Heart to Heart:
A conversational card game about aging-in-place

Project Overview
A toolkit designed to communicate the concept of aging-in-place and building participants’ empathy and understanding in order to develop coping skills, resilience and plans to face future challenges of aging

Challenge

My master’s research project centered on communication about aging-in-place: what does it mean, why is it important, and how can we talk about it in a meaningful way?

According to research, aging-in-place meant different things to individuals, families, organizations and governments. There is no one-size-fits-all definition. This is a pressing issue in Canada, where 1 in 4 people will be age 65 and over by 2035, a big increase to the seniors population. Shifts in the healthcare system are placing emphasis on home and community-based care, including the growth of housing options and supports/services to meet care needs at home.

Aging-in-place is made up of complex factors: personal, environmental and systemic. These broad factors work together to determine how well an older adult will be able to age-in-place. My project question was: how might we communicate different narratives to reveal the complexities of aging-in-place?

Process

I built on the research done for my aging-in-place gigamap project, and strongly based my work on Canadian-American gerontologist Stephen Golant’s research on coping, resilience and aging in the right place. His findings helped me structure the interview process with participatory design elements.

I interviewed 3 older adults (over the age of 50) from different Canadian cities, using narrative and empathetic research techniques in semi-structured interviews. Each interview was done in 3 parts: (i) answering questions about personal experiences with aging-in-place; (ii) sorting cards to rank values associated with successful aging; and (iii) drawing current experiences and future visions for aging.

The research process delivered these insights:

- Older adults who have better coping and appraisal skills could age-in-place better than those who lacked the skills
- Older adults don’t always think of themselves experiencing aging-in-place
- Older adults are aware of future challenges and have different plans and confidence levels to cope

The insights contributed to the direction of the design concept. It was important to engage with content and interact with others to improve coping skills, resilience and feel supported. Being considerate of people’s agency and influencing factors when making decisions are also important, so I emphasized ideas as suggestions, not solutions. Finally, choosing how to position the project in the context of aging and the aging process will be key for uptake.

I originally envisioned an exhibit with workshop activities as a communication vehicle for raising awareness, sharing stories and educating visitors. It would be visually engaging, authentically represent experiences and started conversations at different levels of engagement. Due to the timeframe, I pivoted my idea and scaled it down into a toolkit that would build empathy, create understanding, and promote tangible change.

I took inspiration from open-ended conversation games, specifically Hello, an evidence-informed game about death and dying that got participants to think about planning for end-of-life and its surrounding rituals. Storytelling games, such as Dixit and Balderdash, also inspired me to gamify the concept of aging-in-place into a card game.

Concept

Heart to Heart is a conversational card game about aging-in-place. Players will encounter diverse challenges on aging and come up with ideas to cope with and overcome the challenges. It focuses on 3 main themes: getting to know the characters (personas); encountering different situations (scenarios); and visualizing supports that are the best fit (interventions).

In a nutshell, the game teaches players to use design thinking, user research and journey mapping through a game to help them increase their abilities to imagine possibilities for their own futures. It focuses on proactive thinking to prepare future plans that align with personal values, beliefs and circumstances, rather than reactive thinking to challenges after they’ve occurred.

Rules

Each player chooses a starting character. Each character card has personal information, including name, age and interests. They also have a corresponding set of coping strategy cards and challenge cards. Players are given drawing pads and a number of heart tokens.

The first player will play their character card, a coping strategy card and a challenge card. All players (including the first) use the drawing pad to come up with ideas to overcome the challenge, keeping in mind what they know about the character and their coping style. The ideas are presented and discussed to see which idea is the best fit. Each player will vote with a heart token and place it on the best fit idea. The player(s) who came up with the idea(s) collect the heart tokens, and gameplay continues to the next player.

In future rounds, personal factor cards and major event cards are added to gameplay. Players come up with new ideas to address challenges and build on their existing ideas, representing one’s life course and accumulation of lived experiences. After the 3 rounds are up, players count up their heart tokens. Whoever has the most heart tokens wins the game.

Setting

The game should be played in a safe space for open and honest discussions.

Using the Game

The game is optimized for an intimate group setting for up to 4 players, for example an adult child with their aging parent and family members. It’s meant to initiate conversation and talk about aging-related issues in an objective manner. Players can create custom cards if they don’t wish to use the pre-printed characters or scenarios. After the game is over, each player gets a reflection map with questions about the game, ideas and experiences. Each person is encouraged to write and reflect on their game experience and how much their thoughts on aging have changed.

Through playing the game, I hope people become more empathetic for others and the complex challenges they face in life. By being exposed to different ideas and perspectives, I hope people will become more receptive to different solutions and more inventive in how they perceive aging and aging-in-place.

Result

Due to the COVID-19 pandemic, I wasn’t able to test the game prototype with participants in the current format. However, I received feedback from colleagues and classmates during my formal presentation on how to improve the concept:

- Using plain language that is non-threatening and supportive to improve the game content and how I talk about the game to others
- Creating a better way to obtain and facilitate the game, especially how the host familiarizes themselves with the game first before inviting others to play
- Testing the game with diverse people to make sure I’m achieving my original objectives, whether the gameplay makes sense, and whether the game is impactful

Overall, my research project was about creating a novel approach to communicating a complex topic using design research, knowledge translation and gamification. I’ve learned a great deal about the topic area, conducting qualitative research, and using design methods to develop a unique product.

Next Steps

Since the onset of the COVID-19 pandemic, I’ve been thinking how to take the existing game and re-imagine it as a digital offering as an online platform or service. There’s been a significant shift in adopting technology for virtual interactions, especially for health-based conversations (telehealth, virtual care, remote monitoring, AI, etc.). This uptake is compounded with the ongoing challenges and negative perceptions surrounding long-term care facilities, which may motivate people to choose to remain at home with proper supports.I hope to address these elements as I move forward with the next iteration:

- Building accessibility and inclusivity into the game from the start, so the game can be played by people with varying physical and cognitive abilities, using universal icons and visuals to break the language barrier, and having culturally-sensitive representation
- Better alignment with health communications and innovation systems – where does the game fit into the overall system?
- Educating others through specialized versions of the game for people working with older adults and people creating supports/services for older adults

My goal is to re-design and improve the project using design lenses that consider digital user experience and interactions as a core component, and develop supporting materials to help facilitate and expand the toolkit. My vision for the project is that it will be used to help people have thoughtful and important discussions about aging-in-place, making plans to achieve their goals, and make aging in the right place an obtainable goal for everyone.