title: Engaging Elderly People in Telemedicine Through Gamification.
abstract: BACKGROUND
  Telemedicine can alleviate the increasing demand for elderly care caused by the rapidly aging population. However, user adherence to technology in telemedicine interventions is low and decreases over time. Therefore, there is a need for methods to increase adherence, specifically of the elderly user. A strategy that has recently emerged to address this problem is gamification. It is the application of game elements to nongame fields to motivate and increase user activity and retention.
  
  
  OBJECTIVE
  This research aims to (1) provide an overview of existing theoretical frameworks for gamification and explore methods that specifically target the elderly user and (2) explore user classification theories for tailoring game content to the elderly user. This knowledge will provide a foundation for creating a new framework for applying gamification in telemedicine applications to effectively engage the elderly user by increasing and maintaining adherence.
  
  
  METHODS
  We performed a broad Internet search using scientific and nonscientific search engines and included information that described either of the following subjects: the conceptualization of gamification, methods to engage elderly users through gamification, or user classification theories for tailored game content.
  
  
  RESULTS
  Our search showed two main approaches concerning frameworks for gamification: from business practices, which mostly aim for more revenue, emerge an applied approach, while academia frameworks are developed incorporating theories on motivation while often aiming for lasting engagement. The search provided limited information regarding the application of gamification to engage elderly users, and a significant gap in knowledge on the effectiveness of a gamified application in practice. Several approaches for classifying users in general were found, based on archetypes and reasons to play, and we present them along with their corresponding taxonomies. The overview we created indicates great connectivity between these taxonomies.
  
  
  CONCLUSIONS
  Gamification frameworks have been developed from different backgrounds-business and academia-but rarely target the elderly user. The effectiveness of user classifications for tailored game content in this context is not yet known. As a next step, we propose the development of a framework based on the hypothesized existence of a relation between preference for game content and personality.
authors.affiliation: University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Biomedical Signals and Systems, Telemedicine group, Enschede, Netherlands. a.f.a.devette@utwente.nl.
authors.forename: Frederiek
authors.identifier: http://orcid.org/0000-0003-3313-9327
authors.initials: F
authors.lastname: de Vette
authors.forename: Monique
authors.identifier: http://orcid.org/0000-0001-5082-1112
authors.initials: M
authors.lastname: Tabak
authors.forename: Marit
authors.identifier: http://orcid.org/0000-0001-7886-7008
authors.initials: M
authors.lastname: Dekker-van Weering
authors.forename: Miriam
authors.identifier: http://orcid.org/0000-0002-8372-3022
authors.initials: M
authors.lastname: Vollenbroek-Hutten
keywords: adherence; classification; eHealth; elderly; engagement; framework; gamification; older adults; personality; player type; telemedicine