measures.

Abstract: Social relationships and participation have been considered essential elements in contributing to a higher

quality of life for older adults. Due to the COVID-19 pandemic, many home-dwelling older adults have been

reported as having less social interaction. Older adults are one of the groups most vulnerable to COVID-19,

and they have been heavily impacted by the sheltering measures. Previous studies have shown the potential

of digital games in enhancing the social interaction of older adults. However, the research within this field is

still at an early stage. Furthermore, games that were designed before the pandemic might no longer be suitable

for them due to sheltering measures. Therefore, taking into consideration sheltering measures, in this study

we attempt to enhance the social interaction of home-dwelling older adults by designing gaming technologies

with and for them. A user-centered design approach was adopted where 10 older adults were involved

remotely throughout the study, from gathering user requirements to evaluating prototypes in iterations. The

outcomes included an application with three favorite games and a proposed list of design guidelines. The

older adults were positive in using the application. Further study is required to evaluate the impacts on social

interaction among older adults.

1 INTRODUCTION AND

RELATED WORK

Social relationships and participation have been

considered essential elements in older adults’ quality

of life (Bowling, 2009; Bowling et al., 2002). Older

adults having an active social life tend to have a

higher quality of life (Antonucci, 2001; Cohen &

Janicki-Deverts, 2009). Due to the COVID-19

pandemic, older adults who are considered to be in a

vulnerable group have had to shelter themselves

(WHO, 2020). Sheltering measures, such as

lockdown, staying most of the time at home, social

distancing, restricted gatherings and visits, etc., have

resulted in many home-dwelling older adults having

fewer social interactions and have thus led to lower

quality of life.

In the United States, higher depression and

increased levels of loneliness were reported among

older adults in a study examining the impacts of

shelter-in-place orders due to COVID-19 (Krendl &

https://orcid.org/0000-0003-3714-123X

https://orcid.org/0000-0003-2263-3004

Perry, 2020). Older adults’ social life and interaction

with others reduced despite their efforts in spending

much more time on digital platforms trying to stay

connected with the people they cared about.

Strategies using information and communication

technologies (ICT) to address loneliness among older

adults have been implemented in countries including

Norway, Portugal and Brazil (Monteiro-Junior et al.,

2020). In these three countries, health professionals

have been using available technological facilities to

deliver mental health support to older adults. Some of

these older adults were home-dwelling, while others

were nursing home residents.

We acknowledge that social interaction on digital

platforms cannot replace physical interaction.

However, digital platforms can contribute to the

social interaction of older adults to some extent.

During the difficult time of the pandemic, social

media, such as Facebook, Twitter and Instagram, and

instant messaging applications, such as Facebook

Messenger and WhatsApp, have been used

Bong, W. and Bronshtein, I.

Designing Digital Games with for Home-dwelling Older Adults’ Social Interaction under Sheltering Measures.

DOI: 10.5220/0010467900570068

In Proceedings of the 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2021), pages 57-68

ISBN: 978-989-758-506-7

increasingly by older adults for social interaction

(Krendl & Perry, 2020; Monteiro-Junior et al., 2020).

In Brazil, a psychology team has been providing

mental health support through video calling on

WhatsApp, while populations in Norway have been

encouraged to have more contact with older family

members and friends via telephone or video calls.

Another alternative for digital social interaction is

playing digital games. Playing digital games is a form

of social interaction where two or more older adults,

or one older adult with some other people (children,

grandchildren, other online players, etc.), play a game

on a digital platform together. Doppler et al. (2018)

developed BRELOMATE, a television- and tablet-

based gaming technology that aimed to promote user

engagement and social interaction among older

adults. Although almost half of the participants had

previously used neither a tablet nor an interactive

television, BRELOMATE was perceived as easy and

fun to use. A personal reminder information and

social management (PRISM) computer system was

developed and introduced to older adults with the

primary aim of reducing social isolation (Boot et al.,

2018). The PRISM system consisted of 11 single-

player video games (Chinese Checkers, Crossword,

Droplets, Gem Swap, Memory (matching pairs), My

Jong (a variant of Mahjong), Solitaire, Sudoku,

Tetris, Poker and Word Search). In this study, 150

older adults were assessed in terms of their gaming

behavior over an entire year. A clear favorite in game

preference was identified (i.e., Solitaire), and the

potential for digital games to keep older adults active

was observed.

The research literature has shown that playing

digital games can contribute to improving older

adults’ well-being, but the research is still at an early

stage (Rienzo & Cubillos, 2020). In addition, there is

a clear knowledge gap where digital games that were

designed pre-pandemic may not be suitable in

meeting the special needs of older adults playing

digital games due to the sheltering measures under the

pandemic (e.g., digital games having only a single-

player mode, digital games requiring other players to

be physically together, digital games being difficult

to understand without guidance and assistance given

in person, etc.).

In this study, we attempt to enhance the social

interaction of home-dwelling older adults by

designing gaming technologies with and for them.

The study focuses on home-dwelling older adults

living in Norway, and the game design relates to

measures practiced under the COVID-19 pandemic

restrictions to protect oneself and vulnerable older

adults.

2 METHODOLOGY

We adopt a user-centered design approach (Karat,

1996), which emphasizes involving potential users

throughout an iterative system design and

development process. Several studies have shown

great success by using a user-centered design

approach in designing digital games for older adults

and delivering outcomes that fulfilled their

expectations and needs (Doppler et al., 2018;

Doroudian et al., 2020; Sauvé & Kaufman, 2019). By

involving older adults throughout the whole process,

we intended to gather the user requirements of older

adults in playing digital games and design digital

games that suit their preferences and needs, with a

focus on enhancing their social interaction in a

distance setting.

Participants were recruited using convenience

sampling (i.e., they were selected to participate

because they were easily accessible (Sedgwick,

2013). The inclusion criteria were being aged 70

years or over, being a retiree and being home-

dwelling. All activities were conducted remotely (i.e.,

phone calls and online interviews using Skype, Zoom

and Google Meet). The participants were first briefed

about the project and then presented with the consent

form. Their consent was given prior to participating

in the study.

At the beginning of the study, the participants

were asked about their demographic background. For

ICT skills, they had to rate themselves on a scale from

1 to 10, where 1 is very bad and 10 is very good. In

addition, they were asked about their experiences and

attitudes to games in general (board games, cards,

etc.) and digital games. Examples of questions were:

“What is your experience in terms of playing games?

(from a child, an adult to now as an older adult)?”,

“Who do you usually play these games with?”, “Can

you tell us your positive and/or negative experience

in terms of playing games?” and “Has the pandemic

affected your social and/or gaming activities?”

We conducted a total of four iterations of design,

development and evaluation. During the iterative

process, the first and second iterations’ prototypes

(i.e., wireframes) were created using Figma (a design

tool for designing and prototyping user interfaces).

The code was written in JavaScript. The wireframes

were then further developed into a high-fidelity

prototype and hosted on a domain site for the third

and fourth iterations. For evaluation, semi-structured

interviews together with some testing tasks were

conducted with three to four participants in each

iteration. The prototype that was developed in each

iteration was presented to the participants, and they

ICT4AWE 2021 - 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health

were asked to use it. Participants were requested to

share a screen if necessary.

Questions such as “What do you think about/

understand from this design?”, “What do you think of

the game option here?”, “What do you think of the

option to customize the game?”, etc. were asked to

obtain their feedback. Follow-up questions were

asked to gain more insight from the participants when

necessary. Besides getting clarification from the

participants regarding their feedback about the

prototype, we asked follow-up questions that could

relate their feedback about the prototype to their

experiences and attitudes in playing digital games.

Based on the participants’ feedback, we made

necessary improvements and developed new features

in the next iteration. At the end of each interview

session in the second, third and fourth iterations, we

also asked for the participants’ opinions about playing

digital games to see if their attitudes had changed

after trying out the prototype.

3 RESULTS

3.1 Participants

Table 1 summarizes the demographic data of the

participants. Some participants were invited to

participate in more than one iteration. When asking

about experiences in playing games in general (digital

and non-digital), seven participants stated that they

had never played any digital games. P6, P7 and P8

had experience in playing digital games but in

different ways. P6 used to play games on her

daughter’s computer but stopped playing when her

daughter moved out to study in another city. Due to

her interest in ICT, P7 had been playing digital games

with her grandchildren. As one of the youngest

participants, P8 had been active on social media and

had been playing games on Facebook for some time.

One interesting finding is that P1 misunderstood

the term “digital games.” P1 claimed that he never

really learned ICT as he did not use it in his work

before retirement. However, as the interview

progressed, we found out that he had been playing

Solitaire on his mobile phone. We clarified with him

at the end of the interview regarding this. When asked

about experiences in playing digital games, he was

thinking about computer games and video games that

younger adults were playing, such as World of

Warcraft, Counter-Strike and Dota.

The scoring system in Solitaire was one of the

motivating factors for P1 in playing it. He played

Solitaire very often: “I play whenever I can, as long

as I am not eating, making food, doing housework or

watching something on television!” Another reason

he loved playing Solitaire was because it was a game

that he played a lot during his childhood. He

continued playing it on a computer 12 years ago when

he was introduced to it. He then switched from

playing it on his computer to playing it on his mobile

phone.

Similar to P1, many other participants had also

played Solitaire when they were children; however,

they stopped playing card games as they grew up. P2

claimed that he never really had an interest in any

games (both digital and non-digital) due to not having

any children and living alone all the time. P3 and P9

used to play board games and cards with their

grandchildren when they visited; however, both

families had to put this tradition on hold due to the

pandemic sheltering measures. P4, on the other hand,

did not have this problem as one of her sons and her

son’s children were living next door. In Norway,

children, grandchildren and grandparents were

allowed to visit each other during the pandemic, as

long as they established a “close contact” relationship

(i.e., these are the people they spent most of their time

with physically and/or lived in the same household).

P1 enjoyed playing board games ever since he

was young. He even took pictures of his board game

collection and showed them to us during the

interview. Before the pandemic, he had friends

visiting and playing these board games with him from

time to time. However, this was out of the question

considering his health condition and other sheltering

measures. His all-time favorite board game was

Chinese Checkers, because he could play it with

several players. Besides Chinese Checkers, he also

enjoyed playing billiards, Ludo and other board

games. These were the same games most of the

participants grew up playing. In addition to the games

mentioned above, Sudoku was reported as another

popular game as it could be easily found in

newspapers and magazines.

When the idea of playing board games online was

presented, P1, P3 and P9 were excited about the idea.

P1 had always played Solitaire alone and played

board games with other friends physically together.

Therefore, he had never considered the possibility of

playing games online with other people. The children

of P3 had been trying to encourage her to use ICT

more, but she was never really interested. They

bought her an iPad as a present and wanted her to

have more social interaction using ICT. Considering

the sheltering measures now, she thought the idea of

playing games online could be ideal.

Designing Digital Games with for Home-dwelling Older Adults’ Social Interaction under Sheltering Measures

Similarly, P9 has been having less contact with

her grandchildren due to the sheltering measures and,

therefore, she felt that playing digital games with her

grandchildren could be a good solution. Other

participants, such as P2 and P10, did not show any

excitement, but they commented that it would be

great for older adults who liked playing games and/or

had grandchildren. P7 and P8, who had been playing

digital games for a while, were not particularly

excited. However, they were interested in the type of

game that would be introduced to them.

Table 1: Demographic information of all participants.

Age Gender ICT

skills

(1 to 10)

Education

(years)

Employment

before

retirement*

Marital status Number of

children and

grandchildren

Participated

in iteration

Ever played

digital games

before?

P1 74 M 2 11 Photographer Married 2 children, no

grandchildren

1, 2, 3 No**

P2 76 M 6 13 Ship broker Single None 1 No

P3 82 F 5 11 Housewife Widowed 2 children, 5

grandchildren

1 No

P4 71 F 2 11 Flower shop

owner

Widowed 2 children, 6

grandchildren

1 No

P5 70 M 8 13 Worked with

ICT and

lants

Single None 2 No

P6 79 F 4 10 Housewife Widowed 2 children, 1

grandchild

2 Yes

P7 78 F 7 14 Healthcare Widowed 3 children, 5

grandchildren

3 Yes

P8 70 M 7 12 Road worker In a

relationship

None 3, 4 Yes

P9 79 F 6 10 Housewife Widowed 4 children, 10

grandchildren

4 No

P10 79 M 6 12 Truck driver In a

relationship

3 children, 7

grandchildren

4 No

*All participants were retirees.

**P1 answered “no” when asked. However, later in the interview, it was discovered that he had been playing digital

Solitaire.

ICT4AWE 2021 - 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health

3.2 First Iteration

The prototype produced in this iteration contained a

wireframe with a jigsaw puzzle game with options to

customize the picture of the puzzle, the background

color and the number of pieces in the puzzle (Figure

1). The first page was designed to invite the

participant to create their own puzzle, and the

remaining pages included features to customize the

puzzle game. This prototype was developed prior to

conducting interviews with the participants, and thus

the chosen game did not reflect the older adults’ game

preferences.

Figure 1: First iteration’s wireframe (A) Introductory page,

(B) Customization page to choose the number of pieces in

the puzzle.

In this iteration, P1, P2, P3 and P4 were invited to

participate. All four of them did not understand that

the wireframe showed a puzzle game. We

acknowledged that the interface itself did not explain

much about the game (Figure 1A), in that it only

stated, “Design digital game on an app (application).”

P2, P3 and P4 managed to figure out that it was a

puzzle game after receiving some hints, while we had

to inform P1 explicitly. P1 expressed that he had only

played puzzle games when he was a child and,

therefore, was not so familiar with them.

In terms of customizing games, none of the

participants had considered this possibility. P1 had

difficulty understanding the customization feature,

while the others managed to complete the

customization using the available tools. When the

wireframe was presented to P1 (from the introductory

page to the customization page to choose the number

of pieces in the puzzle), he immediately commented

that he did not understand without even trying: “It

was too complicated. I did not understand a thing

here.” P2 commented that customization could be

useful in many ways, such as choosing the preferred

music for a game, while P3 stated that: “It can be

great for new beginner like me, to first start with easy

(game difficulty) level, and so on …”

3.3 Second Iteration

Figure 2: Second iteration’s wireframe (A) Introductory

page, (B) Customization page to choose the background

color of the game.

The wireframe in this iteration started with an

introductory page where players were asked to choose

a game from a selection of three (Figure 2A). Three

favorite games of older adults were identified from

the interviews and incorporated into the application

(Chinese Checkers, Solitaire and Sudoku). After

choosing a game, the users were then able to

customize their own game. In addition, we created

additional wireframes to demonstrate to the

participants and gather their feedback about the

possibilities for other customizations. For instance, to

choose a picture for the background instead of a solid

color, to choose from more than two color choices

and to choose an option for video and/or audio calls.

Solitaire and Sudoku were not developed further at

this stage. We decided to focus only on the design,

development and evaluation of Chinese Checkers,

since it would require too much time and effort to

have the participants involved throughout the

development process with three games remotely.

P1, P5 and P6 participated in this iteration’s

evaluation. Instructions in the wireframe were

perceived as easy to understand by all of them, and

they appreciated the customization feature. Although

they managed to complete customizing their own

game, we observed that the participants were missing

a feature where they could get a preview look of the

selection before confirming their choice: “Perhaps an

OK button could help? I want to see what the

selection looks like first, compare the choices, then

move to the next …,” said P5.

Both P5 and P6 commented that the black color

for the background of the game was a bit too

“extreme” (Figures 2B and 3B). P1, who was a

proficient player of Chinese Checkers, pointed out

that the wireframe could be improved by having a

page to ask the number of players, instead of having

two players by default, or limiting the game to having

only two players. As illustrated in Figure 3A, the

Designing Digital Games with for Home-dwelling Older Adults’ Social Interaction under Sheltering Measures

players were asked to choose a set of pieces, which

indicated only a two-player game.

Figure 3: Second iteration’s wireframe (A) Customization

page to choose a set of pieces, (B) Last page indicating

game is ready.

In terms of additional customization, all the

participants had different ideas of choosing a picture

instead of a solid color for the background and being

provided with two, four or more colors to choose

from. One thing that all of them agreed on was to have

the option for video and/or audio calls. P1 preferred

to have a solid color for the background, while P5 and

P6 thought the option of choosing a picture as the

background was good as long as the players were

provided with set options and did not have to find

their own pictures. P5 informed us of his experience

in finding the right pictures from his tablet and mobile

phone to send to friends and family; he always found

it challenging browsing the thumbnails. Options of

choosing a color should be restricted to four,

according to P5, two was good enough for P1 and P6,

while more than four color options appeared to be

overbearing for all of them.

The participants stated they would love the ability

to talk to the other player(s) as it could offer the

possibilities for more active social interaction. If they

felt comfortable showing their video to the other

player(s), then they could also choose to turn on

video. “Yes, I would like to talk to the person I am

playing with, either she is my granddaughter or a

friend who I already knew. If she is a new friend, and

after playing the game for a while with her, maybe I

want to know how she looks like …,” expressed P6.

When asked their opinions about playing the

digital games after presenting the prototype, P1 was

particularly excited and wanted to try out the final

version. P5 and P6 appeared more convinced that

playing digital games could be suitable for them.

They would like to play digital games with others if

they were asked to.

3.4 Third Iteration

Figure 4 displays the prototype in this iteration. This

was a high-fidelity prototype, where the Chinese

Checkers game was developed with moveable pieces.

The application was named “Spill Sammen,” which

means “Play Together.” There were two symbolic

buttons on the top left corner (a square and a round

button). They represented starting a new game and the

turn of players who shall move their piece,

respectively. The square button usually represents

stop or start a new game, while the round button refers

to the game in progress. The players could move their

pieces by first clicking the piece they wanted to move;

this piece would then be colored yellow in the middle

(refer to the red piece with a yellow dot in Figure 4).

The players could then click on the hole where they

wanted to move and place the “yellow-dotted” piece.

Figure 4: Third iteration’s application.

The participants in this iteration were asked to use

a tablet or mobile phone to evaluate the prototype so

that they could have a more genuine feeling of using

the application on a mobile device. P1 used his

mobile phone, while P7 and P8 used a Samsung

tablet. In order to test if the design was intuitive and

easy to understand, we did not brief the participants

on how to play the game. Instead, we only asked them

to try playing the Chinese Checkers game while they

were performing the testing tasks with us.

All participants managed to move the pieces and

play the game. A few usability issues were identified

during testing. First, by coincidence (since the players

could customize and choose a set of pieces), the

choice of pieces’ colors could be identical to the

colors of the buttons of “Start a new game” and

“Player’s turn.” As shown in Figure 4, both blue and

red colors of buttons and pieces were identical. Such

a situation confused the players. In addition, P1 and

P7 suggested moving the positions of these buttons.

ICT4AWE 2021 - 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health

These two buttons should not be placed too close to

each other, and the “Player’s turn” button should be

placed in between the players.

The symbolic buttons were perceived differently

by the participants. P8 was used to playing digital

games and, therefore, he understood the button “Start

a new game,” while P1 and P7 needed some time to

figure this out. All of them understood what the round

button meant, as they noticed the change of the round

button’s color when they moved their pieces. Despite

being able to play the Chinese Checkers on Spill

Sammen, the participants advised us to add more text

for explanation. For example, the players could be

informed with text instruction when it was their turn

to move a piece.

P1 felt that the Chinese Checkers game was not

suitable to play using his mobile phone. Due to the

screen size, it was challenging to perform the touch

gestures to move the pieces. On the other hand, P7

and P8, who were playing the Chinese Checkers game

on their tablets, did not face this problem.

After their completion in testing the application,

we asked them about their opinions of playing the

digital game. Similar to the second iteration, P1

expressed that he could not wait to use the final

version of the application when it was fully

developed. P7 was more convinced than before, while

P8’s reaction was simply neutral as he was already an

experienced online gamer. He, however, expressed

that this study could help many other older adults who

were new to playing digital games: “Many of my

friends did not even want to hear me talking about

digital games. But this approach (referring to

choosing games that were already familiar to older

adults) and simple design could perhaps make digital

games more attractive to them!”

3.5 Fourth Iteration

Figure 5: Fourth iteration’s application.

The Chinese Checkers in this iteration was improved

mostly in instructions and colors. As illustrated in

Figure 5, we added textual instructions, such as

“Player 2, your turn now (Spiller 2, din tur nå),”

“Finish movement (Ferdig trekk)” and “Start a new

game (Start et nytt spill).” The color of the “Start a

new game” button was changed so that it had a

different color from other buttons. However, we kept

the colors of the “Finish movement” button the same

as the colors of the pieces. The colors of this button

reflected whose turn it was to make a move.

P8, P9 and P10 were invited to participate in this

iteration. P8 was testing Spill Sammen on his mobile

phone, while P9 and P10 were using tablets. We

asked them to move their pieces and play the game

with us. All three participants managed to play the

Chinese Checkers game without any problem. After

performing the testing task, all participants mentioned

that they were positive about playing the digital game.

P9 expressed her willingness to use Spill Sammen

with her grandchildren. The second wave of the

pandemic was taking place when this evaluation was

conducted; sheltering measures were even stricter

than before and, therefore, she could neither visit nor

be visited by all of her grandchildren. P8 and P10

were happy to see the design and development of Spill

Sammen. They commented that it would benefit older

adults who had to be sheltered at home during the

pandemic as well as in the winter when it could be

cold and slippery outside for many older adults.

4 DISCUSSION

The four iterations of the user-centered design

approach included 10 older adults in the process of

designing, developing and evaluating the prototypes.

Most of the participants were positive about playing

the digital games, especially when their social lives

were restricted due to the COVID-19 sheltering

measures. Through their user involvement, we

received constructive feedback in designing digital

games for home-dwelling older adults. In addition,

we reflected and discussed the research process using

a user-centered design approach where all activities

involving them had to be conducted remotely.

4.1 Design Guidelines

Prior studies have gathered their findings in designing

digital games with and/or for older adults and

presented them as design considerations (Al Mahmud

et al., 2012; Boot et al., 2018; Ijsselsteijn et al., 2007;

Marston, 2013)

.Using the findings from this study,

Designing Digital Games with for Home-dwelling Older Adults’ Social Interaction under Sheltering Measures

we present a list of design guidelines where the game

technologies were targeted to enhance older adults’

social interaction under sheltering measures. The

guidelines are presented in Box 1 and discussed

below.



Box 1: Design guidelines.

1. Use text and images that are easy for older adults

to understand.

2. Create an easy introduction to start the game.

3. Provide games that older adults can relate to.

4. Offer more than one game.

5. Propose a gaming mode that requires more than

one player.

6. Include options for text chat, audio and video

functionality.

7. Allow players to customize the game (speed, color,

difficulty level, etc.).

8. Ensure the players are well-informed.

9. Maximize the playable and touchable area to assist

older adults’ touch gestures.

10. Keep older adults motivated.

1. In this study, the participants indicated their

appreciation regarding simple instructions, both in the

form of text and images. In the third iteration, the

design of Chinese Checkers was based on other

existing digital games: a square symbolic button to

stop and start a new game and a round symbolic

button for the game in progress. However, there was

room for improvement. Despite being able to play the

game, all participants that evaluated the prototype

expressed their wishes to have more text for clearer

instructions. In the next iteration, we put more text for

instructions as recommended by the participants.

Words such as “Player 1, you may start,” “Player 2,

your turn now” and “Start a new game” were added

(Figure 5). These results further support the design of

Foukarakis et al. (2011) in an adaptable card game,

when they used clear, simple text and images to cue

the older players whose turn it was to play or to clarify

what action was required.

2. In the first iteration, when the prototype was

presented to the participants, all participants had

problems understanding the prototype. Although they

had experiences playing puzzle games, the design

appeared unclear to them and therefore they needed

help to figure out what it was. P1 was immediately

skeptical when he was presented with a design that he

found difficult to understand, and he was not

interested in trying further. We therefore suggest

making the design easy to understand, especially on

the very first introductory page of the games. This

kind of approach is more crucial when the games are

introduced to older adults who have little or no

experience in playing digital games, which is

consistent with the findings of Zhang et al. (2017),

who recommended providing clear guidance in

helping older players to better understand the purpose

of the game.

3. Solitaire was reported as the most preferred

game among 150 older adults in Boot et al. (2018)’s

study, and the current study supports their findings.

According to the participants, Solitaire was one of the

common card games played during their childhood.

When P1 found out that Solitaire was available on

desktop computers and mobile phones, he chose to

play it on these devices as well. Boot et al. (2018)

reflected on the popularity of Solitaire being due to

the game’s familiarity, its shallow learning curve and

its inclusion of familiar materials (i.e., cards). These

factors could motivate older adults to play digital

games (Cota & Ishitani, 2015), and we discuss more

about these factors in the last guideline.

4. To ensure that different preferences of diverse

older adults can be met, it is essential to offer them

more than just one game. In this study, our prototype

offered three games (i.e., Chinese Checkers, Solitaire

and Sudoku). They were identified based on the

participants’ experiences in playing games. Most

participants grew up playing the former two, while

Sudoku was commonly provided in newspapers and

magazines. PRISM games offered older players 11

games (Boot et al., 2018). While Solitaire was

reported as the most preferred, other games were

almost equally liked by the players. Zhang et al. (2017)

identified the diverse preferences of older adults

when it came to puzzles; some preferred word puzzles,

while others enjoyed sorting or math puzzles more.

5. In order to foster social interaction among older

adults while playing games, we propose to design

games that require more than one player. Some

participants in this study were excited about the idea

of digital games, as it can be an alternative to physical

board games and/or cards that they used to play with

their grandchildren and visitors before the pandemic.

In addition, instead of simply playing or beating the

game, older players in Doroudian et al. (2020)’s study

were reported to enjoy more the collaborative nature

of a game. This is in accord with our findings, where

most of the participants expressed that they would

appreciate the social interaction aspect in gaming

more than just completing a task or gaining high

scores. P1 and P3 wanted to play digital games so that

they could spend time socializing with others as they

were used to doing before the pandemic.

Games such as Sudoku and Solitaire, which are

usually played in single-player mode, can also be

ICT4AWE 2021 - 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health

modified so that they can be played by more than one

player. This modification can be interpreted as a new

rule or method to play the game, which can appear

exciting to older adults. Mubin et al. (2008) pointed

out the potential of having a new add-on to existing

games for older adults so that they could have a better

player experience.

6. As the games require more than one player, and

the games are targeted to enhance social interaction

among older players, it is recommended to include the

options for text chat, audio and video functionality.

These functionalities can be embedded into the

gaming technologies, both in the game itself and

outside of the game interface, to foster more social

interaction between older players. Doroudian et al.

(2020) reported that the participants had a good time

chatting with each other during and after the game

sessions. While designing a multiplayer online escape

game for older adults, Zhang et al. (2017) observed

that the communications among players were not well

organized and, therefore, recommended providing a

chat and/or video function.

7. Offering customizable fonts or icons can

provide a more satisfying player experience for older

adults, according to previous studies (Al Mahmud et

al., 2012; Doroudian et al., 2020; Mubin et al., 2008)

and a review by Rienzo and Cubillos (2020) in

playability and player experience in digital games for

older adults. Building on this finding, we started the

first iteration with a prototype that incorporated a

customization feature. While the participants in this

study appreciated the customization feature, it should

nonetheless not burden them. In the second iteration,

the participants expressed their concerns when the

customization offered too many options and/or

required them to “do a lot.” P5 liked the idea of

choosing a picture as the background of the game, but

it should not require him to select his own picture.

8. One of the usability heuristics for the user

interface design by Nielsen (1995) is the visibility of

system status, which emphasizes that “the design

should always keep users informed about what is

going on, through appropriate feedback within a

reasonable amount of time.” Older adults playing a

multiplayer online escape game were reported as

needing clear instructions and feedback from the

gameplay (Zhang et al., 2017). Similarly, the

participants in the current study appreciated very

much when they were well informed about the game

status when using the application, for instance,

feedback of whose turn it was to move a piece when

playing the game, an introductory page to select a

game between Solitaire, Sudoku and Chinese

Checkers, and so forth. When performing

customization, a preview feature and “OK” button

could help in clarifying to the older adults concerning

the status of the application and their selection, as

pointed out in the second iteration.

9. Due to weaker muscle control, some older

adults struggle with performing touch gestures (Iancu

& Iancu, 2020). We observed that the touch gesture

required to move the pieces in the Chinese Checkers

game was difficult for P1, as he was using his mobile

phone and it was a much smaller screen as compared

to a tablet device. In order to address this issue, we

recommend providing another layout for mobile

phone players. The empty spaces around the

Checkers board (Figure 4) could be removed to make

the playable and clickable area bigger for the mobile

phone version. Another approach is to suggest that

players use a tablet device for this particular kind of

game.

10. All in all, the design of digital games should

keep older adults motivated while playing them.

Several studies have proposed factors in keeping

older players motivated, which include all the above-

mentioned design guidelines. In addition, participants

in Doroudian et al. (2020)’s study expressed that they

would play the game again if they encountered new

things every time they played. A review by Cota and

Ishitani (2015) pointed out other factors such as

familiarity and ease of learning for the games. Older

adults gained familiarity via playing the games when

they were younger. Ease of learning can be related to

the level of complexity; older adults tend to enjoy

easier games that do not require much of their mental

effort. The findings of this study are in line with those

of previous studies, especially when the older adults

were either new or inexperienced in playing digital

games.

Rewards can be a form of motivation as well.

Both Cota and Ishitani (2015) and Zhang et al. (2017)

suggested rewards, such as unlocking stages, offering

players higher and/or further levels and giving more

information. Rewards to help older adults solve

puzzles could make digital games appear more

attractive to them, thus motivating them further in

playing.

4.2 Remote User-centered Design

Before the pandemic, research activities using user-

centered design could be conducted face-to-face (Al

Mahmud et al., 2012; Doppler et al., 2018; Doroudian

et al., 2020; Sauvé & Kaufman, 2019). In this study,

all interviews and evaluations had to be conducted via

phone calls or online meeting platforms such as

Skype, Zoom and Google Meet. While performing

Designing Digital Games with for Home-dwelling Older Adults’ Social Interaction under Sheltering Measures

the evaluation, participants were requested to share a

screen if necessary. Challenges occurred when the

participants were not familiar with these platforms.

When the participants had an extra device (such as a

tablet or laptop) at home, they preferred to first talk

over the phone to be guided through the process.

Once they had learned how to use the online meeting

platform, they felt comfortable and confident in using

it for the rest of conversations and performing the

evaluations.

We noticed that some of the participants had low

self-confidence in using ICT tools (e.g., P1 and P4).

Although we did not meet them in person, from our

observations on how they managed to use a mobile

phone, tablet or laptop, we can conclude that they had

rated themselves too low in terms of their ICT skills.

A possible explanation for this might be that they had

rarely used ICT previously in their work. A similar

trend was observed when the other participants

performed the testing tasks. At first, they were

uncertain if they could perform the gaming tasks.

However, with guidance and encouragement, most of

the participants managed to complete the tasks; they

were surprised and excited with this outcome!

This finding suggests that older adults need

encouragement, both when designing ICT for them

and while designing ICT with them. We have

reflected upon this as a design guideline in the

previous section, and providing older adults with

encouragement is even more important when all

research activities involving them had to be

conducted remotely. In addition, we would like to

highlight the importance of giving regular breaks to

older adults while conducting remote research with

them. For some cases, we needed to break the

interview and testing into a few sessions to ensure that

they were not worn out.

All in all, in spite of the challenges in using a user-

centered design approach in this study, the outcomes

yielded positive feedback from the participants. Most

of the participants’ attitudes toward digital games

have changed to more positive after witnessing that

digital games could be easy to learn and understand,

and the design was made to suit their desires. P1, who

had been involved in the most iterations, commented,

“I never thought that I could do something like this

(referring to playing the Chinese Checkers game

digitally on his tablet with us). Yes, just let me know

when I can play it with my friends!”

4.3 Limitations

The major limitations of this study are its recruitment

method (i.e., convenience sampling) and the small

number of participants. Convenience sampling

cannot constitute probability sampling/random

sampling, which involves some form of random

selection of the population members (Sedgwick,

2013). It should, therefore, be noted that the

participants in this study are not representative of the

older generation in Norway.

We acknowledge that the number of participants

was small, and it was challenging to recruit

participants with greater variation in terms of

demographic characteristics. Older adults are a

diverse user group. As pointed out by Al Mahmud et

al. (2012) in their reflection of designing games with

and for older adults, 65 years old is not equal to 80

years old. In this study, the age of participants ranged

from 70 to 82, with an average age of 75.8. We had

some challenges in recruiting older adults above 80

years old. A few older adults above 80 years old that

we approached appeared skeptical when we briefed

them about the project, or when they were presented

with the consent form where the project was

described in detail.

Another limitation is that we have yet to evaluate

the participants’ social interaction, despite the fact

that the aim of the study was to enhance the social

interaction of home-dwelling older adults. Due to the

sheltering measures and restricted resources, the user-

centered design process took a longer time and more

effort. Time and effort were spent on setting up the

remote backdrop, in addition to actual data collection.

This was also the reason why the participants were

asked to rate their own ICT skills, instead of other

methodologies, such as using a questionnaire.

Therefore, we suggest evaluating the social

interaction aspect as part of future research.

5 CONCLUSION AND FUTURE

WORKS

This paper has demonstrated a four-iteration user-

centered design study that aimed to enhance the social

interaction of home-dwelling older adults living in

Norway by designing gaming technologies with and

for them. Both the game design and the research

process reflected the sheltering measures practiced

under the current COVID-19 pandemic in Norway to

protect oneself and vulnerable older adults (i.e.,

staying at home most of the time with restricted home

visits). All research activities involving the 10 older

participants had to be conducted remotely, and the

game technologies were designed for social

interaction at a distance.

ICT4AWE 2021 - 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health

Through the research process, we produced an

application, Spill Sammen, with three favorite games

of older adults (Chinese Checkers, Solitaire and

Sudoku). Only the Chinese Checkers was fully

developed at the time of writing. We reflected on the

findings and proposed a list of design guidelines for

designing digital games for older adults. The older

adults were positive in using the application and

would like to use it to play games with other players.

Further research will include continuing to

develop Spill Sammen and implementing features

such as providing text, audio and/or video

functionality. We would like to improve the prototype

and use it to conduct focus group interviews remotely

(i.e., two or more older adults can be online together

and play a game). In addition, we shall evaluate the

impact of home-dwelling older adults playing digital

games in relation to their social interaction. We have

yet to explore the ways home-dwelling older adults

could use Spill Sammen by themselves and the impact

of this in relation to their social interaction.

In addition, we will explore gaming technologies

focusing on intergenerational play, where the user-

centered design approach is extended to include

children and grandchildren as end users. Previous

studies have demonstrated promising results of

playing intergenerational digital games (De la Hera et

al., 2017; Li et al., 2019; Loos et al., 2019). Some

participants in this study who had grandchildren

expressed their interest in playing Spill Sammen with

their grandchildren. Last but not least, such digital

games need not be limited to home-dwelling older

adults, but they can also benefit older adults living in

nursing homes.

ACKNOWLEDGMENTS

We would like to thank all participants for their

enthusiastic participation despite the sheltering

measures and the fact that all activities had to be

conducted remotely.

REFERENCES

Al Mahmud, A., Shahid, S., & Mubin, O. (2012). Designing

with and for older adults: experience from game design.

In Human-Computer Interaction: The Agency

Perspective (pp. 111-129): Springer.

Antonucci, T. C. (2001). Social relations: An examination

of social networks, social support, and sense of control.

Boot, W. R., Moxley, J. H., Roque, N. A., Andringa, R.,

Charness, N., Czaja, S. J., Rogers, W. A. (2018).

Exploring older adults’ video game use in the PRISM

computer system. Innovation in aging, 2(1).

Bowling, A. (2009). The psychometric properties of the

older people's quality of life questionnaire, compared

with the CASP-19 and the WHOQOL-OLD. Current

Gerontology and Geriatrics Research, 2009.

Bowling, A., Banister, D., Sutton, S., Evans, O., &

Windsor, J. (2002). A multidimensional model of the

quality of life in older age. Aging & mental health, 6(4),

355-371.

Cohen, S., & Janicki-Deverts, D. (2009). Can We Improve

Our Physical Health by Altering Our Social Networks?

Perspectives on Psychological Science, 4(4), 375-378.

doi:10.1111/j.1745-6924.2009.01141.x

Cota, T. T., & Ishitani, L. (2015). Motivation and benefits

of digital games for the elderly: a systematic literature

review. Revista Brasileira de Computação Aplicada,

7(1), 2-16.

De la Hera, T., Loos, E., Simons, M., & Blom, J. (2017).

Benefits and factors influencing the design of

intergenerational digital games: a systematic literature

review. Societies, 7(3), 18.

Doppler, J., Gradl, C., Sommer, S., & Rottermanner, G.

(2018). Improving User Engagement and Social

Participation of Elderly People Through a TV and

Tablet-Based Communication and Entertainment

Platform. Paper presented at the International

Conference on Computers Helping People with Special

Needs.

Doroudian, A., Loos, E., Ter Vrugt, A., & Kaufman, D.

(2020). Designing an Online Escape Game for Older

Adults: The Implications of Playability Testing

Sessions with a Variety of Dutch Players. Paper

presented at the International Conference on Human-

Computer Interaction.

Foukarakis, M., Leonidis, A., Adami, I., Antona, M., &

Stephanidis, C. (2011). An adaptable card game for

older users. Paper presented at the Proceedings of the

4th International Conference on PErvasive

Technologies Related to Assistive Environments.

Iancu, I., & Iancu, B. (2020). Designing mobile technology

for elderly. A theoretical overview. Technological

Forecasting and Social Change, 155, 119977.

Ijsselsteijn, W., Nap, H. H., de Kort, Y., & Poels, K. (2007).

Digital game design for elderly users. Paper presented

at the Proceedings of the 2007 conference on Future

Play.

Karat, J. (1996). User centered design: quality or quackery?

Interactions, 3(4), 18-20.

Krendl, A. C., & Perry, B. L. (2020). The impact of

sheltering in place during the COVID-19 pandemic on

older adults’ social and mental well-being. The

Journals of Gerontology Series B: Psychological

Sciences and Social Sciences.

Li, C., Hu, J., Hengeveld, B., & Hummels, C. (2019). Story-

me: design of a system to support intergenerational

storytelling and preservation for older adults. Paper

presented at the

Companion Publication of the 2019 on

Designing Interactive Systems Conference 2019

Companion.

Designing Digital Games with for Home-dwelling Older Adults’ Social Interaction under Sheltering Measures

Loos, E., de la Hera, T., Simons, M., & Gevers, D. (2019).

Setting up and conducting the co-design of an

intergenerational digital game: A state-of-the-art

literature review. Paper presented at the International

Conference on Human-Computer Interaction.

Marston, H. R. (2013). Design recommendations for digital

game design within an ageing society. Educational

Gerontology, 39(2), 103-118.

Monteiro-Junior, R. S., Carneiro, L. S., Barca, M. L.,

Kristiansen, K. M., Sampaio, C. A., Haikal, D. S. A., . .

. Deslandes, A. C. (2020). COVID-19 pandemic: a

multinational report providing professional experiences

in the management of mental health of elderly.

International Psychogeriatrics, 32(10), 1153-1156.

Mubin, O., Shahid, S., & Mahmud, A. A. (2008). Walk 2

win: towards designing a mobile game for elderly’s

social engagement. People and Computers XXII

Culture, Creativity, Interaction 22, 11-14.

Nielsen, J. (1995). 10 usability heuristics for user interface

design. Nielsen Norman Group, 1(1).

Organization, W. H. (2020). Health care considerations for

older people during COVID-19 pandemic. Retrieved

from https://www.euro.who.int/en/health-topics/

health-emergencies/coronavirus-covid-19/publica

tions-and-technical-guidance/vulnerable-populations/

health-care-considerations-for-older-people-during-

covid-19-pandemic

Rienzo, A., & Cubillos, C. (2020). Playability and Player

Experience in Digital Games for Elderly: A Systematic

Literature Review. Sensors, 20(14), 3958.

Sauvé, L., & Kaufman, D. (2019). User-centered design:

An effective approach for creating online educational

games for seniors. Paper presented at the International

Conference on Computer Supported Education.

Sedgwick, P. (2013). Convenience sampling. Bmj, 347,

f6304.

Zhang, F., Doroudian, A., Kaufman, D., Hausknecht, S.,

Jeremic, J., & Owens, H. (2017). Employing a user-

centered design process to create a multiplayer online

escape game for older adults. Paper presented at the

International Conference on Human Aspects of IT for

the Aged Population.

ICT4AWE 2021 - 7th International Conference on Information and Communication Technologies for Ageing Well and e-Health