Social Work in Health Care

ISSN: 0098-1389 (Print) 1541-034X (Online) Journal homepage: https://www.tandfonline.com/loi/wshc20

Effect of board game activities on cognitive

function improvement among older adults in adult
day care centers

Yao Ching-Teng

To cite this article: Yao Ching-Teng (2019): Effect of board game activities on cognitive function
improvement among older adults in adult day care centers, Social Work in Health Care, DOI:
10.1080/00981389.2019.1656143

To link to this article: https://doi.org/10.1080/00981389.2019.1656143

Published online: 21 Aug 2019.

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SOCIAL WORK IN HEALTH CARE
https://doi.org/10.1080/00981389.2019.1656143

Effect of board game activities on cognitive function

improvement among older adults in adult day care centers
Yao Ching-Teng, PhD
Master Program of Long-Term Care in Aging, Kaohsiung Medical University, Kaohsiung, Taiwan

ABSTRACT ARTICLE HISTORY

Stimulating leisure activities are considered as possible protec- Received 12 February 2019
Revised 3 July 2019
tive factors against dementia and cognitive decline in older Accepted 8 August 2019
adults, particularly due to the enhancement of cognitive
reserve. This study tested the effectiveness of board game KEYWORDS
activities improving the cognitive function of older adults in Board game; older adults;
adult day care centers. This was a quasi-experimental study. adult day care centers;
A purposive sampling strategy was used to select 82 subjects cognitive function
who were aged 65 and above with intact mental functions and
currently residing in adult day care centers. 41 subjects who
participated in a selection of 12 board game activities were
assigned to the experimental group and 41 subjects who
adhered to their ordinary activities were allocated to the con-
trol group. Structured questionnaires of the board game pro-
grams were used for data collection. The board game
programs showed promising effects in the cognitive function
of older adults living in adult day care centers. A possible
beneficial effect of board game playing on the risk of dementia
could be mediated by a less cognitive decline in older adults.
Board game activities may benefit the cognitive function of
older adults. Incorporating board game activities into social
work care may help develop long-term care into a more
diverse, unique and innovative direction.

Introduction
Rapid population aging is a prevalent phenomenon of demographic transi-
tion worldwide. In Taiwan, the aged population is increasing year by year,
having reached 14.56% of the total population by the end of December 2018
(Ministry of Health and Welfare Statistic, Taiwan, ROC, 2019). According to
the results of a 2017 survey regarding the epidemiology of dementia, 18.32%
of older adults exhibited mild cognitive impairment (MCI), with the pre-
valence rate of dementia being 7.93%. Cognitive function degradation leads
to a decrease in cognitive abilities and a decline in memory, thus affecting
older adults’ independence and ability to conduct activities of daily living.
This results in a substantial increase in long-term care needs (Taiwan
Alzheimer’s Disease Association, 2017).

CONTACT Yao Ching-Teng, PhD angusyao@kmu.edu.tw Master Program of Long-Term Care in Aging,
Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan
© 2019 Taylor & Francis
2 Y. CHING-TENG

Studies have reported that midbrain activation exercises can provide adequate
stimulation to older adults, helping to improve cognitive abilities and slow
cognitive decline (Vance et al., 2008; Woods, Aguirre, Spector, & Orrell,
2012). As the concept of successful aging has been promoted worldwide, the
importance of older adults’ leisure activities and active lifestyles has attracted
increasing attention (Granbom, Kristensson, & Sandberg, 2017). Studies have
found that older adults’ participation in leisure and social activities is associated
with decreased death rate, increased quality of life and protection of cognitive
ability (Agahi, Ouyang, Mesiar, Pap, & Štrboja, 2011; Silverstein & Parker, 2002;
Wang et al., 2013). Moreover, leisure activities can help stimulate positive
emotions, enabling older adults to release stress and reduce depression
(Iwasaki, 2003; Simone & Haas, 2013). Leisure activities can also improve
older adults’ psychological health through psychological and behavioral paths,
in turn alleviating cognitive decline (Wang, Xu, & Pei, 2012).
Use of board games as cognitive stimulation activities has grown in recent years,
which has drawn the attention of researchers’ in the field of geriatrics. However,
studies on the application of board games for intervention and assessment of older
adults have been scarce; therefore, more evidence-based research is required to
verify if playing board games can be a valid nonpharmacological treatment in
geriatric social work. Furthermore, studies in Taiwan have not investigated board
game interventions by focusing on older adults in community adult day care
centers. Hence, in this study, a group board game program was designed to
match to the characteristics of older adults living in the community, and the
beneficial effect of board game interventions on the cognitive functions of older
adults in community adult day care centers was verified.

Literature review
Application of board games and older adults’ cognitive functions
Board games are played on tabletops and require no electronic devices, and
are thus termed “unplugged games.” Compared with other game types, board
games provide players with concrete experiences that increase participation
intentions and stimulate higher-order thinking. In addition to being a leisure
activity, board games also provide players with the opportunity to learn and
feel a sense of accomplishment and excitement (d’Astous & Gagnon, 2007).
Board games have been widely applied in education, and numerous research-
ers have investigated related topics. These include motivation and perfor-
mance (Klein, 1992; Klein & Freitag, 1991), attitude and affection (Wilde,
1994), and cognitive development and knowledge comprehension (Caldwell,
1998; Selvidge, 2006; Siegler & Ramani, 2008). Studies have mostly found
positive effects of playing board games, indicating that such games can
support learning through various methods and are thus effective and valuable
 SOCIAL WORK IN HEALTH CARE 3

instructional tools. Treher (2011) considered that board games are exercise
for the mind and the hands, are suitable for all ages, and can be about any
subject. Playing board games cloud be one of the best methods to combine
knowledge acquisition and experience. The atmosphere of board games is
competitive but not threatening, which motivates players to concentrate on
the games and enhances their learning.
Cognitive functions include concentration, memory, language, spatial
orientation and decision-making and executive abilities. Dementia is
a brain disease that is frequently accompanied by cognitive function degra-
dation in addition to memory decline. Petersen et al. (2014) defined MCI as
an intermediate stage between optimal cognitive functioning and clinical
dementia when individuals experience cognitive decline. People with MCI
are a high-risk group of dementia, and MCI is also a main characteristic of
developing Alzheimer’s disease (Feldman et al., 2007; Morris et al., 2001).
Cognitive impairment is a loss of brain function that affects normal thinking,
and dementia is a gradual loss of cognitive abilities that causes patients to
entirely lose autonomy and the ability to perform activities.

Analysis of cognitive stimulation activities

Cognitive training for patients with MCI is increasingly prevalent in Taiwan
and in other countries. Vance et al. (2008) and Tseng et al. (2011) noted that
providing adequate stimulus to a patient’s brain can force the brain’s neurons
to form new connections, thereby improving cognitive abilities and slowing
cognitive decline. The theoretical foundation of cognitive stimulation can be
traced to reality orientation therapy, which was developed in the late 1950s.
Cognitive stimulation is an intervention method for patients with cognitive
impairment that provides a series of stimulating activities, which are typically
conducted in groups; through these activities, patients’ concentration, think-
ing ability and memory can be enhanced.
Previous studies on cognitive stimulation activities have mostly focused on
people with physical or mental disabilities, such as children with sensory
integration disorder, patients with chronic mental illness, and older adults
with cognitive impairment, finding positive effects of cognitive stimulation
activities on these groups (Hill, Trusler, Furniss, & Lancioni, 2012). Studies
on sensory stimulation activities for older adults have typically centered on
older adults with moderate or severe dementia, investigating the influence of
sensory stimulation activities or multisensory environments on their beha-
viors and emotions (Riley-Doucet, 2009; van der Putten, Vlaskamp, &
Schuivens, 2011). Woods et al. (2012) indicated that cognitive stimulation
activities, including reminiscence activities, word games, puzzles, music and
gardening, are conducted to stimulate older adults’ abilities to think and
memorize. Cognitive stimulation is a nonpharmacological treatment. Current
4 Y. CHING-TENG

evidence indicates that cognitive stimulation activities are significantly effec-

tive in improving patients’ cognitive functions, social interaction and com-
munication abilities, and quality of life (Cove et al., 2014).

Effect of board games on improving cognitive abilities in older adults

Board games are emerging as a cognitive stimulation activity that can be
adopted as an intervention for preventing dementia in older adults. Some
studies have reported that cognitive decline among older adults can be
slowed by playing board games. In their 21-year longitudinal research,
Verghese et al. (2003) explored the relationship between leisure activities
and dementia risk among 469 older adults aged 75 years and older. The
participants completed six cognitive activities, including reading books or
newspapers, writing, crossword puzzles, board games, group discussions and
playing instruments. Verghese et al. (2003) identified a significant correlation
between cognitive activity participation and dementia risk reduction; speci-
fically, participating in one activity per week reduced the risk of dementia by
7%. Knoefel and Jankowiak (2006) targeted 5000 older adults living in the
community and investigated the relationship between participation and
duration of playing a board game (mahjong) and the risk of cognitive
decline. They found that playing the board game was associated with
a reduction in the risk of cognitive impairment. Only 11% of older adults
in the experimental group exhibited a decline in cognitive abilities; older
adults who played board games for longer also had lower risks of cognitive
impairment. Dartigues et al. (2013) randomly sampled 3777 older adults aged
65 years and older in southwestern France to conduct a 20-year follow-up
study exploring the relationship between participation in board game activ-
ities and cognitive risk. They found that dementia risk among the older
adults who played board games was 15% lower than that of those who did
not play board games, with the risk reduction being a long-term effect. In
addition, after other factors including age, gender, marriage and physical
condition were added, the relationship between board game activity and
dementia risk remained strong. Mayor (2017) conducted a 4-year follow-up
study on 1929 older adults aged 70 years and older in Minnesota, finding that
older adults playing board games one to two times a week had 22% lower risk
of MCI than those playing board games two to three times a month.
Moreover, performing cognitive stimulation activities regularly could reduce
MCI risk in healthy older adults because board games are intensive cognitive
stimulation activities that exert a positive influence on the brain and can have
positive preventive effects on cognitive decline. Altogether, prior studies have
shown that playing board games can improve cognitive performances in
healthy older adults. Existing studies, however, seldom have evaluated train-
ing effects and rigorous testing by the participants in adult day care centers.
 SOCIAL WORK IN HEALTH CARE 5

Methods
Research design, location and participants
The present study was a quasi-experimental study based on pre- and post-tests.
Purposive sampling was conducted in two adult day care centers in southern
Taiwan from March to June 2018. There are 32 adult day care centers in
Kaohsiung in southern Taiwan. In Taiwan, adult day care centers are places
where participants go for socializing and to benefit from services during the day.
According to the regulation, the ratio of social workers to older adults is 1:20, and
the presence of a full-time activity coordinator is required in adult day care centers.
Social workers help older adults in case of management in their daily life, and
leisure activities are provided by the activity coordinators in the facilities or by
volunteers from the community. The ratio of social workers to older adults,
environment and regular activities are subject to consideration. We selected two
government-funded adult day care centers and recruited participants from these
two sites in the study. To avoid bias, the two adult day care centers were assigned to
be the comparison or intervention institution using a random number generator.
The recruitment activities took place at the two sites on the same day. Social
workers at the adult day centers referred to participants based on the study criteria.
Subsequently, the participants completed a form to consent to their involvement in
the study. The inclusion criteria for this study were as follows: (a) be aged
a minimum of 65 years, (b) be able to communicate in Mandarin or Taiwanese,
and (c) have scored ≥8 points in the Short Portable Mental Status Questionnaire
(SPMSQ). The participants that exhibited severe dementia or severe depression or
were incapable of communication were excluded from this study.
The samples sizes for this study were calculated using G power software. The
alpha value was .05, the test force was 80, the effect size was 80, and the estimated
number of samples needed was 84. This study was conducted for 3 months and
involved the aforementioned experimental and comparison groups, which fea-
tured 42 participants each for a total of 84. The board game sessions were
conducted for 90 min each for a total of 12 weeks. Only the participants that
partook in a minimum of nine sessions were included in the data analysis. Each
session was led by the same researcher to ensure the consistency of the inter-
vention measures. Scale tests were conducted before the beginning of and after
the program. The comparison group participants participated in regular activ-
ities (singing, drawing and sports) in the adult day care centers and received the
same scale tests at the same time points as the experimental group.

Instruments
The structured questionnaire adopted in this study comprised a table of demo-
graphic questions (e.g., sex, age, education level, religious, marital status, living
conditions, perceived health status), a GDS-SF, and a Montreal Cognitive
6 Y. CHING-TENG

Assessment Scale. These scales employ a validated Chinese language version in

Taiwanese. The GDS-SF is a simplified form of the original Geriatric Depression
Scale created by Yesavage and Sheikh (1986) and is intended to examine the self-
perceived emotions of older adults in the preceding week to clarify changes in their
emotions during the therapeutic intervention. The GDS-SF comprises 15 items
and features binary scores for a total score of 0–15; a higher score indicates a more
severe case of depression. The Cronbach’s α obtained from the pretest data was .89.
The Montreal Cognitive Assessment (MoCA) was developed by Nasreddine et al.
(2005) was used to measure the cognitive function by the participants (including
mild cognitive impairment and dementia). This study applied the Chinese version
of the scale proposed by Tsai and Chuan (2010) in a study on the cognitive function
of older adults residing in long-term care institutions which included six cognitive
function items: (1) attention, (2) immediate and delayed memory, (3) speech, (4)
orientation, (5) visual construction, and (6) abstract thinking. The test duration
was 15–20 min. One extra point was given to participants who received less than 12
years of education (Tseng, Chan, & Lee, 2011). The total score was 30. A higher
score indicates that participants perceived a stronger sense of cognitive function.
The Cronbach’s α obtained from the pretest data was .86. The cognitive assess-
ments given to the participants 1 week before and 1 week after the intervention.
Cognitive function was collected at baseline during a face-to-face interview con-
ducted by a psychologist.

Intervention measure
The primary leader, an eligible recreational therapist, conducted the intervention.
The intervener in this study served as leader of the board game program. The
recreational therapist was highly experienced in leading community and institu-
tional older adult activities and had received training pertinent to long-term care
and research ethics. All group board game activities in this study were conducted
by her. She aided participants in playing games. The intervention group experi-
enced board game activities in 12 sessions of 90 min once a week. The board game
activities were conducted in a small group setting and were randomly assigned to
six teams of five or six people each. Before the activity, the physical and mental
states of participants were examined, and the social worker ensured the safety of
the participants during the activities. During an expert panel discussion involving
a psychologist, nursing professor, recreational therapist and social worker all
experienced in working with older adults, various board games were selected for
the sessions. Considering the attention status, and life background of the partici-
pants, 12 sessions of 90 min were deemed appropriate. The topics of the 12
activities were (a) destined to gather together, (b) memory quiz, (c) childhood
memory, (d) unity is strength, (e) speed test, (f) brainstorming and (g) graduation
ceremony. Details of the board game program are shown in Table 1.
 SOCIAL WORK IN HEALTH CARE 7

Table 1. Content of the board game program.

Week Name of board
number Name of unit Activity goals game
1 Destined to gather 1. Form the group and help all members get to
together know each other.
2. Introduce the activity goals and methods.
3. Establish rules for the group.
2–3 Memory quiz 1. Train group members to construct a visual space. Zicke Zacke
2. Enhance members’ memories. Huhnerkacke
3. Increase opportunities for interpersonal
interaction between members.
4–5 Childhood memory 1. Enhance members’ comprehension ability. Hisss
2. Strengthen members’ concentration.
6–7 Unity is strength 1. Enhance members’ hand coordination. Noah’s ark
2. Improve members’ thinking ability.
3. Strengthen members’ calculation ability.
8–9 Speed test 1. Train members’ response ability. Speed cups
2. Enhance members’ concentration.
3. Increase opportunities for interpersonal
interaction.
10–11 Brainstorming 1. Improve members’ abstract thinking ability. Rummikub
2. Train members’ logical thinking ability.
3. Strengthen members’ decision analysis ability.
12 Graduation 1. Review the feelings felt when playing the board
ceremony games.
2. Discuss the activity that left the deepest
impression.
3. Give feedback to each member.

Research ethics
This study was approved by the Institutional Review Board of National Cheng
Kung University (CKU-IRB-2018–287) and was conducted with the consent of the
two adult day care centers. The participants were sampled from March 1 to
June 30, 2018. The researcher explained the objective and method of this study
to the participants and acquired written consent from the participants.
Questionnaires were distributed to the participants before and after the 8-week
program. All research data were encoded to ensure the anonymity of the partici-
pants and used only for academic research purposes. The participants were
permitted to withdraw from a session or to quit the study altogether during the
research procedure for any reason without having their rights to receive care
affected.

Data analysis
Data were filed and analyzed using SPSS 22.0 statistical software, and a single-tail
test was used (α < .05). The chi-square test and independent-samples T-test were
used to compare the differences in the demographics and cognitive function of
these two groups at baseline. The cognitive function of the two groups before and
after the intervention was compared by paired T-test. Generalized estimating
8 Y. CHING-TENG

equations (GEE) were used to analyze the invention of (or interaction between)
board game activities and time interaction, as well as the interaction of time and
group to examine changes in cognitive function at different time points.

Results
Demographic information
In this study, 84 cases were reported, but two quit for a loss rate of 2%. One
participant in the experimental group participated in no more than seven
activities because of physical discomfort, and one participant in the compar-
ison group was hospitalized and did not participate in the posttest. A total of
82 participants, 41 in the experimental group and 41 in the comparison
group, completed all parts of the study. Of the total, 11 subjects were male
and 71 were female, with an average of 76.43 years of age; 42.7% had
elementary education; 92.7 were Taoism; 51.2% were widowed; 59.8% were
living with children, and 39.0% of the subjects were in condition, the average
depression score was 2.51, and the average cognitive function of 20.89 points.
There were no statistically significant findings in the demographic character-
istics or cognitive function levels of the two groups by chi-square test or
independent-samples t-test (Table 2).

Efficacy of board game activities in improving older adults’ cognitive

function
A paired t-test was performed to examine the effect of the intervention. The results
showed that the pretest and posttest mean scores of the intervention group for
cognitive function were 19.88 and 23.24, respectively; the cognitive function
alleviation of the intervention group was significant (t = 11.203, p = .031) and
higher than that of the comparison group (t = −0.162, p = .717). These results are
listed in Table 3.
This study was calculated by the GEE repeated-measures and tracking
effect to maintain the statistical methods outlined in the literature (Chiang
et al., 2010; Wu, 2011). The GEE model was applied to determine whether
there were any significant differences in the improvement of the cognitive
function of these two groups at different times. The comparisons of post-test
and pretest (T2 vs. T1) were made, and model base and exchangeable
adopted as the covariance matrix, to verify the final impact on the elders of
the adult day care centers in the aspects of the intervention of board game
treatment and the interaction of time. According to the results of the inter-
action analysis, and then inferring the range of improvement in the experi-
mental group in the post-test (T2), cognitive function was higher than that of
the comparison group (mean difference = 2.32, p < .001) (Table 4).
 SOCIAL WORK IN HEALTH CARE 9

Table 2. Basic properties comparison between intervention group and comparison group.
Intervention Group (n = 41) Comparison Group (n = 41)
Variables M SD n % M SD n % pa/pb
Sex .105
Male 8 19.5 3 7.3
Female 33 80.5 38 92.7
Education .532
Illiterate 19 46.3 15 36.6
Elementary 15 36.6 20 48.8
> Junior High School 7 17.1 6 14.6
Religious .201
Taoism 40 97.6 36 87.8
Buddhism 1 2.4 5 12.2
Marital Status
Married 21 51.2 19 46.3
Widowed 20 48.8 22 53.7
Living Conditions .366
Living with Spouse 13 31.7 10 24.4
Living with Children 25 61.0 24 58.5
Living Alone 3 7.3 7 17.1
Perceived Health Status .357
Out of Condition. 8 19.5 12 29.3
Not Too Bad 14 34.1 16 39.0
In Condition. 19 46.3 13 31.7
Age 77.93 6.54 75.93 5.36 .126
Depression Level 2.24 2.25 2.78 2.50 .309
Cognitive Function 19.88 8.16 21.90 6.72 .224
Note: pa = Chi-square test; pb = Independent sample t-test.

Table 3. Cognitive function comparison between intervention group and comparison

group.
Pretest (T1) Posttest I (T2) T2–T1
Variables M ±SD M ± SD ta
Intervention Group 19.88 ± 8.16 23.24 ± 6.56ab −2.163*
Comparison Group 21.90 ± 6.72 21.46 ± 6.21 −0.162
tb −1.226 1.262
Note: ta = paired-samples t-test; tb = independent-samples T-test; a = Significant difference
between T2–T1; b = Significant difference between Experimental Group and Comparison
Group at T2.
*p < .05 **p < .01

Table 4. Generalized estimation equations analysis of cognitive function.

Predictor Variables Estimate Parameters (β) SE Wald χ2 p
Intercept 9.81 1.89 26.99 .000***
Categories(Intervention Group vs. Comparison Group) −4.79 2.51 3.66 .056
Time
T2 vs. T1 −.510 1.20 .179 .672
Categories × Time
Intervention Group × (T2 vs. T1) 3.87 1.95 3.94 .047*
Note: T1 = Before intervention; T2 = After intervention
*p < .05 ***p < .001
10 Y. CHING-TENG

Discussion
Efficacy of board games in improving older adults’ cognitive function
This study found that after board game activities interventions, the cognitive
function of experimental group participants substantially improved and were
better than those in comparison group. Regarding health-related cognitive
function, results imply the board game activities may possibly improve their
abilities of cognitive function. Previous papers have shown that playing board
games can improve cognitive performances in healthy older adult participants
(Dartigues et al., 2013; Verghese et al., 2003). Thus, playing board games could
be a particularly relevant way to preserve cognition and to prevent cognitive
decline or dementia, and could be recommended without any real drawbacks.
Our results also supported the board games activities could improve cognitive
function of older adults living in adult day care centers.
In this population-based study of Taiwan people aged 65 and older in
adult day care centers, participation in board game activities was possibly
related to maintained or improved cognitive function of subsequent cognitive
decline. There are a number of proposed hypotheses about the mechanism
through which activities impact cognition. Cognitive reserve is the most
relevant hypothesis that proposes that life experience may influence neural
processing and synaptic organization by permitting neurological processes to
become more efficient, adaptive and plastic, thus allowing some people to
cope with progressing dementia pathology better than others (Stern, 2002).
Social activities may offer a stimulating social environment that involves not
only navigating social cues, dealing with complex and challenging social
issues, but also physical movement and information processing that in turn
enhance cognitive reserve. Board game activities may also have beneficial
effects through psychological and behavioral pathways by lowering stress,
having a better diet and healthier lifestyle, promoting psychological well-
being, and lowering inflammation, consequently reducing the risk of devel-
oping various diseases that are associated with worse cognitive function.
Social activities predominantly affect the immune system (Seeman, 1996)
and influence inflammatory processes in the brain. Active individuals are
more likely to engage with others, leading to positive emotional states and
lower stress, protecting people against cognitive decline via their beneficial
effect on cardiovascular and cerebrovascular diseases (Crowe, Andel,
Pedersen, Johansson, & Gatz, 2003).

Implications for clinical social work practice

Caillois (2001) noted that having experience with games is conducive to
physical and psychological development. From the perspective of the hier-
archy of needs developed by Marslow (1943), board game activities can
 SOCIAL WORK IN HEALTH CARE 11

provide new interaction communities for older adults in day care centers, in
which older adults can experience role changes, establish new relationships,
alter their normal perceptions of the world, and feel giddy happiness. Playing
board games are a great opportunity for social interaction among older adults
in long-term care facilities, because these adults often lack social stimulation.
Playing board games can also be a self-growth and learning process for
older adults that can facilitate problem-solving and decision-making skills
(Wright & Forrest, 2007), provide opportunities for social interaction and
communication, and construct new knowledge (De Freitas & Griffiths, 2008;
Kafai, 2006). Through playing board games, players can learn new skills and
establish interpersonal relationships. In summary, board game activities may
have a positive effect against cognitive decline. While these findings need to
be confirmed by more longitudinal studies, this study underscores the
importance of encouraging older adults participating in board game activities
to maintain cognition or prevent cognitive decline. This could be promoted
for successful aging benefits because currently, no efficient treatment for
cognitive impairment is available.

Research limitations
Some limitations to this work should be mentioned. First, this study was
conducted through purposive sampling and focused on older adults in
adult day care centers. The results cannot be generalized to older adults
with other attributes housed in long-term care institutes. The outcomes of
this study, which were based on only the pretest results and the posttest
results obtained after the 12th week of the intervention, did not predict the
follow-up duration of the effect of the board game activities. Second, the
intervention was conducted in adult day care centers. As such, generalization
of this result to other institutions should be cautioned. Third, because of the
inherent characteristics of adult day care centers in Taiwan, a small number
of male participants was included in the study. Fourth, it is not entirely clear
which types of board games may have contributed to the outcomes observed.
Fifth, it is possible that participants’ attention bias played a role in the group
outcomes. The study results should be further verified with a randomized
controlled trial design. A larger sample size is recommended in future
research, and it is also suggested that further works to explore the potential
benefits of different board game activities for the older adults. Given that,
board game activities were only performed once per week for 12 continuous
weeks, and this intervention number of times may not be adequate. Thus, it
will be worthwhile to consider designing a series study to examine the
relationship between the intervention frequency and duration of the board
game program. Finally, long-term studies in different institutions are needed
to further confirm the effectiveness of this board game program.
12 Y. CHING-TENG

Conclusion
This study applied board game activities in adult day care centers to older
adults, whose cognitive function was investigated before and after a 12-week
activity intervention. Results for the participants in the experimental group
were significantly more satisfactory than those of the control group at
enhancing cognitive function. Therefore, the board game activities may
effectively improved the older adults’ cognitive function in adult day care
centers. Playing board games is a recreational activity that promotes exposure
to novelty, taking initiatives, planning, adaptation to winning or losing and
brings immediate pleasure to participants. Thus, the board game activities
have the advantage of a dementia prevention strategy for the older adults in
adult day care centers.

ORCID
Yao Ching-Teng http://orcid.org/0000-0002-0307-270X

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