The Study of Toy Acceptance among Older Adults with Normal Cognition and Mild Cognitive Impairment

The Study of Toy Acceptance among Older Adults with Normal Cognition and Mild Cognitive Impairment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Study of Toy Acceptance among Older Adults with Normal Cognition and Mild Cognitive Impairment Chih-Fu Wu, Hsi-Nao Tsai, Hsiang-Ju Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6712672/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Introduction: As global aging accelerates, cognitive decline has become a critical issue in elderly care. Although toys are increasingly recognized as tools to enhance cognitive and social functions among older adults, most commercially available toys are designed for children, lacking consideration for the cognitive diversity of the elderly. This study investigates toy acceptance among older adults with normal cognition and mild cognitive impairment (MCI), aiming to develop an evidence-based model and assessment tools that inform senior-friendly toy design. Methods: Drawing from literature and theoretical frameworks such as the Unified Theory of Acceptance and Use of Technology (UTAUT), this study developed a modified UTAUT model incorporating additional constructs like perceived need and enjoyment. A mixed-methods approach was used, including cognitive screening with the Montreal Cognitive Assessment (MoCA), toy game experience workshops, participant observation, and pre- and post-experiment questionnaires. Toy categories were refined through expert interviews and cluster analysis. SPSS statistical tools were used for regression and factor analysis to validate the model and evaluate toy design elements. Results: Data from 129 valid participants (aged 51–86) revealed significant differences in toy acceptance between cognitively normal and MCI groups. Among cognitively normal elders, perceived enjoyment and social promotion were key drivers of toy usage. In contrast, for MCI participants, social promotion was the primary motivator, influenced strongly by community support. The revised model showed that the easier a toy was to use, the lower the perceived enjoyment, suggesting that cognitively normal elders preferred more challenging toys. The study also developed the "Toys for the Elderly Cognitive Function Assessment Form" and a corresponding set of design guidelines to evaluate and adapt children's toys for elderly users. Conclusion: This study demonstrates that cognitive ability significantly influences older adults’ toy acceptance patterns. Social promotion emerged as a dominant factor across cognitive groups, particularly for those with MCI. The revised UTAUT model effectively predicts behavioral intention and use of toys among older adults. The proposed assessment form and design guidelines offer practical value for eldercare professionals and the toy industry, bridging cognitive evaluation with product design to support healthy aging and dementia prevention. Health sciences/Health care Health sciences/Health occupations older adults MCI UTAUT acceptability of toys MoCA Figures Figure 1 Figure 2 Figure 3 Introduction As the global population ages, the demand for entertainment, social interaction, and cognitive stimulation among older adults is also increasing [ 1 ]. WHO estimates that by 2050, one in five people will be over 60 years old, and the number of people over 80 will double [ 2 ]. As older adults age, their physical functions and cognitive systems deteriorate normally. However, the decline and damage of cognitive functions hinder the ability of the elderly to independently carry out daily life, increase their dependence on others, and cause frustration, leading to cognitive impairment and dementia care issues for older adults around the world. Toys are used as intervention tools in cognitive health care and social health. However, most of the toys on the market are children's products, and are also used by older adults, government long-term care institutions, and community care centers. There is a lack of toys designed specifically for the needs of older adults. At this stage, the toys used by Older Adults are directly selected from children's toys. However, children's toys cannot necessarily be directly used as toys for Older Adults because the needs and abilities of the two should be completely different. Perhaps some children's toys may be specially designed or suitable for older adults in some aspects. Therefore, this study hopes to explore the acceptance of toys by older adults with normal cognition and mild cognitive impairment, and how to select more appropriate toys and develop design assessment applications according to the needs and behavioral intentions of older adults, to more effectively promote the cognitive function of older adults and improve their quality of life. Based on the above literature, few studies compare the differences in behavioral intention between older adults with normal cognition and mild cognitive impairment in toy use and systematically explore the comprehensive impact of multiple independent variables on the behavioral intention of the elderly. Toys and games can promote cognition, but most of the existing toys are aimed at the children's market and lack consideration for the unique needs of older adults. The needs of older adults in terms of toys, games, and entertainment are different from those of children. It is necessary to consider the toy preferences and suitability of older adults with different cognitive abilities to ensure that the toys can provide older adults with appropriate challenges and fun. However, the influencing factors that mainly prompt older adults to start accepting toys cannot be obtained from the literature. Therefore, this study uses experimental research to explore the specific acceptance situations of the elderly playing with toys. The aim is to gain a deeper understanding of older adults’s behavioral intention in accepting and using toys, so that older adults with different cognitive abilities can make more appropriate choices for the use of toys and provide practical applications in the care field. Use the evaluation to design toys suitable for different cognitive states to promote mental function and social interaction, improve the elderly's acceptance of toys, prevent and delay dementia, and improve their quality of life. Literatures review Needs and cognitive function of older adults Old age is a mid- to late-stage of the life cycle [ 3 ], and the common status changes that people face include physical decline [ 4 ], changes in psychological and cognitive levels [ 5 ], and changes in social roles [ 6 ]. The aging of the elderly’s physical functions includes: visual and auditory deterioration, decreased vision and hearing impairment [ 7 ]; muscle degeneration [ 8 ]. People in their 60s begin to experience coordination problems and vision deterioration, making it difficult to perform delicate tasks such as threading a needle [ 9 ]. Due to social decline, the inability to define their roles, the need to fill their free time [ 10 ], and the fact that they no longer bear the economic responsibilities of the family, older adults are facing the situation of transforming their lifestyle and social roles from being the economic breadwinner of the family to a "rollerless" social status [ 11 ]. This role change has created a strong need for older adults to strengthen emotional connections to confirm their role in life [ 12 ] and to establish new social circles to increase the fun of life and relieve loneliness [ 13 ]. A theory of human motivation proposed by Maslow [ 14 ] is the source of the social psychology demand factor, which divides demand into high-level and low-level needs. Therefore, this study refers to Maslow's [ 15 ] need motivation theory and divides the primary needs faced by older adults into two major demand dimensions: "Function Promotion" derived from low-level Deficiency needs, D-needs, and "Social Promotion" derived from high-level Being needs, B-needs [ 16 ]. “Function Promotion” demand factors include increasing movement and speaking [ 19 ], training eye-hand-brain coordination[ 20 ], strengthening sense of orientation and enhancing language expression [ 21 ], training memory and improving concentration [ 22 ]; “Social Promotion” demand factors include strengthening emotional connections [ 23 ] and establishing new social circles[ 24 ]). Cognitive function generally includes four aspects: sensory motor, cognitive development, language communication, and social emotion [ 25 ]. Overall, there is a considerable overlap with the aforementioned needs of older adults. Therefore, this study defines the needs of older adults as the need to promote cognitive function. The decline in cognitive ability is an essential factor affecting the quality of life of older adults [ 26 ]. In general, 1–2% of the elderly population will develop dementia each year. Mild Cognitive Impairment (MCI) is in the clinical gray area between "normal cognition" and "dementia" [ 27 ], with a 10–15% chance of suffering from Alzheimer's disease (AD) or other dementias. Therefore, maintaining or improving cognitive ability can promote exercise, thinking, and interaction in the elderly, thereby delaying and preventing dementia. The detection of MCI can be considered a precursor to dementia [ 28 ]. Nasreddine et al. and other scholars [ 29 ] developed the Montreal Cognitive Assessment, or MoCA for short. The scale includes delayed memory, visual-spatial, executive function, abstract concepts, attention, language ability, and sense of orientation. The total score is 30. A score greater than 26 indicates normal cognitive ability. Taking into account the influence of education, 1 point is added to the score for subjects with ≤ 12 years of education. Later studies have shown that the MoCA has a higher sensitivity than the MMSE scale in identifying MCI and AD patients [ 30 ]. Since the development of the MoCA scale, alternative versions of the test questionnaire have also been developed to adapt to different countries and regions and test needs. To avoid the memory effect of the subjects, this study used the alternative version of the MoCA test questionnaire as a test questionnaire for cognitive ability before and after the toy game experiment [ 31 , 32 ]. Cognitive function and toy Cognitive ability is composed of multifaceted and interrelated skills [ 33 ]. Jean Piaget [34], through studying the intellectual development of children, divided cognitive skills into the Sensorimotor Stage, Preoperational Stage, Concrete Operational Stage, and Formal Operational Stage according to age. Children's cognitive abilities are accumulated gradually. Each stage accumulates previous abilities, which continue into school-age education to form a complete cognitive system. From Jean Piaget’s child development theory[34] and Berk’s research on child development stages [ 35 ], we have developed four stages of early childhood development milestones, namely sensorimotor, cognitive development, language communication, and social-emotional [ 36 ]. Both research on children’s cognitive development and cognitive degeneration [ 37 ] focus on the entire stage of cognitive development, so toys are almost always designed for children. Except for children's toys, which are systematically planned, the toy market for other age groups has no systematic classification or definition. The Consumer Product Safety Commission (CPSC) classifies toys based on children's cognitive abilities, age, and behavioral intentions. It publishes Age Determination Guidelines [38], which divides games into eight categories and proposes 14 items for Product Characteristics. In Taiwan, the national standard CNS 4797 Safety Toy Specifications classifies toys into 29 categories based on their functions, appearance, and game scenarios. The level of happiness that the elderly experience when playing games is significantly higher than their level of joy in daily life [ 39 ]. The Fat Brain Toys website asked its customers about their toys and then launched a recommended toy menu for older adults over 65 years old[ 40 ]. Toys for the Elderly has become a development trend in current toy design. As a tool to promote social interaction, Toys for the Elderly can help older adults interact with family, friends, or other community members, increase social connections, and encourage emotional connections [ 24 ]. Toys for the Elderly, as a special type of toy, have unique designs and functions. They can help older adults maintain their cognitive abilities, improve their emotional state, increase social interactions, etc. [ 41 ]. As one of the countries with a rapidly aging population, Taiwan Center of R&D and Testing for Commodities proposed the Toys for the Elderly certification standard in 2021[ 42 ]. In addition to complying with the general safety toy testing standards [43] (CNS 4797), the design must meet four significant aspects: large fonts, large parts, promotion of cognition and interpersonal interaction, and promotion of manual dexterity. However, most toys on the market are currently designed for children, and the needs and characteristics of older adults are not fully considered. Therefore, it is necessary to research the behavioral intention of older adults towards toys to meet their needs for entertainment and social interaction and improve their quality of life and sense of happiness. Integrated technology acceptance model and related application research Venkatesh et al. [ 44 ] proposed the Unified Theory of Acceptance and Use of Technology (UTAUT) based on the Technology Acceptance Model (TAM) used by Davis [ 45 ] to explain and predict people's adoption of new technologies or concepts and how to evaluate people's acceptance level. The model provides a more comprehensive understanding and prediction of behavioral intentions in technology adoption. UTAUT is an integration of eight theoretical models, including Theory of Reasoned Action (TRA), Technology Acceptance Model (TAM), Motivational Model (MM), Theory of Planning Behavior (TPB), Combined TAM and TPB (C-TAM-TPB), Model of PC Utilization (MPCU), Innovation Diffusion Theory (IDT) and Social Cognitive Theory, (SCT). It is widely used to explain and predict behavioral intentions in different fields of technology adoption. The dimension variables of the UTAUT model are: Performance Expectancy: the degree to which an individual feels that using the system is helpful, Effort Expectancy: the degree of effort an individual needs to put in using the system, Social Influence: the degree to which an individual feels the influence of the surrounding groups on themselves, such as social pressure or public image, Facilitating Conditions: the degree to which an individual feels that support and assistance can be obtained in terms of related technology, equipment, and resources, Behavioral Intention: the degree to which an individual is willing to accept and use the system, Behavioral: the specific behavioral intention of an individual to adopt a new system, Gender: the gender of the user, Age: the age of the user, Experience: the user's experience, Voluntariness of Use: the degree to which users actively use the new system. The independent variables are: Performance Expectancy, Effort Expectancy, Social Influence, Facilitating Conditions, the mediating variable is: Behavioral Intention, and the dependent variable is: Behavioral. In the integrated technology acceptance model, the user's objective conditions are taken into consideration, and four interfering variables are included: Gender, Age, Experience, and Voluntariness of Use. The UTAUT model can be flexibly expanded with other constructs to understand users' behavioral intentions toward technology adoption and use more comprehensively. The model has been widely used in research and practice to guide the design and implementation of technology interventions. The UTAUT model can be used to understand users' acceptance and use of artificial intelligence tools [ 45 ]; identify important personal and interpersonal factors that influence older adults' attitudes and intentions to use gerontology [ 46 ]; apply the UTAUT model to explain students' acceptance of higher education early warning systems [ 47 ]; investigate how consumers evaluate two types of recommendation systems in the context of e-commerce [48]; and study the intention of older users to accept wearable devices [ 49 ]. This shows that when designing technologies or products for older adults, the UTAUT model can effectively help understand the factors that affect their acceptance. It can serve as the theoretical basis for this study to understand older adults's acceptance of toys. The UTAUT model provides a framework for understanding elders’ acceptance of novelty. Methods We collected and summarized literature background data, constructed an integrated acceptance hypothesis model of toys for older adults and a cognitive function assessment form for Toys for the Elderly, screened experimental toys for the elderly and formulated experimental courses for game experience workshops, implemented questionnaire tests before and after the experiment, analyzed data using SPSS statistical software, explored the attitudes and behavioral intentions of the elderly with different cognitive abilities towards toys, conducted experiments and model modification verification, and evaluated the design elements of children's toy conversion Toys for the Elderly. “All methods were carried out in accordance with relevant guidelines and regulations. The experimental protocol was approved by the Research Ethics Committee of National Taiwan University, approval number 202405ES102. Informed consent was obtained from all subjects and/or their legal guardians prior to participation. Study scope and limitations The United Nations (UN) defines older adults as people aged 60 and above[ 50 ]; retirement is also an indicative basis for identifying old age [51]; 65 years old is widely accepted as the starting age of old age and is also the standard age used by governments in most countries when formulating retirement and social welfare policies [ 52 ]. Therefore, our target group of subjects is retired older adults who can take care of themselves. The experimental content has no regional or language differences. We hope that the results of this study are applicable to Taiwan but can also be applied to the replication of experiments in other countries and regions. This study held 10 experimental toy and game experience workshops for older adults (hereinafter referred to as "toy and game experiments") and invited the elderly who had participated in the Elderly Health Function Promotion Course to participate in the toy and game experiments. Before the experiment, the content and purpose of the experiment were fully introduced to all subjects, and the subjects agreed to use the experimental results they provided. The questionnaire data were divided into data of older adults with normal cognition (MoCA ≥ 26) and data of older adults with MCI (mild cognitive impairment) (MoCA ≤ 25) according to the MoCA cognitive test scores of the participants before the experiment. The valid data were identified as questionnaire data of retired older adults. Since the subjects in the experiment often know in advance that they will be observed, they usually show behavioral intentions that are different from the norm. To understand the objective authenticity of the research purpose, the participant observation method [53] was adopted. The researcher personally joined the group to be studied, recorded and analyzed the participation of older adults in the elderly experimental toys, understood the behavioral intention dimension of the group to be explored, and then explained his research findings and understood the problems faced by the elderly in using toys, as well as the factors that affect older adults’s demand for toys. Selection of experimental toys for the elderly The elders interviewed in the pre-test questionnaire of this study first surveyed the suitability of Toys for the Elderly based on the classification of children's toys discussed in the literature above, using a five-point Likert scale [ 54 ], with opinions ranging from "strongly disagree" to "strongly agree" and giving a rating of 1 to 5. We selected 12 categories of toys with an average number of toys chosen by the elders ≥ 3 as the basis for classifying toys in subsequent experiments. Based on the previous literature comparing children's toys and Toys for the Elderly, it can be found that children's toys tend to be related to sensory motor and social learning for young children, while the types of toys that older adults think can become Toys for the Elderly tend to be related to social orientation, cognitive learning and function promotion. To understand the classification method of Toys for the Elderly, based on the 12 categories of toys selected by the elderly mentioned above, this study invited three experts from the Taiwanese toy industry, two social workers from elderly homes, one healthy retired elderly, and one elderly with Parkinson's disease to complete an expert questionnaire interview and conduct another toy category screening. We then used cluster analysis to identify four types of toys: (1) technology interactive games that require fine motor skills; (2) puzzle strategy games; (3) cognitive coordination games; and (4) perceptual games that require gross motor skills. We used these as experimental toys for older adults in subsequent toy game experiences and compared them with the questionnaire analysis. Construction of the UTAUT hypothesis model framework Since toys span from traditional interfaces to technological interfaces, based on the needs of older adults discussed in the literature, the integrated technology acceptance model UTAUT was used to design a model hypothesis to explore the correspondence between toys and older adults, continuing the UTAUT integrated acceptance model. This study incorporates two additional constructs, "perceived need" and "perceived enjoyment", into UTAUT to consider older adults's acceptance of toys; "function promotion" and "social promotion" are used as demand elements of older adults's "perceived neediness" (PN); if it were not for the global population changes such as declining birthrates and aging, toys would always be exclusive to children [ 55 ]. Therefore, when it comes to the acceptance of toy products, older adults are generally influenced by stereotypes: humans have specific preconceived notions about particular people, things, and objects [ 56 ], as well as challenges from past experiences and the strange looks of the surrounding society [ 57 ]. Regarding the stereotype of older adults towards toys, the “Stereotype” dimension was added to the social influence, and the “Perceived Ease of Use” (PEOU) and “Perceived Usefulness” (PU) of the TAM model were used to replace the performance expectations and effort expectations. Because Toys for the Elderly is still in its infancy and most toys on the market are children's toys, few people have experience using Toys for the Elderly. Therefore, this study omitted the three structures of UTAUT: convenience, experience, and voluntary use. In addition, because this study focused on the impact of the cognitive ability of older adults on toys, it discarded the moderating factors of gender and age. It used "cognitive ability" as the model observation value. The hypothetical model framework of UTAUT proposed in this study is shown in Fig. 1 . Figure 1 . Older adults’s UTAUT hypothesis framework for toys insert here Defining and measuring research variables The toy acceptance questionnaire in this study is divided into five categories, including basic information of the subjects, cognitive ability (MoCA) pre-test and post-test, main variables, toy usage attitude, and purchase status. Among them, Perceived Usefulness (PU), Perceived Ease of Use (PEOU), perceived need (PN): including Function promotion (FP) and Social promotion (SP), community influence (SI), Stereotype (ST), and Perceived Enjoyment (PE) are independent variables; Behavioral Intention is the relay variable; Behavioral Intention is the dependent variable; and cognitive ability is the observed value for model analysis. The operational definitions, measurements, and reference sources of the main variables are detailed in Table 1 . The Likert five-point scale was used for the questionnaire survey[ 54 ], with opinions ranging from "strongly disagree" to "strongly agree" and rated from 1 to 5. Table 1 Variable Definitions and Questionnaire Scales for Senior Toy Acceptance Variable Definition ID Item Perceived Usefulness (Davis, 1993) The degree to which an individual believes that using the system will enhance their effectiveness PU 1 I feel that playing with this toy can promote physical activity. PU 2 I feel that playing with this toy can increase coordination. PU3 I feel that playing with this toy can promote cognitive ability. PU 4 I feel that playing with this toy can increase expressive ability. Perceived Ease of Use (Davis, 1993) The degree to which an individual believes using the system will be effort-free. PEOU 1 Playing with this toy is easy for me PEOU 2 After hearing the rules of the game, I understood how to play. PEOU 3 Only after playing did I understand how to play. PEOU 4 I feel that this toy is easy to operate. PEOU 5 I feel that this toy is easy to get started with. Perceived Need Function Promotion Whether the system has the practicality of promoting cognitive function. FP 1 Do you feel the need to promote increased physical activity and the amount of speaking? FP 2 Do you feel the need to promote coordination ability? FP 3 Do you feel the need to strengthen your memory? FP 4 Do you feel the need to promote concentration and calculation skills? FP 5 Do you feel the need to increase opportunities for verbal expression? Social Promotion The system becomes A tool for individuals to increase social interaction, develop social skills, and satisfy the need to interact with others. SP 1 Do you feel the need to strengthen relationships with family and friends? SP 2 Do you feel the need to expand your social circle? SP 3 I feel that playing with this toy can promote family relationships. SP 4 I feel that playing with this toy can promote social interaction. SP 5 I feel that playing with this toy can pass the time. Social Influence (Venkatesh et al., 2003) External factors are what most people believe an individual should engage in the behavior. SI 1 My peers play with it, so I play with it too. SI 2 The community / senior learning courses use it so that I will play with it. Stereotype (Spencer et al., 2016) An individual's preconceived notion about a specific thing. ST 1 Toys are for children, so I do not play with them. ST 2 It is strange for seniors to play with toys, so I do not play with them. Perceived Enjoyment (Heerink et al., 2010) An individual's experience of enjoying the system. PE 1 I do not answer the phone or deal with other things when playing with this toy. PE 2 When playing with this toy, time always passes quickly. PE 3 This toy makes me want to play with it again and again. Behavioral Intention (Davis, 1993) Internal and external factors reflect an individual's behavior. BI 1 I will buy a toy because it is easy to operate. BI 2 I will buy a toy because it is challenging. BI 3 I will buy a toy because it looks fun. BI 4 I will buy a toy because my friends play with it. BI 5 I will buy a toy because it promotes health. BI 6 I will buy a toy because it enhances relationships with relatives and friends. BI 7 I will buy a toy because it can help me make new friends. Behavior (Davis, 1993) The higher the intention, the higher the individual's usage. UB 1 I want to purchase perceptual-motor toys. UB 2 I want to purchase cognitive-coordination toys. UB 3 I want to purchase educational strategy toys. UB 4 I want to purchase technology game toys. Table 1 : Definition of variables and questionnaire scales of Toys for the Elderly acceptance Insert here Hypothesis and verification of the integrated technology acceptance model of toys among the elderly The integrative technology acceptance model hypothesis of this study is: (1) The impact of perceived usefulness on behavioral intention: the subject's perceived usefulness of a toy will positively affect their intention to use the toy; that is, the higher the perceived usefulness, the stronger the intention to use the toy. H1: Perceived Usefulness (PU) positively affects Behavioral Intention (BI) of toy use; (2) The impact of Perceived Ease of Use on Behavioral Intention: The Perceived Ease of Use of a toy will positively affect the user's Behavioral Intention, that is, the higher the ease of use, the stronger the intention to use. H2: Perceived Ease of Use (PEOU) positively affects Behavioral Intention (BI) of toy use; (3) The impact of perceived need on behavioral intention: The user's perceived need for a toy will positively affect their intention to use the toy, that is, the higher the perceived need, the stronger the intention to use the toy; perceived need consists of two parts: Function Promotion (FP) and Social Promotion (SP), so the higher the degree of Function promotion and Social promotion of the toy to the user, the stronger the intention to use the toy. H3: Perceived need (PN) positively affects behavioral intention (BI) of toy use, H3a: Function promotion (FP) positively affects behavioral intention (BI) of toy use, H3b: Social promotion (SP) positively affects behavioral intention (BI) of toy use; (4) The impact of community influence on behavioral intention: The influence of toys in the community will positively affect the behavioral intention of users, that is, the greater the community influence, the stronger the intention to use. H4: Social influence (SI) positively affects behavioral intention (BI) in toy use; (5) The impact of stereotype on behavioral intention: The user's stereotype of a toy will negatively affect his or her intention to use the toy, that is, the worse the stereotype, the weaker the intention to use the toy. H5: Stereotype (ST) negatively affects Behavioral Intention (BI) of toy usage; (6) The impact of perceived enjoyment on behavioral intention: The user's perceived enjoyment of a toy will positively affect his or her intention to use the toy, that is, the higher the perceived enjoyment, the stronger the intention to use the toy. H6: Perceived Enjoyment (PE) positively affects Behavioral Intention (BI) in toy use; (7) The impact of Behavioral Intention on Behavioral Intention: The user's Behavioral Intention for the toy will positively affect their actual Behavioral Intention, that is, the stronger the Behavioral Intention, the more frequent the actual use of the Behavioral Intention. H7: Behavioral Intention (BI) positively affects the usage of toys. In order to understand the acceptance pattern of toys among the elderly, this study used stepwise multiple linear regression analysis through the statistical analysis software SPSS to verify and analyze the model hypothesis, and deeply explored the subjects' intention to use toys and behavioral intentions, as a questionnaire analysis verification comparison and application discussion for subsequent toy game experiments. Results Participant background analysis The sample source of this study was voluntary participants in elderly activities. There were 139 participants, 129 valid questionnaires, and a response rate of approximately 92.8%. The average age of the experimental subjects was 69.57 years, including retired seniors aged 51–86. Educational level ranges from elementary school to college/junior college, with an average of 14.19 years of education. Regarding retirement status, including those who have just retired and those who have been retired for 35 years, the average retirement years is 9.86 years. The results of the MoCA cognitive ability pre-test showed 107 older adults with normal cognition, with an average test score of 27.96 points; there were 22 older adults with mild cognitive impairment (MCI), with an average MoCA test score of 23.14 points. The MoCA cognitive test is scored by adding 1 to the score of those with less than 12 years of education, which shows the critical impact of years of education on cognitive ability. For older adults with junior high school education or below, the MCI group accounted for 22.7%, which is much higher than the 3.6% of the cognitively normal group, indicating that the number of years of education does affect the cognitive ability of older adults. In the background information of the subjects, the gender of the participants was higher in females (79.8%) than in males (20.2%). Regarding the deterioration of physical functions caused by aging, vision deterioration (65.9%) is more serious than hearing deterioration (38.0%) among older adults. The proportions of the MCI group, both in terms of vision (68.2%) and hearing (45.5%), were higher than those in the cognitively normal group, indicating that the functional deterioration of the MCI group was more serious. Notably, most older adults, whether cognitively healthy (65.4%) or MCI (68.2%), have deteriorating vision. Therefore, when converting the design of Toys for the Elderly, sufficient recognition (such as large fonts and large parts) must be provided. Regarding Behavioral Intention in purchasing toys, the lowest proportion of older adults buy toys for themselves (9.3%), while 25.6% buy toys to play with their grandchildren. Most older adults (34.9%) have never purchased any toys. This shows that in the subsequent design of Toys for the Elderly, sufficient intergenerational parent-child interaction factors must be considered to meet and improve the needs and willingness of older adults to use toys. Questionnaire analysis and hypothesis model verification results In order to confirm the consistency of the items in the hypothesis model, the questionnaire items were first analyzed. Each item's critical ratio (CR value) was obtained through extreme group comparisons. To detect whether the questionnaire items were closely related to the total score of the scale, correlation analysis was used to test the internal consistency. Using Pearson correlation analysis, it was found that except for UB2, the CR value of the remaining items in the questionnaire of this study was 0.7, which was highly correlated [ 59 ]. Therefore, the invalid item UB2 was deleted, and the items used in the subsequent Behavioral Intention facet (UB) were UB1, UB3, and UB4. The reliability analysis of the questionnaire facets was determined using Cronbach’s α coefficient as follows: Perceived Usefulness (0.874), Perceived Ease of Use (0.912), Cognitive Promotion (0.876), Social Promotion (0.887), Community Influence (0.696), Stereotype (0.911), Perceived Enjoyment (0.658), Behavioral Intention (0.856), and Behavioral Intention (0.781). Except for function and social promotion, which were negatively correlated with Stereotypes, all other facets were positively correlated. This study used stepwise multiple linear regression analysis to verify the hypothesis model. The statistical analysis software SPSS found that among the independent variables, the variables with significant predictive power for Behavioral Intention were Perceived Usefulness and social influence. The T test determines whether each dimension is sufficient to explain the model hypothesis, and the R2 variation is used to estimate the model fit in the multiple regression analysis. The higher the R2 value, the higher the model fit. The R2 of the stepwise multiple linear regression of the hypothesis of this study is 0.113, indicating that only 11.3% of the total variance in the regression model can be explained by the independent variables. According to the literature [60], the research hypothesis of this study has only low explanatory power. The significant F value of the regression model is 8.002, and the significant p value is < 0.01, rejecting the null hypothesis, indicating that this model has specific predictive ability. According to the results of stepwise multiple linear regression analysis, the results of the hypothesis testing of this study are determined to be H1: Perceived Usefulness positively affects Behavioral Intention in the use of Toys for the Elderly; H4: Community influence positively affects Behavioral Intention in the use of Toys for the Elderly; and H7: Behavioral Intention positively affects Behavioral Intention in the use of Toys for the Elderly. Integrated technology acceptance model revision and verification results Since the research dimensions of the experimental hypothesis are insufficient to explain the lack of depth, it is impossible to explore the acceptance patterns of older adults towards Toys for the Elderly. Therefore, exploratory factor analysis was used to re-test the elements of the model dimensions. KMO (Kaiser-Meyer-Olkin) test and Bartlett's Test of Sphericity were used statistically to determine whether the sample data was suitable for factor analysis and to ensure the credibility of the analysis results. The KMO value was 0.807 > 0.7, and the data P value < .05, which was significant, indicating that factor analysis was suitable for facet item screening and correlation matrix analysis. The questionnaire items in this study were designed based on the variable facets in the literature. Using exploratory factor analysis, nine factors were extracted, cumulatively explaining 76.23% of the total variance, indicating that the extracted facets fully represented the factor. The cross-loading items were eliminated by rotating the factor matrix, namely PU3, SP1, SP2, and BI2. Through factor analysis, the model facet items were changed to Perceived Ease of Use, which includes all items of PEOU 1–5; Function promotion consists of all items of FP 1–5; Social promotion includes SP3-SP5 and PE2 and PE3 items; Behavioral Intention includes BI1, BI4-BI7 items; Perceived Usefulness includes PU1, PU2, and PU4; Stereotype consists of all original items, Social influence includes all original items, Behavioral Intention includes UB1, UB3, and UB4; Perceived Enjoyment includes PE1. The reliability of the overall questionnaire in this study, Cronbach’s α value, was 0.860, which is greater than 0.7, indicating that the overall questionnaire results were highly reliable [ 55 ]. Except for the low reliability level of social influence (0.696), the reliability of other dimensions: Perceived Ease of Use (0.892), Function promotion (0.876), Social promotion (0.903), Behavioral Intention (0.821), Behavioral Intention (0.781), Perceived Usefulness (0.832), Stereotype (0.911) show that the reliability of each variable dimension of this questionnaire is high. The Composite Reliability (CR) values sed to assess the consistency of the questionnaire items in this study were Perceived Ease of Use (0.900), Function promotion (0.868), Social promotion (0.838), Behavioral Intention (0.866), Behavioral Intention (0.860), Perceived Usefulness (0.779), Stereotype (0.935), and Community Influence (0.831). The CR values of each questionnaire item were all greater than 0.6, indicating a high degree of consistency within each questionnaire item. Convergent validity was used to test the correlation between the items of each dimension. The average explained variance (AVE) of the test values of this questionnaire was Perceived Ease of Use (0.644), Function promotion (0.572), Social promotion (0.513), Behavioral Intention (0.564), Behavioral Intention (0.674), Perceived Usefulness (0.541), Stereotype (0.878), and Community Influence (0.711). The AVE values of the above items were all greater than 0.5, showing a convergent effect, indicating that the dimension sample has a convergent effect and is sufficient to explain the dimension content. For the facets sorted out by factor analysis, the two groups of elders were divided into normal cognition and mild impairment, and stepwise multiple regression analysis was used to modify and verify the acceptance model. First, the modified acceptance model of cognitively normal elderly people was used with "behavioral intention" as the dependent variable, and perceived ease of use, behavioral intention, function promotion, social promotion, perceived usefulness, perceived enjoyment, stereotype, and community influence as independent variables. Stepwise linear regression was performed, and it was found that the effects of "social promotion" and "behavioral intention" on "behavior" were significant. Then, by taking "Behavioral Intention" as the dependent variable, we can obtain that "Perceived Usefulness" has a significant effect on "Behavioral Intention"; by taking "Perceived Usefulness" as the dependent variable, we can obtain that "Social promotion", "Function promotion", and "Perceived Enjoyment" have a significant effect on "Perceived Usefulness"; by taking "Perceived Ease of Use" as the dependent variable, we can obtain that "Social promotion" and "Perceived Enjoyment" have a significant effect on "Perceived Ease of Use", and the higher the degree of Social promotion, the higher the degree of Perceived Ease of Use; the higher the degree of Perceived Enjoyment, the lower the Perceived Ease of Use (β = -0.195); by taking "Function promotion" as the dependent variable, we can obtain that "Social promotion" and "Perceived Usefulness" have a significant effect on "Function promotion"; by taking "Social Taking "Perceived Usefulness", "Perceived Ease of Use" and "Function promotion" as the dependent variable, we can obtain that "Perceived Usefulness", "Perceived Ease of Use" and "Function promotion" have significant effects on "Social promotion". Taking "Perceived Enjoyment" as the dependent variable, we can obtain that "Perceived Usefulness" and "Perceived Ease of Use" have significant effects on "Perceived Enjoyment". The higher the degree of Perceived Usefulness, the higher the degree of Perceived Enjoyment; the higher the degree of Perceived Ease of Use, the lower the degree of Perceived Enjoyment (β = -0.197), as shown in the model in Figure F2(a). The integrated acceptance model analysis of cognitively normal elderly people showed that "social influence" and "Stereotype" did not influence all dimensions. "Behavioral Intention" is more affected by "Perceived Enjoyment" than "Social Promotion". “Behavioral Intention” is influenced by “Perceived Usefulness”. The factors that influence “Social promotion” are “Perceived Ease of Use”, “Perceived Usefulness”, and “Function promotion”; however, “Social promotion” influences “Perceived Ease of Use”, “Perceived Usefulness”, and “Function promotion” to a greater extent. The higher the "Perceived Usefulness" level, the higher the Perceived Enjoyment. “Perceived Usefulness” affects “Perceived Enjoyment”, “Function promotion”, and “Social promotion”, while “Function promotion” affects “Perceived Usefulness” and “Social promotion”. The model shows that the behavioral intention of older adults is significantly affected by social promotion and perceived enjoyment. This is because older adults with normal cognition can focus on interacting and sharing with others in the group, promote social interaction to expand their circle of friends, enhance relationships, and want to play again and again to enjoy the fun. Therefore, in social interaction, people are happy to perceive enjoyment and clearly show behavioral intention to use. In terms of “Perceived Enjoyment”, the higher the level of “Perceived Ease of Use” (β = -0.197), the lower the level of Perceived Enjoyment. This is consistent with the fact that the higher the level of Perceived Enjoyment, the lower the Perceived Ease of Use (β = -0.195). This is because the easier it is to use a toy to complete a game, the less likely it is to increase perceived enjoyment. In other words, cognitively normal older adults will feel proud and satisfied after participating in a challenging game. The modified MCI acceptance model for older adults takes "Behavioral Intention" as the dependent variable, and Perceived Ease of Use, Behavioral Intention, Function promotion, Social promotion, Perceived Usefulness, Perceived Enjoyment, Stereotype, and community influence as independent variables. Stepwise linear regression is performed, and it is found that the effect of "Perceived Enjoyment" on "Behavioral Intention" is significant. Then, step by step, taking "Perceived Usefulness" as the dependent variable, we can obtain that the influence of "Social promotion" on "Perceived Usefulness" is significant; taking "Function promotion" as the dependent variable, we can obtain that the influence of "Social promotion" and "Perceived Usefulness" on "Function promotion" is significant; taking "Social promotion" as the dependent variable, we can obtain that the influence of "Perceived Usefulness" on "Social promotion" is substantial; taking "Community influence" as the dependent variable, we can obtain that the influence of "Function promotion" on "Community influence" is significant; taking "Stereotype" as the dependent variable, we can obtain that the influence of "Community influence" on "Stereotype" is substantial, as shown in Figure F(b). The results of the integrated MCI elder acceptance model analysis showed that "Behavioral Intention", "Perceived Ease of Use," and "Perceived Enjoyment" did not influence all dimensions. "Behavioral Intention" is only affected by "Social promotion". In addition to affecting Behavioral Intention, "Social promotion" also involves "Function promotion" and "Perceived Usefulness", and affects "Perceived Usefulness" on a mutual basis. The main factor of social influence is "Function promotion", which has a greater influence than the influence of social influence on Function promotion. In addition, the higher the "social influence" is, the more it can offset the negative impact of stereotype (β = -0.433). This is because the elderly need to enrich their lives. In addition to increasing the fun of life and relieving loneliness[58], the MCI elderly, in particular, develop peer communication and mutual assistance through social influence, find fun and comfort in social activities, promote older adults's self-cognition, and gradually change the negative impact of the original stereotype of toys. Figure 2 Integrated technology acceptance model of toys for elders with different cognitive levels Insert here Figure 2 shows that in the acceptance model of Toys for the Elderly, the factors such as perceived usefulness and perceived ease of use do not influence behavioral intention, thereby generating user behavioral intention. From the effect of facet variables, we can understand that "social promotion" is the main factor in older adults's acceptance of Toys for the Elderly, and the lower the cognitive ability of older adults (such as MCI elderly), the greater the influence of "social promotion" on behavioral intention. In the cognitively normal elderly model, higher Perceived Ease of Use reduces user experience (Perceived Enjoyment). However, Perceived Ease of Use has a positive impact on social promotion. Therefore, when designing Toys for the Elderly, the balance between "ease of use" and "sociality" must be considered. As for the four types of toys for the elderly experiment mentioned above, since the acceptance model of cognitively normal elderly people will reduce their enjoyment of toys with low challenges, we can infer that cognitively normal elderly people should prefer "educational strategy" and "technological games" with higher cognitive loads as the types of toys that this group prefers. In the MCI acceptance model, Perceived Ease of Use and Perceived Enjoyment are not within the scope of influence for this group. Compared with the cognitively normal group, "community influence" has a greater impact on MCI elders. The influence of social media can effectively reduce the "stereotype" influence of toys on MCI elderly people. Therefore, the model can infer that the toys that MCI elderly people prefer should be educational strategy toys that focus on "social promotion" and "social influence". Discussion Older adults in each session of this research experiment maintained and promoted their cognitive abilities by playing with toys with different cognitive function promotion functions, ranging from simple games with a single function to games with complex rules and longer duration. To understand whether the cognitive abilities of the elderly show differences before and after the experiment, the MoCA cognitive ability pre-test and post-test were conducted before and after the experiment. The Comparison of Cognitive Function Observations showed that before the toy game experiment, there were 22 people in the MCI mild cognitive impairment group, with an average MoCA score of 22.14 points. After the game, there were only 10 elders in the MCI group, with an average MoCA score of 22.80 points. As for the elders in the cognitively normal group, the initial test count was 107 people. Even with the addition of 12 elders with cognitive improvements, the average score increased from the original 27.96 to 28.03 points, which also showed that the cognitive post-test scores of the original cognitively normal group elders also improved. The distribution of the number of pre- and post-tests of MoCA scores can provide a clearer understanding of the cognitive score progress of the participating elders. The original minimum score of the MoCA pre-test was 18 points, and by the cognitive post-test, the minimum score increased to 19 points, indicating that even for elders with poor cognitive abilities, the high-density toy and game play and learning activity courses can indeed promote cognitive abilities. This is consistent with the statistical results mentioned above that the number of years of education and learning does affect the cognitive abilities of the elders. By encouraging the elders to actively participate in toy and game activities to maintain or enhance their cognitive abilities, it can promote their exercise, brain activity and interaction, thereby delaying and preventing dementia in the elders. This shows that providing the elders with appropriate Toys for the Elderly has a positive impact on promoting cognitive abilities through entertainment. We conducted a frequency statistical percentage analysis based on the four question groups of game preference, perceived enjoyment, family sharing, and social sharing of the above four toys, and obtained a comparison of toy preferences of the elderly with different cognitive abilities (Fig. 3 ). We learned that "educational strategy toys" are the toys most preferred by the elderly. They require players to focus on lower cognitive abilities such as number comparison, arrangement and calculation. In addition, the elderly may have the highest preference due to factors such as the activation of cooperation and competition in social interaction. "Cognitive coordination toys" are the experimental toys with the lowest preference among the elderly. This type of toy requires higher cognitive abilities. The elderly may have deteriorating cognition and vision, and it takes more effort to match colors, resulting in the lowest preference. The next most preferred is technological game toys. Although there is a greater motivation for interaction and competition, the difficulty of completing the game is more difficult than puzzle strategy, so the preference ranks second. The reason why elderly people with normal cognition prefer toys over those with MCI is that the toys they use to complete the game are more difficult but give them a greater sense of achievement, which is consistent with the UTAUT model for this group of people. Cognition requires thinking rather than random reflex actions. It needs to be combined with basic visual, auditory and other perceptual abilities to make cognitive thinking and judgments. However, the deterioration of hearing and vision in the elderly increases the difficulty of cognition, especially for MCI elderly people, which leads to a lower willingness to prefer. Figure 3 . Comparison of toy preferences among elders with different cognitive abilities Insert here In the integrated technology acceptance model for cognitively normal elderly people constructed above, it can be seen that in terms of influencing "Behavioral Intention", the cognitively normal group focuses more on "Perceived Enjoyment" than "Social promotion", which means that for this group, whether Toys for the Elderly are fun is the primary consideration for this group. Whether the perceived enjoyment can be improved, "Perceived Ease of Use" and "Perceived Usefulness" play completely different key roles. Perceived Usefulness can improve the degree of perceived enjoyment, but Perceived Ease of Use will reduce the experience. Therefore, the model predicts that "Puzzle Strategy and Technology Game Toys" with higher cognitive load are the types that this group prefers more. This result is consistent with the toy preference comparison chart F3. On the other hand, in the MCI elder acceptance model, “social promotion” and “community influence” are important components of influencing factors. Social promotion not only affects "Behavioral Intention", but also affects "Function promotion" and "Perceived Usefulness", and there is a two-way influence relationship between social promotion and perceived Usefulness. In the model, although MCI elders themselves have no internal or external factors to induce Behavioral Intention towards toys, they can activate their brains through "social interaction" and "community influence" during group participation, significantly offsetting the negative impact of "Stereotype". Elders do not reject toys and follow group activities, and the sense of accomplishment generated can positively affect the Behavioral Intention performance of using toys. Therefore, the model infers that "educational strategy toys" are the type that this group prefers more. This prediction is consistent with the preference comparison results obtained in Fig. 3 from the actual toy game experience. Toys for the elderly cognitive function assessment form and toys for the elderly transformation design elements assessment application Due to the different cognitive abilities of the elderly, they have different acceptance models for play. Therefore, the design of Toys for the Elderly should be closely related to the cognitive abilities of the elderly. Judging from the cognitive ability scores of the elderly, it is speculated that the elderly with normal cognition (27.96 points) should have a high acceptance of "technology games, puzzle strategy" games; the elderly with MCI (23.14) should have a higher acceptance of "puzzle strategy" games. By integrating literature research data, it is inferred that the design of Toys for the Elderly should be adjusted according to the cognitive ability and cognitive decline stage of the elderly to adapt to the cognitive decline problems caused by aging. Based on the cognitive milestones of early childhood development[ 25 ], the correspondence between cognitive abilities of the DSM-5 Cognitive Impairment Monitoring Item[ 59 ] and the stages of brain degeneration, and the Montreal Cognitive Assessment Scale[ 29 ], etc., the literature on cognitive degeneration manifestations and cognitive construction and degeneration was considered as a whole. The "Toys for the Elderly Cognitive Function Assessment Form" was created by deleting duplicate assessment items and consolidating the results as shown in Table 2. Table 2 Toys for the Elderly cognitive function assessment form Insert here We used this evaluation form to evaluate and score the cognitive load of the four experimental toys in Toys for the Elderly. The statistical results showed that the "sensory movement" toys scored 10 points, the "cognitive coordination" toys scored 13 points, the "puzzle strategy" toys scored 23 points, and the "technological game" toys scored 27 points. The ranking of the scores shows that the results predicted by this evaluation form are consistent with the toy preference comparison results of the toy game experiment. From the proportion of preferred categories in Toys for the Elderly in Fig. 3 , we can see that the elderly with normal cognition have a more balanced preference for toy types, but have a higher preference for "technical games" and "strategy puzzles". The preference of the elderly with MCI is more concentrated on "strategy puzzle" toys, and the preference for other categories is low. This also shows that there is a clear correspondence between the Toys for the Elderly cognitive function assessment form and cognitive ability. We used this Toys for the Elderly cognitive function assessment form, referred to the toy design standards defined in the toy recommendation guidelines [38], the Toys for the Elderly design standards [ 42 ], and combined with toy game experimental observations, to construct the "Toys for the Elderly Design Elements Guidelines" as shown in Table 3 . It includes 13 factors to be considered, including the size of parts, easy identification, interlocking or loose parts, cause and effect, sensory elements, realism, classic games, smart machines, education, sensory skill requirements, reaction time, game time, and game rules. Table 3 Design Elements of Senior-Friendly Toys Design Guidelines Design Elements Design Details Large Parts and Fonts Part Size Richards et al. (2020). Senior-Friendly Toy Standards Two-handed grip size, One-handed grip size、Toddler grip size, Preschooler-friendly operation size, Large parts Easy to Recognize Senior-Friendly Toy Standards Observation Results Large fonts Content should be readable from different angles Enhancing Cognition and Social Interaction Interlocking or Loose Parts Richards et al. (2020) Puzzles, Musical Instrument components, Hooks, Cards, etc. Cause and Effect Richards et al. (2020). Cognitive Function Assessment for Senior-Friendly Toys Real-time input and feedback. Increase stimulation Sensory Elements Richards et al. (2020). Cognitive Function Assessment for Senior-Friendly Toys Visual, Auditory, Tactile Realistic Experience Richards et al. (2020) Screen games, Virtual reality (VR), Augmented reality (AR), Realistic toys Classic Games Richards et al. (2020). Traditional games, such as Ball games Smart Technology Richards et al. (2020). Cognitive function assessment for senior-friendly toys Cognitive or physical interactive smart toys and software Educational Richards et al. (2020). Cognitive function assessment for senior-friendly toys Promotes Understanding of Educational Goals such as Colors, Letters, Numbers, Counting, Ordinal Numbers, Shapes, Comparison, and Directionality Promote Hand Dexterity Button Pressing, Squeezing, Gross Motor Skills, Fine Motor Skills, Hand-Eye Coordination, Balancing, Kicking, Catching, Throwing Reaction Time Richards et al. (2020). Cognitive function assessment for senior-friendly toys Reaction Time should be flexible or extended. A reaction time that is too short significantly reduces the willingness of seniors with MCI to play again. Game Duration (Observation Results) Instruction Time: Under 4 minutes Game Round Duration: 20–30 minutes Game Rules (Observation Results) Game Design Rules: Comparing sizes, accumulating points, scoring by throwing, clicking, or territory control—choose at most two rule combinations. Too many game rules increase difficulty and reduce the willingness of seniors to play again. Table 3 Evaluation criteria for design elements of Toys for the Elderly Insert here This study evaluated the compliance of the above four elderly experimental toys with the design criteria elements in Table 3 in sequence, and the results were generally consistent. According to feedback from some elders, in terms of the size of parts, the design of cognitive coordination toys and technology games is considered to be too small, so such parts need to be enlarged; in terms of easy-to-identify design elements, the elders all responded that it is difficult to identify puzzle strategy and technology games, so the recognition needs to be enhanced in terms of color contrast and digital fonts; in terms of reaction time, the sensory motor game time is too fast, with each round lasting less than one minute, and the technology game time is too long (45 minutes), which also received negative feedback from the elders, so it is necessary to consider providing flexibility and autonomy in reaction time for the elders with different cognitive abilities and the game time should be moderate to avoid the elders with insufficient physical fitness; in terms of game rules, the elders reported that sensory motor games only tested eye-hand coordination and had a single game function, while the laws of technology games were complicated and the scoring rules were relatively complicated. Therefore, the controls and game rules of Toys for the Elderly should be of moderate difficulty. If the toys are too simple and monotonous, the elderly will lose interest in playing with them again. The rules of the toy games should also be avoided from being too complicated. This is because older adults are subject to physical or psychological limitations, which makes them less willing to learn and use new toy games. Therefore, Toys for the Elderly can use the design criteria to evaluate older adults with different cognitive abilities, and then make detailed design adjustments to enhance older adults’s acceptance and usage of Toys for the Elderly. Based on the above results, we understand the different acceptance patterns of Toys for the Elderly among elderly people with different cognitions, and use the "Toys for the Elderly Cognitive Load Assessment Table" we created to estimate the cognitive load value (i.e., challenge) of Toys for the Elderly. Combined with cognitive tests, it can be provided to nursing homes, silver hair clubs, day care centers, community care centers and other related units and places, so that the elderly, especially those with MCI, can obtain more appropriate Toys for the Elderly usage options, promote cognitive function to prevent and delay dementia, and improve the quality of life and health of the elderly. When applied to the design and development of Toys for the Elderly, the characteristics of elderly groups with different cognitive abilities must be considered. Referring to the Toys for the Elderly design guidelines of this study, toy manufacturers can make corresponding innovative conversion designs for older adults to enhance their acceptance of Toys for the Elderly and the effectiveness of their use. Conclusion Children play with toys to explore, develop, and train their cognitive abilities. In contrast, the elderly, whose cognitive skills have matured and who are trapped by aging and degeneration, actively seek ways to maintain their cognitive health. Therefore, the initial purpose of playing with toys is different. This study is the first to combine behavioral intention science and industrial design assessment tools to establish an integrated technology acceptance model with "cognitive ability" as the core, exploring the differences in toy use between elderly people with normal cognition and mild cognitive impairment. It can be found that MCI older adults play with toys to make friends, while cognitively normal older adults play with toys because of perceived enjoyment. Compared with cognitive promotion, "social promotion" is more critical and direct in affecting the behavioral intention of older adults; it even directly impacts behavioral intention among older adults in the MCI group. Based on the research results, the "Toys for the Elderly Cognitive Function Assessment Form" was created, and further practical suggestions for transforming toy design elements were put forward. The theoretical contribution of this study is to confirm that the constructed UTAUT model can effectively predict the behavioral intention of toy use among cognitively normal and MCI elderly people; the creation of an evaluation form fills the integration gap between "cognitive training" and "design specifications", provides a systematic path from evaluation to design, and promotes industry standardization. In terms of practical implications for industrial applications, the "Toys for the Elderly Cognitive Function Assessment Form" was established to provide practical application value in the field of elderly care with different cognitive abilities; combined with the Toys for the Elderly design guidelines, the toy industry is supplied with a reference for innovative design and application of children's toy design conversion Toys for the Elderly based on the actual needs of older adults. Declarations Statement of Ethics This study protocol was reviewed and approved by the Research Ethics Committee, Tatung University. Written informed consent was obtained from all the participants prior to any testing in accordance with the Declaration of Helsinki. Conflict of Interest Statement The authors have no conflicts of interest to declare. Funding Sources This study was financially supported by the National Science and Technology Council of Taiwan (NSTC 113-2410-H-036-002-MY3). 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Definition of an older person. Proposed working definition of an older person in Africa for the MDS Project. ; (2001). https://doi.org/10.13140/2.1.5188.9286 Jackson, R. The global retirement crisis. Geneva Papers on Risk and Insurance. Issues Pract. 486–511. https://doi.org/10.1111/1468-0440.00187 (2002). Kowal, P. & Dowd, J. E. Definition of an older person. Proposed working definition of an older person in Africa for the MDS Project. World Health Organization, Geneva, ; https://doi.org/10(2.1), (2001). 5188.9286 Cooper, J., Lewis, R. & Urquhart, C. Using participant or non- participant observation to explain information behaviour. Information Research, 2004; 9(4): 9 – 4. (2004). Joshi, A., Kale, S., Chandel, S. & Pal, D. K. Likert scale: Explored and explained. Br. J. Appl. Sci. Technol. 7 (4), 396–403. https://doi.org/10.9734/BJAST/2015/14975 (2015). Venkatesh, V., Thong, J. Y. & Xu, X. Consumer acceptance and use of information technology: extending the unified theory of acceptance and use of technology. MIS Q. 36 , 157–178. http:s://doi.org/10.2307/41410412 (2012). Hall, L, Paracha, S, Flint, T, MacFarlane, K, Stewart, F, Hagan-Green, G, Watson,D. Still looking for new ways to play and learn… Expert perspectives and expectations for interactive toys. International Journal of Child-Computer Interaction. 2022; 31, 100361. https://doi.org/10.1016/j.ijcci.2021.100361. Brubaker, T. H. & Powers, E. A. The stereotype of old—a review and alternative approach. J. Gerontol. 31 (4), 441–447. https://doi.org/10.1093/geronj/31.4.441 (1976). Spencer, S., Logel, C. & Davies, P. G. Stereotype threat. Ann. Rev. Psychol. 67 , 415–437. https://doi.org/10.1146/annurev-psych-073115-103235 (2016). Sayago, S. et al. Digital games and older adults from a theoretical and conceptual perspective: a critical literature review. Ageing and Digital Technology: Designing and Evaluating Emerging Technologies for Older Adults, ; 83–96. (2019). https://doi.org/10.1007/978-981-13-3693-5_6 Wright, B. & Panchapakesan, N. A procedure for sample-free item analysis. Educ. Psychol. Meas. 29 (1), 23–48. https://doi.org/10.1177/001316446902900102 (1969). Sedgwick, P. Pearson’s correlation coefficient. BMJ. ; 345. (2012). https://doi.org/https://doi.org/10.1136/bmj.e4483 Hair, J. F., Ringle, C. M. & Sarstedt, M. PLS-SEM: Indeed a silver bullet. J. Mark. Theory Pract. 19 (2), 139–152 (2011). Tavakol, M. & Dennick, R. Making sense of Cronbach's alpha. Int. J. Med. Educ. 2 , 53. https://doi.org/10.5116/ijme.4dfb.8dfd (2011). Fornell, C. & Larcker, D. F. Structural equation models with unobservable variables and measurement error: Algebra and statistics (In: Sage Publications Sage CA, 1981). Chen, Y. F. & Janicki, S. A cognitive-based board game with augmented reality for older adults: development and usability study. JMIR Serious Games . 8 , e22007. https://doi.org/10.2196/22007 (2020). Sachdev, P. S. et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat. Reviews Neurol. 10 (11), 634–642. https://doi.org/10.1038/nrneurol.2014.181 (2014). Song, Y., Yang, Y. & Cheng, P. The investigation of adoption of voice-user interface (VUI) in smart home systems among Chinese older adults. Sensors, 2022; 22(4): 1614. (2022). https://doi.org/10.3390/s22041614 Table 2 Table 2 is not available with this version. Table 2 Toys for the Elderly cognitive function assessment form Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 29 Nov, 2025 Reviews received at journal 23 Oct, 2025 Reviewers agreed at journal 16 Oct, 2025 Reviewers invited by journal 16 Oct, 2025 Editor invited by journal 03 Jun, 2025 Editor assigned by journal 28 May, 2025 Submission checks completed at journal 23 May, 2025 First submitted to journal 23 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6712672","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":535002201,"identity":"cb3362c5-c1e2-44be-bf33-12b0359854d5","order_by":0,"name":"Chih-Fu Wu","email":"","orcid":"","institution":"Tatung University","correspondingAuthor":false,"prefix":"","firstName":"Chih-Fu","middleName":"","lastName":"Wu","suffix":""},{"id":535002202,"identity":"07c9dfc1-21d8-4b2a-b4c3-0d6a2e70f733","order_by":1,"name":"Hsi-Nao Tsai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACAwYGxgcMDBIyQHYCEDMTo4WZGahNggehhY2wFjYJIM0D5ROhxVy6/1jVjRoLHgb+A88kGCqsExvkewzwarGcc5jtds4xoMMkEtIkGM6kJzaw8eDXYnAjGaiFDaSFIU2Cse0wUAvvBoJainP+SYAcBtTyj0gtzLltoBADOoyxgTgtxtK5fRI8bBIJyRYJx9KN29jyPxDQkvjwc863Ojl+/jOJNz7UWMv2Mx9LwKsFDtgYeBLAkUkoWpAB+wESFI+CUTAKRsFIAgCjiTsDhWDD8QAAAABJRU5ErkJggg==","orcid":"","institution":"Tatung University","correspondingAuthor":true,"prefix":"","firstName":"Hsi-Nao","middleName":"","lastName":"Tsai","suffix":""},{"id":535002203,"identity":"6010f929-f367-4a4a-ae21-61417d8d6f8b","order_by":2,"name":"Hsiang-Ju Chen","email":"","orcid":"","institution":"Lunghwa University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Hsiang-Ju","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-05-21 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07:08:24","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":172119,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6712672/v1/f6ab59c6a612fe9f3546ccde.html"},{"id":94731362,"identity":"188ea283-63dc-49a6-9050-63034dcca352","added_by":"auto","created_at":"2025-10-30 07:08:24","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":143044,"visible":true,"origin":"","legend":"\u003cp\u003eOlder adults’s UTAUT hypothesis framework for toys\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6712672/v1/6f8f076d462bc408f34d4e6c.jpeg"},{"id":94731365,"identity":"838a64a8-c0d6-473e-aba5-59a23df28292","added_by":"auto","created_at":"2025-10-30 07:08:26","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":169303,"visible":true,"origin":"","legend":"\u003cp\u003eIntegrated technology acceptance model of toys for elders with different cognitive levels\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6712672/v1/0c533b48e3d51022fe64b66c.jpeg"},{"id":94731358,"identity":"4ff65c71-060a-4965-b007-a7bc9669afb8","added_by":"auto","created_at":"2025-10-30 07:08:21","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":52974,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of toy preferences among elders with different cognitive abilities\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6712672/v1/2e974f4b75ad680b38adfc0f.jpeg"},{"id":94827184,"identity":"2660abf2-f366-4d1d-93f6-ba0cfc1ecbd1","added_by":"auto","created_at":"2025-10-31 06:55:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1327850,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6712672/v1/1e9de14e-d057-46ba-a551-9d54a5a39793.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Study of Toy Acceptance among Older Adults with Normal Cognition and Mild Cognitive Impairment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAs the global population ages, the demand for entertainment, social interaction, and cognitive stimulation among older adults is also increasing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. WHO estimates that by 2050, one in five people will be over 60 years old, and the number of people over 80 will double [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As older adults age, their physical functions and cognitive systems deteriorate normally. However, the decline and damage of cognitive functions hinder the ability of the elderly to independently carry out daily life, increase their dependence on others, and cause frustration, leading to cognitive impairment and dementia care issues for older adults around the world. Toys are used as intervention tools in cognitive health care and social health. However, most of the toys on the market are children's products, and are also used by older adults, government long-term care institutions, and community care centers. There is a lack of toys designed specifically for the needs of older adults. At this stage, the toys used by Older Adults are directly selected from children's toys. However, children's toys cannot necessarily be directly used as toys for Older Adults because the needs and abilities of the two should be completely different. Perhaps some children's toys may be specially designed or suitable for older adults in some aspects. Therefore, this study hopes to explore the acceptance of toys by older adults with normal cognition and mild cognitive impairment, and how to select more appropriate toys and develop design assessment applications according to the needs and behavioral intentions of older adults, to more effectively promote the cognitive function of older adults and improve their quality of life.\u003c/p\u003e\u003cp\u003eBased on the above literature, few studies compare the differences in behavioral intention between older adults with normal cognition and mild cognitive impairment in toy use and systematically explore the comprehensive impact of multiple independent variables on the behavioral intention of the elderly. Toys and games can promote cognition, but most of the existing toys are aimed at the children's market and lack consideration for the unique needs of older adults. The needs of older adults in terms of toys, games, and entertainment are different from those of children. It is necessary to consider the toy preferences and suitability of older adults with different cognitive abilities to ensure that the toys can provide older adults with appropriate challenges and fun. However, the influencing factors that mainly prompt older adults to start accepting toys cannot be obtained from the literature. Therefore, this study uses experimental research to explore the specific acceptance situations of the elderly playing with toys. The aim is to gain a deeper understanding of older adults’s behavioral intention in accepting and using toys, so that older adults with different cognitive abilities can make more appropriate choices for the use of toys and provide practical applications in the care field. Use the evaluation to design toys suitable for different cognitive states to promote mental function and social interaction, improve the elderly's acceptance of toys, prevent and delay dementia, and improve their quality of life.\u003c/p\u003e\u003cp\u003eLiteratures review\u003c/p\u003e\n\u003ch3\u003eNeeds and cognitive function of older adults\u003c/h3\u003e\n\u003cp\u003eOld age is a mid- to late-stage of the life cycle [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and the common status changes that people face include physical decline [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], changes in psychological and cognitive levels [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and changes in social roles [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The aging of the elderly’s physical functions includes: visual and auditory deterioration, decreased vision and hearing impairment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]; muscle degeneration [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. People in their 60s begin to experience coordination problems and vision deterioration, making it difficult to perform delicate tasks such as threading a needle [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Due to social decline, the inability to define their roles, the need to fill their free time [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and the fact that they no longer bear the economic responsibilities of the family, older adults are facing the situation of transforming their lifestyle and social roles from being the economic breadwinner of the family to a \"rollerless\" social status [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This role change has created a strong need for older adults to strengthen emotional connections to confirm their role in life [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and to establish new social circles to increase the fun of life and relieve loneliness [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA theory of human motivation proposed by Maslow [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] is the source of the social psychology demand factor, which divides demand into high-level and low-level needs. Therefore, this study refers to Maslow's [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] need motivation theory and divides the primary needs faced by older adults into two major demand dimensions: \"Function Promotion\" derived from low-level Deficiency needs, D-needs, and \"Social Promotion\" derived from high-level Being needs, B-needs [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. “Function Promotion” demand factors include increasing movement and speaking [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], training eye-hand-brain coordination[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], strengthening sense of orientation and enhancing language expression [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], training memory and improving concentration [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]; “Social Promotion” demand factors include strengthening emotional connections [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and establishing new social circles[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]).\u003c/p\u003e\u003cp\u003eCognitive function generally includes four aspects: sensory motor, cognitive development, language communication, and social emotion [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Overall, there is a considerable overlap with the aforementioned needs of older adults. Therefore, this study defines the needs of older adults as the need to promote cognitive function. The decline in cognitive ability is an essential factor affecting the quality of life of older adults [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In general, 1–2% of the elderly population will develop dementia each year. Mild Cognitive Impairment (MCI) is in the clinical gray area between \"normal cognition\" and \"dementia\" [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], with a 10–15% chance of suffering from Alzheimer's disease (AD) or other dementias. Therefore, maintaining or improving cognitive ability can promote exercise, thinking, and interaction in the elderly, thereby delaying and preventing dementia.\u003c/p\u003e\u003cp\u003eThe detection of MCI can be considered a precursor to dementia [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Nasreddine et al. and other scholars [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] developed the Montreal Cognitive Assessment, or MoCA for short. The scale includes delayed memory, visual-spatial, executive function, abstract concepts, attention, language ability, and sense of orientation. The total score is 30. A score greater than 26 indicates normal cognitive ability. Taking into account the influence of education, 1 point is added to the score for subjects with ≤ 12 years of education. Later studies have shown that the MoCA has a higher sensitivity than the MMSE scale in identifying MCI and AD patients [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Since the development of the MoCA scale, alternative versions of the test questionnaire have also been developed to adapt to different countries and regions and test needs. To avoid the memory effect of the subjects, this study used the alternative version of the MoCA test questionnaire as a test questionnaire for cognitive ability before and after the toy game experiment [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eCognitive function and toy\u003c/h2\u003e\u003cp\u003eCognitive ability is composed of multifaceted and interrelated skills [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Jean Piaget [34], through studying the intellectual development of children, divided cognitive skills into the Sensorimotor Stage, Preoperational Stage, Concrete Operational Stage, and Formal Operational Stage according to age. Children's cognitive abilities are accumulated gradually. Each stage accumulates previous abilities, which continue into school-age education to form a complete cognitive system. From Jean Piaget’s child development theory[34] and Berk’s research on child development stages [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e], we have developed four stages of early childhood development milestones, namely sensorimotor, cognitive development, language communication, and social-emotional [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Both research on children’s cognitive development and cognitive degeneration [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] focus on the entire stage of cognitive development, so toys are almost always designed for children. Except for children's toys, which are systematically planned, the toy market for other age groups has no systematic classification or definition. The Consumer Product Safety Commission (CPSC) classifies toys based on children's cognitive abilities, age, and behavioral intentions. It publishes Age Determination Guidelines [38], which divides games into eight categories and proposes 14 items for Product Characteristics. In Taiwan, the national standard CNS 4797 Safety Toy Specifications classifies toys into 29 categories based on their functions, appearance, and game scenarios.\u003c/p\u003e\u003cp\u003eThe level of happiness that the elderly experience when playing games is significantly higher than their level of joy in daily life [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The Fat Brain Toys website asked its customers about their toys and then launched a recommended toy menu for older adults over 65 years old[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Toys for the Elderly has become a development trend in current toy design. As a tool to promote social interaction, Toys for the Elderly can help older adults interact with family, friends, or other community members, increase social connections, and encourage emotional connections [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Toys for the Elderly, as a special type of toy, have unique designs and functions. They can help older adults maintain their cognitive abilities, improve their emotional state, increase social interactions, etc. [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. As one of the countries with a rapidly aging population, Taiwan Center of R\u0026amp;D and Testing for Commodities proposed the Toys for the Elderly certification standard in 2021[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. In addition to complying with the general safety toy testing standards [43] (CNS 4797), the design must meet four significant aspects: large fonts, large parts, promotion of cognition and interpersonal interaction, and promotion of manual dexterity. However, most toys on the market are currently designed for children, and the needs and characteristics of older adults are not fully considered. Therefore, it is necessary to research the behavioral intention of older adults towards toys to meet their needs for entertainment and social interaction and improve their quality of life and sense of happiness.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eIntegrated technology acceptance model and related application research\u003c/h3\u003e\n\u003cp\u003eVenkatesh et al. [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e44\u003c/span\u003e] proposed the Unified Theory of Acceptance and Use of Technology (UTAUT) based on the Technology Acceptance Model (TAM) used by Davis [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] to explain and predict people's adoption of new technologies or concepts and how to evaluate people's acceptance level. The model provides a more comprehensive understanding and prediction of behavioral intentions in technology adoption. UTAUT is an integration of eight theoretical models, including Theory of Reasoned Action (TRA), Technology Acceptance Model (TAM), Motivational Model (MM), Theory of Planning Behavior (TPB), Combined TAM and TPB (C-TAM-TPB), Model of PC Utilization (MPCU), Innovation Diffusion Theory (IDT) and Social Cognitive Theory, (SCT). It is widely used to explain and predict behavioral intentions in different fields of technology adoption.\u003c/p\u003e\u003cp\u003eThe dimension variables of the UTAUT model are: Performance Expectancy: the degree to which an individual feels that using the system is helpful, Effort Expectancy: the degree of effort an individual needs to put in using the system, Social Influence: the degree to which an individual feels the influence of the surrounding groups on themselves, such as social pressure or public image, Facilitating Conditions: the degree to which an individual feels that support and assistance can be obtained in terms of related technology, equipment, and resources, Behavioral Intention: the degree to which an individual is willing to accept and use the system, Behavioral: the specific behavioral intention of an individual to adopt a new system, Gender: the gender of the user, Age: the age of the user, Experience: the user's experience, Voluntariness of Use: the degree to which users actively use the new system. The independent variables are: Performance Expectancy, Effort Expectancy, Social Influence, Facilitating Conditions, the mediating variable is: Behavioral Intention, and the dependent variable is: Behavioral. In the integrated technology acceptance model, the user's objective conditions are taken into consideration, and four interfering variables are included: Gender, Age, Experience, and Voluntariness of Use.\u003c/p\u003e\u003cp\u003eThe UTAUT model can be flexibly expanded with other constructs to understand users' behavioral intentions toward technology adoption and use more comprehensively. The model has been widely used in research and practice to guide the design and implementation of technology interventions. The UTAUT model can be used to understand users' acceptance and use of artificial intelligence tools [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]; identify important personal and interpersonal factors that influence older adults' attitudes and intentions to use gerontology [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]; apply the UTAUT model to explain students' acceptance of higher education early warning systems [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]; investigate how consumers evaluate two types of recommendation systems in the context of e-commerce [48]; and study the intention of older users to accept wearable devices [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. This shows that when designing technologies or products for older adults, the UTAUT model can effectively help understand the factors that affect their acceptance. It can serve as the theoretical basis for this study to understand older adults's acceptance of toys. The UTAUT model provides a framework for understanding elders’ acceptance of novelty.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe collected and summarized literature background data, constructed an integrated acceptance hypothesis model of toys for older adults and a cognitive function assessment form for Toys for the Elderly, screened experimental toys for the elderly and formulated experimental courses for game experience workshops, implemented questionnaire tests before and after the experiment, analyzed data using SPSS statistical software, explored the attitudes and behavioral intentions of the elderly with different cognitive abilities towards toys, conducted experiments and model modification verification, and evaluated the design elements of children's toy conversion Toys for the Elderly. “All methods were carried out in accordance with relevant guidelines and regulations. The experimental protocol was approved by the Research Ethics Committee of National Taiwan University, approval number 202405ES102. Informed consent was obtained from all subjects and/or their legal guardians prior to participation.\u003c/p\u003e\u003ch3\u003eStudy scope and limitations\u003c/h3\u003e\u003cp\u003eThe United Nations (UN) defines older adults as people aged 60 and above[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]; retirement is also an indicative basis for identifying old age [51]; 65 years old is widely accepted as the starting age of old age and is also the standard age used by governments in most countries when formulating retirement and social welfare policies [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Therefore, our target group of subjects is retired older adults who can take care of themselves. The experimental content has no regional or language differences. We hope that the results of this study are applicable to Taiwan but can also be applied to the replication of experiments in other countries and regions. This study held 10 experimental toy and game experience workshops for older adults (hereinafter referred to as \"toy and game experiments\") and invited the elderly who had participated in the Elderly Health Function Promotion Course to participate in the toy and game experiments. Before the experiment, the content and purpose of the experiment were fully introduced to all subjects, and the subjects agreed to use the experimental results they provided. The questionnaire data were divided into data of older adults with normal cognition (MoCA ≥ 26) and data of older adults with MCI (mild cognitive impairment) (MoCA ≤ 25) according to the MoCA cognitive test scores of the participants before the experiment. The valid data were identified as questionnaire data of retired older adults. Since the subjects in the experiment often know in advance that they will be observed, they usually show behavioral intentions that are different from the norm. To understand the objective authenticity of the research purpose, the participant observation method [53] was adopted. The researcher personally joined the group to be studied, recorded and analyzed the participation of older adults in the elderly experimental toys, understood the behavioral intention dimension of the group to be explored, and then explained his research findings and understood the problems faced by the elderly in using toys, as well as the factors that affect older adults’s demand for toys.\u003c/p\u003e\u003ch3\u003eSelection of experimental toys for the elderly\u003c/h3\u003e\u003cp\u003eThe elders interviewed in the pre-test questionnaire of this study first surveyed the suitability of Toys for the Elderly based on the classification of children's toys discussed in the literature above, using a five-point Likert scale [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e54\u003c/span\u003e], with opinions ranging from \"strongly disagree\" to \"strongly agree\" and giving a rating of 1 to 5. We selected 12 categories of toys with an average number of toys chosen by the elders ≥ 3 as the basis for classifying toys in subsequent experiments.\u003c/p\u003e\u003cp\u003eBased on the previous literature comparing children's toys and Toys for the Elderly, it can be found that children's toys tend to be related to sensory motor and social learning for young children, while the types of toys that older adults think can become Toys for the Elderly tend to be related to social orientation, cognitive learning and function promotion. To understand the classification method of Toys for the Elderly, based on the 12 categories of toys selected by the elderly mentioned above, this study invited three experts from the Taiwanese toy industry, two social workers from elderly homes, one healthy retired elderly, and one elderly with Parkinson's disease to complete an expert questionnaire interview and conduct another toy category screening. We then used cluster analysis to identify four types of toys: (1) technology interactive games that require fine motor skills; (2) puzzle strategy games; (3) cognitive coordination games; and (4) perceptual games that require gross motor skills. We used these as experimental toys for older adults in subsequent toy game experiences and compared them with the questionnaire analysis.\u003c/p\u003e\u003ch3\u003eConstruction of the UTAUT hypothesis model framework\u003c/h3\u003e\u003cp\u003eSince toys span from traditional interfaces to technological interfaces, based on the needs of older adults discussed in the literature, the integrated technology acceptance model UTAUT was used to design a model hypothesis to explore the correspondence between toys and older adults, continuing the UTAUT integrated acceptance model. This study incorporates two additional constructs, \"perceived need\" and \"perceived enjoyment\", into UTAUT to consider older adults's acceptance of toys; \"function promotion\" and \"social promotion\" are used as demand elements of older adults's \"perceived neediness\" (PN); if it were not for the global population changes such as declining birthrates and aging, toys would always be exclusive to children [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Therefore, when it comes to the acceptance of toy products, older adults are generally influenced by stereotypes: humans have specific preconceived notions about particular people, things, and objects [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], as well as challenges from past experiences and the strange looks of the surrounding society [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Regarding the stereotype of older adults towards toys, the “Stereotype” dimension was added to the social influence, and the “Perceived Ease of Use” (PEOU) and “Perceived Usefulness” (PU) of the TAM model were used to replace the performance expectations and effort expectations. Because Toys for the Elderly is still in its infancy and most toys on the market are children's toys, few people have experience using Toys for the Elderly. Therefore, this study omitted the three structures of UTAUT: convenience, experience, and voluntary use. In addition, because this study focused on the impact of the cognitive ability of older adults on toys, it discarded the moderating factors of gender and age. It used \"cognitive ability\" as the model observation value. The hypothetical model framework of UTAUT proposed in this study is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Older adults’s UTAUT hypothesis framework for toys\u003c/p\u003e\u003cp\u003einsert here\u003c/p\u003e\u003ch2\u003eDefining and measuring research variables\u003c/h2\u003e\u003cp\u003eThe toy acceptance questionnaire in this study is divided into five categories, including basic information of the subjects, cognitive ability (MoCA) pre-test and post-test, main variables, toy usage attitude, and purchase status. Among them, Perceived Usefulness (PU), Perceived Ease of Use (PEOU), perceived need (PN): including Function promotion (FP) and Social promotion (SP), community influence (SI), Stereotype (ST), and Perceived Enjoyment (PE) are independent variables; Behavioral Intention is the relay variable; Behavioral Intention is the dependent variable; and cognitive ability is the observed value for model analysis. The operational definitions, measurements, and reference sources of the main variables are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The Likert five-point scale was used for the questionnaire survey[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e54\u003c/span\u003e], with opinions ranging from \"strongly disagree\" to \"strongly agree\" and rated from 1 to 5.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVariable Definitions and Questionnaire Scales for Senior Toy Acceptance\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDefinition\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eID\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c2\" namest=\"c1\" rowspan=\"4\"\u003e\u003cp\u003ePerceived Usefulness \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(Davis, 1993)\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eThe degree to which an individual believes that using the system will enhance their effectiveness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePU 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI feel that playing with this toy can promote physical activity.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePU 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI feel that playing with this toy can increase coordination.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePU3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI feel that playing with this toy can promote cognitive ability.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePU 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI feel that playing with this toy can increase expressive ability.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c2\" namest=\"c1\" rowspan=\"5\"\u003e\u003cp\u003ePerceived Ease of Use\u003c/p\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(Davis, 1993)\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eThe degree to which an individual believes using the system will be effort-free.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePEOU 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePlaying with this toy is easy for me\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePEOU 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAfter hearing the rules of the game, I understood how to play.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePEOU 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOnly after playing did I understand how to play.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePEOU 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI feel that this toy is easy to operate.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePEOU 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI feel that this toy is easy to get started with.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e\u003cp\u003ePerceived Need\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eFunction Promotion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eWhether the system has the practicality of promoting cognitive function.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFP 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDo you feel the need to promote increased physical activity and the amount of speaking?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFP 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDo you feel the need to promote coordination ability?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFP 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDo you feel the need to strengthen your memory?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFP 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDo you feel the need to promote concentration and calculation skills?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFP 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDo you feel the need to increase opportunities for verbal expression?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eSocial Promotion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eThe system becomes \u003c/p\u003e\u003cp\u003eA tool for individuals\u003c/p\u003e \u003cp\u003eto increase social interaction, develop social skills, and satisfy the need to interact with others.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSP 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDo you feel the need to strengthen relationships with family and friends?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSP 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDo you feel the need to expand your social circle?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSP 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI feel that playing with this toy can promote family relationships.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSP 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI feel that playing with this toy can promote social interaction.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSP 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI feel that playing with this toy can pass the time.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eSocial Influence\u003c/p\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(Venkatesh et al., 2003)\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eExternal factors are what most people believe an individual should engage in the behavior.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSI 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMy peers play with it, so I play with it too.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSI 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThe community / senior learning courses use it so that I will play with it.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eStereotype\u003c/p\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(Spencer et al., 2016)\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAn individual's preconceived notion about a specific thing.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eST 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eToys are for children, so I do not play with them.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eST 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIt is strange for seniors to play with toys, so I do not play with them.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003ePerceived Enjoyment\u003c/p\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(Heerink et al., 2010)\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAn individual's experience of enjoying the system.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePE 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI do not answer the phone or deal with other things when playing with this toy.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePE 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWhen playing with this toy, time always passes quickly.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePE 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThis toy makes me want to play with it again and again.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"6\" nameend=\"c2\" namest=\"c1\" rowspan=\"7\"\u003e\u003cp\u003eBehavioral Intention\u003c/p\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(Davis, 1993)\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eInternal and external factors reflect an individual's behavior.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBI 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI will buy a toy because it is easy to operate.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBI 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI will buy a toy because it is challenging.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBI 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI will buy a toy because it looks fun.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBI 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI will buy a toy because my friends play with it.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBI 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI will buy a toy because it promotes health.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBI 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI will buy a toy because it enhances relationships with relatives and friends.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBI 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI will buy a toy because it can help me make new friends.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c2\" namest=\"c1\" rowspan=\"4\"\u003e\u003cp\u003eBehavior\u003c/p\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(Davis, 1993)\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eThe higher the intention, the higher the individual's usage.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUB 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI want to purchase perceptual-motor toys.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUB 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI want to purchase cognitive-coordination toys.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUB 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI want to purchase educational strategy toys.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUB 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI want to purchase technology game toys.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: Definition of variables and questionnaire scales of Toys for the Elderly acceptance\u003c/p\u003e\u003cp\u003eInsert here\u003c/p\u003e\u003ch3\u003eHypothesis and verification of the integrated technology acceptance model of toys among the elderly\u003c/h3\u003e\u003cp\u003eThe integrative technology acceptance model hypothesis of this study is: (1) The impact of perceived usefulness on behavioral intention: the subject's perceived usefulness of a toy will positively affect their intention to use the toy; that is, the higher the perceived usefulness, the stronger the intention to use the toy. H1: Perceived Usefulness (PU) positively affects Behavioral Intention (BI) of toy use; (2) The impact of Perceived Ease of Use on Behavioral Intention: The Perceived Ease of Use of a toy will positively affect the user's Behavioral Intention, that is, the higher the ease of use, the stronger the intention to use. H2: Perceived Ease of Use (PEOU) positively affects Behavioral Intention (BI) of toy use; (3) The impact of perceived need on behavioral intention: The user's perceived need for a toy will positively affect their intention to use the toy, that is, the higher the perceived need, the stronger the intention to use the toy; perceived need consists of two parts: Function Promotion (FP) and Social Promotion (SP), so the higher the degree of Function promotion and Social promotion of the toy to the user, the stronger the intention to use the toy. H3: Perceived need (PN) positively affects behavioral intention (BI) of toy use, H3a: Function promotion (FP) positively affects behavioral intention (BI) of toy use, H3b: Social promotion (SP) positively affects behavioral intention (BI) of toy use; (4) The impact of community influence on behavioral intention: The influence of toys in the community will positively affect the behavioral intention of users, that is, the greater the community influence, the stronger the intention to use. H4: Social influence (SI) positively affects behavioral intention (BI) in toy use; (5) The impact of stereotype on behavioral intention: The user's stereotype of a toy will negatively affect his or her intention to use the toy, that is, the worse the stereotype, the weaker the intention to use the toy. H5: Stereotype (ST) negatively affects Behavioral Intention (BI) of toy usage; (6) The impact of perceived enjoyment on behavioral intention: The user's perceived enjoyment of a toy will positively affect his or her intention to use the toy, that is, the higher the perceived enjoyment, the stronger the intention to use the toy. H6: Perceived Enjoyment (PE) positively affects Behavioral Intention (BI) in toy use; (7) The impact of Behavioral Intention on Behavioral Intention: The user's Behavioral Intention for the toy will positively affect their actual Behavioral Intention, that is, the stronger the Behavioral Intention, the more frequent the actual use of the Behavioral Intention. H7: Behavioral Intention (BI) positively affects the usage of toys. In order to understand the acceptance pattern of toys among the elderly, this study used stepwise multiple linear regression analysis through the statistical analysis software SPSS to verify and analyze the model hypothesis, and deeply explored the subjects' intention to use toys and behavioral intentions, as a questionnaire analysis verification comparison and application discussion for subsequent toy game experiments.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eParticipant background analysis\u003c/h2\u003e\u003cp\u003eThe sample source of this study was voluntary participants in elderly activities. There were 139 participants, 129 valid questionnaires, and a response rate of approximately 92.8%. The average age of the experimental subjects was 69.57 years, including retired seniors aged 51\u0026ndash;86. Educational level ranges from elementary school to college/junior college, with an average of 14.19 years of education. Regarding retirement status, including those who have just retired and those who have been retired for 35 years, the average retirement years is 9.86 years. The results of the MoCA cognitive ability pre-test showed 107 older adults with normal cognition, with an average test score of 27.96 points; there were 22 older adults with mild cognitive impairment (MCI), with an average MoCA test score of 23.14 points. The MoCA cognitive test is scored by adding 1 to the score of those with less than 12 years of education, which shows the critical impact of years of education on cognitive ability. For older adults with junior high school education or below, the MCI group accounted for 22.7%, which is much higher than the 3.6% of the cognitively normal group, indicating that the number of years of education does affect the cognitive ability of older adults.\u003c/p\u003e\u003cp\u003eIn the background information of the subjects, the gender of the participants was higher in females (79.8%) than in males (20.2%). Regarding the deterioration of physical functions caused by aging, vision deterioration (65.9%) is more serious than hearing deterioration (38.0%) among older adults. The proportions of the MCI group, both in terms of vision (68.2%) and hearing (45.5%), were higher than those in the cognitively normal group, indicating that the functional deterioration of the MCI group was more serious. Notably, most older adults, whether cognitively healthy (65.4%) or MCI (68.2%), have deteriorating vision. Therefore, when converting the design of Toys for the Elderly, sufficient recognition (such as large fonts and large parts) must be provided.\u003c/p\u003e\u003cp\u003eRegarding Behavioral Intention in purchasing toys, the lowest proportion of older adults buy toys for themselves (9.3%), while 25.6% buy toys to play with their grandchildren. Most older adults (34.9%) have never purchased any toys. This shows that in the subsequent design of Toys for the Elderly, sufficient intergenerational parent-child interaction factors must be considered to meet and improve the needs and willingness of older adults to use toys.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eQuestionnaire analysis and hypothesis model verification results\u003c/h2\u003e\u003cp\u003eIn order to confirm the consistency of the items in the hypothesis model, the questionnaire items were first analyzed. Each item's critical ratio (CR value) was obtained through extreme group comparisons. To detect whether the questionnaire items were closely related to the total score of the scale, correlation analysis was used to test the internal consistency. Using Pearson correlation analysis, it was found that except for UB2, the CR value of the remaining items in the questionnaire of this study was \u0026lt;\u0026thinsp;3.0, and the CR value of the remaining items was greater than 3.0 [58]; and the total score correlation of the items was \u0026gt;\u0026thinsp;0.7, which was highly correlated [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Therefore, the invalid item UB2 was deleted, and the items used in the subsequent Behavioral Intention facet (UB) were UB1, UB3, and UB4.\u003c/p\u003e\u003cp\u003eThe reliability analysis of the questionnaire facets was determined using Cronbach\u0026rsquo;s α coefficient as follows: Perceived Usefulness (0.874), Perceived Ease of Use (0.912), Cognitive Promotion (0.876), Social Promotion (0.887), Community Influence (0.696), Stereotype (0.911), Perceived Enjoyment (0.658), Behavioral Intention (0.856), and Behavioral Intention (0.781). Except for function and social promotion, which were negatively correlated with Stereotypes, all other facets were positively correlated.\u003c/p\u003e\u003cp\u003eThis study used stepwise multiple linear regression analysis to verify the hypothesis model. The statistical analysis software SPSS found that among the independent variables, the variables with significant predictive power for Behavioral Intention were Perceived Usefulness and social influence. The T test determines whether each dimension is sufficient to explain the model hypothesis, and the R2 variation is used to estimate the model fit in the multiple regression analysis. The higher the R2 value, the higher the model fit. The R2 of the stepwise multiple linear regression of the hypothesis of this study is 0.113, indicating that only 11.3% of the total variance in the regression model can be explained by the independent variables. According to the literature [60], the research hypothesis of this study has only low explanatory power. The significant F value of the regression model is 8.002, and the significant p value is \u0026lt;\u0026thinsp;0.01, rejecting the null hypothesis, indicating that this model has specific predictive ability.\u003c/p\u003e\u003cp\u003eAccording to the results of stepwise multiple linear regression analysis, the results of the hypothesis testing of this study are determined to be H1: Perceived Usefulness positively affects Behavioral Intention in the use of Toys for the Elderly; H4: Community influence positively affects Behavioral Intention in the use of Toys for the Elderly; and H7: Behavioral Intention positively affects Behavioral Intention in the use of Toys for the Elderly.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eIntegrated technology acceptance model revision and verification results\u003c/h2\u003e\u003cp\u003eSince the research dimensions of the experimental hypothesis are insufficient to explain the lack of depth, it is impossible to explore the acceptance patterns of older adults towards Toys for the Elderly. Therefore, exploratory factor analysis was used to re-test the elements of the model dimensions. KMO (Kaiser-Meyer-Olkin) test and Bartlett's Test of Sphericity were used statistically to determine whether the sample data was suitable for factor analysis and to ensure the credibility of the analysis results. The KMO value was 0.807\u0026thinsp;\u0026gt;\u0026thinsp;0.7, and the data P value\u0026thinsp;\u0026lt;\u0026thinsp;.05, which was significant, indicating that factor analysis was suitable for facet item screening and correlation matrix analysis.\u003c/p\u003e\u003cp\u003eThe questionnaire items in this study were designed based on the variable facets in the literature. Using exploratory factor analysis, nine factors were extracted, cumulatively explaining 76.23% of the total variance, indicating that the extracted facets fully represented the factor. The cross-loading items were eliminated by rotating the factor matrix, namely PU3, SP1, SP2, and BI2. Through factor analysis, the model facet items were changed to Perceived Ease of Use, which includes all items of PEOU 1\u0026ndash;5; Function promotion consists of all items of FP 1\u0026ndash;5; Social promotion includes SP3-SP5 and PE2 and PE3 items; Behavioral Intention includes BI1, BI4-BI7 items; Perceived Usefulness includes PU1, PU2, and PU4; Stereotype consists of all original items, Social influence includes all original items, Behavioral Intention includes UB1, UB3, and UB4; Perceived Enjoyment includes PE1.\u003c/p\u003e\u003cp\u003eThe reliability of the overall questionnaire in this study, Cronbach\u0026rsquo;s α value, was 0.860, which is greater than 0.7, indicating that the overall questionnaire results were highly reliable [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Except for the low reliability level of social influence (0.696), the reliability of other dimensions: Perceived Ease of Use (0.892), Function promotion (0.876), Social promotion (0.903), Behavioral Intention (0.821), Behavioral Intention (0.781), Perceived Usefulness (0.832), Stereotype (0.911) show that the reliability of each variable dimension of this questionnaire is high. The Composite Reliability (CR) values sed to assess the consistency of the questionnaire items in this study were Perceived Ease of Use (0.900), Function promotion (0.868), Social promotion (0.838), Behavioral Intention (0.866), Behavioral Intention (0.860), Perceived Usefulness (0.779), Stereotype (0.935), and Community Influence (0.831). The CR values of each questionnaire item were all greater than 0.6, indicating a high degree of consistency within each questionnaire item.\u003c/p\u003e\u003cp\u003eConvergent validity was used to test the correlation between the items of each dimension. The average explained variance (AVE) of the test values of this questionnaire was Perceived Ease of Use (0.644), Function promotion (0.572), Social promotion (0.513), Behavioral Intention (0.564), Behavioral Intention (0.674), Perceived Usefulness (0.541), Stereotype (0.878), and Community Influence (0.711). The AVE values of the above items were all greater than 0.5, showing a convergent effect, indicating that the dimension sample has a convergent effect and is sufficient to explain the dimension content.\u003c/p\u003e\u003cp\u003eFor the facets sorted out by factor analysis, the two groups of elders were divided into normal cognition and mild impairment, and stepwise multiple regression analysis was used to modify and verify the acceptance model. First, the modified acceptance model of cognitively normal elderly people was used with \"behavioral intention\" as the dependent variable, and perceived ease of use, behavioral intention, function promotion, social promotion, perceived usefulness, perceived enjoyment, stereotype, and community influence as independent variables. Stepwise linear regression was performed, and it was found that the effects of \"social promotion\" and \"behavioral intention\" on \"behavior\" were significant. Then, by taking \"Behavioral Intention\" as the dependent variable, we can obtain that \"Perceived Usefulness\" has a significant effect on \"Behavioral Intention\"; by taking \"Perceived Usefulness\" as the dependent variable, we can obtain that \"Social promotion\", \"Function promotion\", and \"Perceived Enjoyment\" have a significant effect on \"Perceived Usefulness\"; by taking \"Perceived Ease of Use\" as the dependent variable, we can obtain that \"Social promotion\" and \"Perceived Enjoyment\" have a significant effect on \"Perceived Ease of Use\", and the higher the degree of Social promotion, the higher the degree of Perceived Ease of Use; the higher the degree of Perceived Enjoyment, the lower the Perceived Ease of Use (β = -0.195); by taking \"Function promotion\" as the dependent variable, we can obtain that \"Social promotion\" and \"Perceived Usefulness\" have a significant effect on \"Function promotion\"; by taking \"Social Taking \"Perceived Usefulness\", \"Perceived Ease of Use\" and \"Function promotion\" as the dependent variable, we can obtain that \"Perceived Usefulness\", \"Perceived Ease of Use\" and \"Function promotion\" have significant effects on \"Social promotion\". Taking \"Perceived Enjoyment\" as the dependent variable, we can obtain that \"Perceived Usefulness\" and \"Perceived Ease of Use\" have significant effects on \"Perceived Enjoyment\". The higher the degree of Perceived Usefulness, the higher the degree of Perceived Enjoyment; the higher the degree of Perceived Ease of Use, the lower the degree of Perceived Enjoyment (β = -0.197), as shown in the model in Figure F2(a).\u003c/p\u003e\u003cp\u003eThe integrated acceptance model analysis of cognitively normal elderly people showed that \"social influence\" and \"Stereotype\" did not influence all dimensions. \"Behavioral Intention\" is more affected by \"Perceived Enjoyment\" than \"Social Promotion\". \u0026ldquo;Behavioral Intention\u0026rdquo; is influenced by \u0026ldquo;Perceived Usefulness\u0026rdquo;. The factors that influence \u0026ldquo;Social promotion\u0026rdquo; are \u0026ldquo;Perceived Ease of Use\u0026rdquo;, \u0026ldquo;Perceived Usefulness\u0026rdquo;, and \u0026ldquo;Function promotion\u0026rdquo;; however, \u0026ldquo;Social promotion\u0026rdquo; influences \u0026ldquo;Perceived Ease of Use\u0026rdquo;, \u0026ldquo;Perceived Usefulness\u0026rdquo;, and \u0026ldquo;Function promotion\u0026rdquo; to a greater extent. The higher the \"Perceived Usefulness\" level, the higher the Perceived Enjoyment. \u0026ldquo;Perceived Usefulness\u0026rdquo; affects \u0026ldquo;Perceived Enjoyment\u0026rdquo;, \u0026ldquo;Function promotion\u0026rdquo;, and \u0026ldquo;Social promotion\u0026rdquo;, while \u0026ldquo;Function promotion\u0026rdquo; affects \u0026ldquo;Perceived Usefulness\u0026rdquo; and \u0026ldquo;Social promotion\u0026rdquo;. The model shows that the behavioral intention of older adults is significantly affected by social promotion and perceived enjoyment. This is because older adults with normal cognition can focus on interacting and sharing with others in the group, promote social interaction to expand their circle of friends, enhance relationships, and want to play again and again to enjoy the fun. Therefore, in social interaction, people are happy to perceive enjoyment and clearly show behavioral intention to use. In terms of \u0026ldquo;Perceived Enjoyment\u0026rdquo;, the higher the level of \u0026ldquo;Perceived Ease of Use\u0026rdquo; (β = -0.197), the lower the level of Perceived Enjoyment. This is consistent with the fact that the higher the level of Perceived Enjoyment, the lower the Perceived Ease of Use (β = -0.195). This is because the easier it is to use a toy to complete a game, the less likely it is to increase perceived enjoyment. In other words, cognitively normal older adults will feel proud and satisfied after participating in a challenging game.\u003c/p\u003e\u003cp\u003eThe modified MCI acceptance model for older adults takes \"Behavioral Intention\" as the dependent variable, and Perceived Ease of Use, Behavioral Intention, Function promotion, Social promotion, Perceived Usefulness, Perceived Enjoyment, Stereotype, and community influence as independent variables. Stepwise linear regression is performed, and it is found that the effect of \"Perceived Enjoyment\" on \"Behavioral Intention\" is significant. Then, step by step, taking \"Perceived Usefulness\" as the dependent variable, we can obtain that the influence of \"Social promotion\" on \"Perceived Usefulness\" is significant; taking \"Function promotion\" as the dependent variable, we can obtain that the influence of \"Social promotion\" and \"Perceived Usefulness\" on \"Function promotion\" is significant; taking \"Social promotion\" as the dependent variable, we can obtain that the influence of \"Perceived Usefulness\" on \"Social promotion\" is substantial; taking \"Community influence\" as the dependent variable, we can obtain that the influence of \"Function promotion\" on \"Community influence\" is significant; taking \"Stereotype\" as the dependent variable, we can obtain that the influence of \"Community influence\" on \"Stereotype\" is substantial, as shown in Figure F(b).\u003c/p\u003e\u003cp\u003eThe results of the integrated MCI elder acceptance model analysis showed that \"Behavioral Intention\", \"Perceived Ease of Use,\" and \"Perceived Enjoyment\" did not influence all dimensions. \"Behavioral Intention\" is only affected by \"Social promotion\". In addition to affecting Behavioral Intention, \"Social promotion\" also involves \"Function promotion\" and \"Perceived Usefulness\", and affects \"Perceived Usefulness\" on a mutual basis. The main factor of social influence is \"Function promotion\", which has a greater influence than the influence of social influence on Function promotion. In addition, the higher the \"social influence\" is, the more it can offset the negative impact of stereotype (β = -0.433). This is because the elderly need to enrich their lives. In addition to increasing the fun of life and relieving loneliness[58], the MCI elderly, in particular, develop peer communication and mutual assistance through social influence, find fun and comfort in social activities, promote older adults's self-cognition, and gradually change the negative impact of the original stereotype of toys.\u003c/p\u003e\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e Integrated technology acceptance model of toys for elders with different cognitive levels\u003c/p\u003e\u003cp\u003eInsert here\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that in the acceptance model of Toys for the Elderly, the factors such as perceived usefulness and perceived ease of use do not influence behavioral intention, thereby generating user behavioral intention. From the effect of facet variables, we can understand that \"social promotion\" is the main factor in older adults's acceptance of Toys for the Elderly, and the lower the cognitive ability of older adults (such as MCI elderly), the greater the influence of \"social promotion\" on behavioral intention. In the cognitively normal elderly model, higher Perceived Ease of Use reduces user experience (Perceived Enjoyment). However, Perceived Ease of Use has a positive impact on social promotion. Therefore, when designing Toys for the Elderly, the balance between \"ease of use\" and \"sociality\" must be considered. As for the four types of toys for the elderly experiment mentioned above, since the acceptance model of cognitively normal elderly people will reduce their enjoyment of toys with low challenges, we can infer that cognitively normal elderly people should prefer \"educational strategy\" and \"technological games\" with higher cognitive loads as the types of toys that this group prefers. In the MCI acceptance model, Perceived Ease of Use and Perceived Enjoyment are not within the scope of influence for this group. Compared with the cognitively normal group, \"community influence\" has a greater impact on MCI elders. The influence of social media can effectively reduce the \"stereotype\" influence of toys on MCI elderly people. Therefore, the model can infer that the toys that MCI elderly people prefer should be educational strategy toys that focus on \"social promotion\" and \"social influence\".\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOlder adults in each session of this research experiment maintained and promoted their cognitive abilities by playing with toys with different cognitive function promotion functions, ranging from simple games with a single function to games with complex rules and longer duration. To understand whether the cognitive abilities of the elderly show differences before and after the experiment, the MoCA cognitive ability pre-test and post-test were conducted before and after the experiment. The Comparison of Cognitive Function Observations showed that before the toy game experiment, there were 22 people in the MCI mild cognitive impairment group, with an average MoCA score of 22.14 points. After the game, there were only 10 elders in the MCI group, with an average MoCA score of 22.80 points. As for the elders in the cognitively normal group, the initial test count was 107 people. Even with the addition of 12 elders with cognitive improvements, the average score increased from the original 27.96 to 28.03 points, which also showed that the cognitive post-test scores of the original cognitively normal group elders also improved. The distribution of the number of pre- and post-tests of MoCA scores can provide a clearer understanding of the cognitive score progress of the participating elders. The original minimum score of the MoCA pre-test was 18 points, and by the cognitive post-test, the minimum score increased to 19 points, indicating that even for elders with poor cognitive abilities, the high-density toy and game play and learning activity courses can indeed promote cognitive abilities. This is consistent with the statistical results mentioned above that the number of years of education and learning does affect the cognitive abilities of the elders. By encouraging the elders to actively participate in toy and game activities to maintain or enhance their cognitive abilities, it can promote their exercise, brain activity and interaction, thereby delaying and preventing dementia in the elders. This shows that providing the elders with appropriate Toys for the Elderly has a positive impact on promoting cognitive abilities through entertainment.\u003c/p\u003e\u003cp\u003eWe conducted a frequency statistical percentage analysis based on the four question groups of game preference, perceived enjoyment, family sharing, and social sharing of the above four toys, and obtained a comparison of toy preferences of the elderly with different cognitive abilities (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). We learned that \"educational strategy toys\" are the toys most preferred by the elderly. They require players to focus on lower cognitive abilities such as number comparison, arrangement and calculation. In addition, the elderly may have the highest preference due to factors such as the activation of cooperation and competition in social interaction. \"Cognitive coordination toys\" are the experimental toys with the lowest preference among the elderly. This type of toy requires higher cognitive abilities. The elderly may have deteriorating cognition and vision, and it takes more effort to match colors, resulting in the lowest preference. The next most preferred is technological game toys. Although there is a greater motivation for interaction and competition, the difficulty of completing the game is more difficult than puzzle strategy, so the preference ranks second. The reason why elderly people with normal cognition prefer toys over those with MCI is that the toys they use to complete the game are more difficult but give them a greater sense of achievement, which is consistent with the UTAUT model for this group of people. Cognition requires thinking rather than random reflex actions. It needs to be combined with basic visual, auditory and other perceptual abilities to make cognitive thinking and judgments. However, the deterioration of hearing and vision in the elderly increases the difficulty of cognition, especially for MCI elderly people, which leads to a lower willingness to prefer.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Comparison of toy preferences among elders with different cognitive abilities\u003c/p\u003e\u003cp\u003eInsert here\u003c/p\u003e\u003cp\u003eIn the integrated technology acceptance model for cognitively normal elderly people constructed above, it can be seen that in terms of influencing \"Behavioral Intention\", the cognitively normal group focuses more on \"Perceived Enjoyment\" than \"Social promotion\", which means that for this group, whether Toys for the Elderly are fun is the primary consideration for this group. Whether the perceived enjoyment can be improved, \"Perceived Ease of Use\" and \"Perceived Usefulness\" play completely different key roles. Perceived Usefulness can improve the degree of perceived enjoyment, but Perceived Ease of Use will reduce the experience. Therefore, the model predicts that \"Puzzle Strategy and Technology Game Toys\" with higher cognitive load are the types that this group prefers more. This result is consistent with the toy preference comparison chart F3.\u003c/p\u003e\u003cp\u003eOn the other hand, in the MCI elder acceptance model, \u0026ldquo;social promotion\u0026rdquo; and \u0026ldquo;community influence\u0026rdquo; are important components of influencing factors. Social promotion not only affects \"Behavioral Intention\", but also affects \"Function promotion\" and \"Perceived Usefulness\", and there is a two-way influence relationship between social promotion and perceived Usefulness. In the model, although MCI elders themselves have no internal or external factors to induce Behavioral Intention towards toys, they can activate their brains through \"social interaction\" and \"community influence\" during group participation, significantly offsetting the negative impact of \"Stereotype\". Elders do not reject toys and follow group activities, and the sense of accomplishment generated can positively affect the Behavioral Intention performance of using toys. Therefore, the model infers that \"educational strategy toys\" are the type that this group prefers more. This prediction is consistent with the preference comparison results obtained in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e from the actual toy game experience.\u003c/p\u003e\u003cp\u003e\u003cem\u003eToys for the elderly cognitive function assessment form and toys for the elderly transformation design elements assessment application\u003c/em\u003e\u003c/p\u003e\u003cp\u003eDue to the different cognitive abilities of the elderly, they have different acceptance models for play. Therefore, the design of Toys for the Elderly should be closely related to the cognitive abilities of the elderly. Judging from the cognitive ability scores of the elderly, it is speculated that the elderly with normal cognition (27.96 points) should have a high acceptance of \"technology games, puzzle strategy\" games; the elderly with MCI (23.14) should have a higher acceptance of \"puzzle strategy\" games. By integrating literature research data, it is inferred that the design of Toys for the Elderly should be adjusted according to the cognitive ability and cognitive decline stage of the elderly to adapt to the cognitive decline problems caused by aging. Based on the cognitive milestones of early childhood development[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], the correspondence between cognitive abilities of the DSM-5 Cognitive Impairment Monitoring Item[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e] and the stages of brain degeneration, and the Montreal Cognitive Assessment Scale[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], etc., the literature on cognitive degeneration manifestations and cognitive construction and degeneration was considered as a whole. The \"Toys for the Elderly Cognitive Function Assessment Form\" was created by deleting duplicate assessment items and consolidating the results as shown in Table\u0026nbsp;2.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;2 Toys for the Elderly cognitive function assessment form\u003c/p\u003e\u003cp\u003eInsert here\u003c/p\u003e\u003cp\u003eWe used this evaluation form to evaluate and score the cognitive load of the four experimental toys in Toys for the Elderly. The statistical results showed that the \"sensory movement\" toys scored 10 points, the \"cognitive coordination\" toys scored 13 points, the \"puzzle strategy\" toys scored 23 points, and the \"technological game\" toys scored 27 points. The ranking of the scores shows that the results predicted by this evaluation form are consistent with the toy preference comparison results of the toy game experiment. From the proportion of preferred categories in Toys for the Elderly in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, we can see that the elderly with normal cognition have a more balanced preference for toy types, but have a higher preference for \"technical games\" and \"strategy puzzles\". The preference of the elderly with MCI is more concentrated on \"strategy puzzle\" toys, and the preference for other categories is low. This also shows that there is a clear correspondence between the Toys for the Elderly cognitive function assessment form and cognitive ability.\u003c/p\u003e\u003cp\u003eWe used this Toys for the Elderly cognitive function assessment form, referred to the toy design standards defined in the toy recommendation guidelines [38], the Toys for the Elderly design standards [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], and combined with toy game experimental observations, to construct the \"Toys for the Elderly Design Elements Guidelines\" as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e. It includes 13 factors to be considered, including the size of parts, easy identification, interlocking or loose parts, cause and effect, sensory elements, realism, classic games, smart machines, education, sensory skill requirements, reaction time, game time, and game rules.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDesign Elements of Senior-Friendly Toys\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDesign Guidelines\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDesign Elements\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesign Details\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLarge Parts and Fonts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePart Size\u003c/p\u003e\u003cp\u003eRichards et al. (2020).\u003c/p\u003e\u003cp\u003eSenior-Friendly Toy Standards\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTwo-handed grip size, One-handed grip size、Toddler grip size, Preschooler-friendly operation size, Large parts\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEasy to Recognize\u003c/p\u003e\u003cp\u003eSenior-Friendly Toy Standards Observation Results\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLarge fonts\u003c/p\u003e\u003cp\u003eContent should be readable from different angles\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eEnhancing Cognition and Social Interaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterlocking or Loose Parts\u003c/p\u003e\u003cp\u003eRichards et al. (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePuzzles, Musical Instrument components, Hooks, Cards, etc.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCause and Effect\u003c/p\u003e\u003cp\u003eRichards et al. (2020).\u003c/p\u003e\u003cp\u003eCognitive Function Assessment for Senior-Friendly Toys\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReal-time input and feedback.\u003c/p\u003e\u003cp\u003eIncrease stimulation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSensory Elements\u003c/p\u003e\u003cp\u003eRichards et al. (2020).\u003c/p\u003e\u003cp\u003eCognitive Function Assessment for Senior-Friendly Toys\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVisual, Auditory, Tactile\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRealistic Experience\u003c/p\u003e\u003cp\u003eRichards et al. (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScreen games, Virtual reality (VR), Augmented reality (AR), Realistic toys\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClassic Games\u003c/p\u003e\u003cp\u003eRichards et al. (2020).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTraditional games, such as Ball games\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSmart Technology\u003c/p\u003e\u003cp\u003eRichards et al. (2020).\u003c/p\u003e\u003cp\u003eCognitive function assessment for senior-friendly toys\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCognitive or physical interactive smart toys and software\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEducational\u003c/p\u003e\u003cp\u003eRichards et al. (2020).\u003c/p\u003e\u003cp\u003eCognitive function assessment for senior-friendly toys\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePromotes Understanding of Educational Goals such as Colors, Letters, Numbers, Counting, Ordinal Numbers, Shapes, Comparison, and Directionality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePromote Hand Dexterity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eButton Pressing, Squeezing, Gross Motor Skills, Fine Motor Skills, Hand-Eye Coordination, Balancing, Kicking, Catching, Throwing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReaction Time\u003c/p\u003e\u003cp\u003eRichards et al. (2020).\u003c/p\u003e\u003cp\u003eCognitive function assessment for senior-friendly toys\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReaction Time should be flexible or extended.\u003c/p\u003e\u003cp\u003eA reaction time that is too short significantly reduces the willingness of seniors with MCI to play again.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eGame Duration\u003c/p\u003e\u003cp\u003e(Observation Results)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInstruction Time: Under 4 minutes\u003c/p\u003e\u003cp\u003eGame Round Duration: 20\u0026ndash;30 minutes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eGame Rules\u003c/p\u003e\u003cp\u003e(Observation Results)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGame Design Rules: Comparing sizes, accumulating points, scoring by throwing, clicking, or territory control\u0026mdash;choose at most two rule combinations.\u003c/p\u003e\u003cp\u003eToo many game rules increase difficulty and reduce the willingness of seniors to play again.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e Evaluation criteria for design elements of Toys for the Elderly\u003c/p\u003e\u003cp\u003eInsert here\u003c/p\u003e\u003cp\u003eThis study evaluated the compliance of the above four elderly experimental toys with the design criteria elements in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e in sequence, and the results were generally consistent. According to feedback from some elders, in terms of the size of parts, the design of cognitive coordination toys and technology games is considered to be too small, so such parts need to be enlarged; in terms of easy-to-identify design elements, the elders all responded that it is difficult to identify puzzle strategy and technology games, so the recognition needs to be enhanced in terms of color contrast and digital fonts; in terms of reaction time, the sensory motor game time is too fast, with each round lasting less than one minute, and the technology game time is too long (45 minutes), which also received negative feedback from the elders, so it is necessary to consider providing flexibility and autonomy in reaction time for the elders with different cognitive abilities and the game time should be moderate to avoid the elders with insufficient physical fitness; in terms of game rules, the elders reported that sensory motor games only tested eye-hand coordination and had a single game function, while the laws of technology games were complicated and the scoring rules were relatively complicated. Therefore, the controls and game rules of Toys for the Elderly should be of moderate difficulty. If the toys are too simple and monotonous, the elderly will lose interest in playing with them again. The rules of the toy games should also be avoided from being too complicated. This is because older adults are subject to physical or psychological limitations, which makes them less willing to learn and use new toy games. Therefore, Toys for the Elderly can use the design criteria to evaluate older adults with different cognitive abilities, and then make detailed design adjustments to enhance older adults\u0026rsquo;s acceptance and usage of Toys for the Elderly.\u003c/p\u003e\u003cp\u003eBased on the above results, we understand the different acceptance patterns of Toys for the Elderly among elderly people with different cognitions, and use the \"Toys for the Elderly Cognitive Load Assessment Table\" we created to estimate the cognitive load value (i.e., challenge) of Toys for the Elderly. Combined with cognitive tests, it can be provided to nursing homes, silver hair clubs, day care centers, community care centers and other related units and places, so that the elderly, especially those with MCI, can obtain more appropriate Toys for the Elderly usage options, promote cognitive function to prevent and delay dementia, and improve the quality of life and health of the elderly. When applied to the design and development of Toys for the Elderly, the characteristics of elderly groups with different cognitive abilities must be considered. Referring to the Toys for the Elderly design guidelines of this study, toy manufacturers can make corresponding innovative conversion designs for older adults to enhance their acceptance of Toys for the Elderly and the effectiveness of their use.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eChildren play with toys to explore, develop, and train their cognitive abilities. In contrast, the elderly, whose cognitive skills have matured and who are trapped by aging and degeneration, actively seek ways to maintain their cognitive health. Therefore, the initial purpose of playing with toys is different. This study is the first to combine behavioral intention science and industrial design assessment tools to establish an integrated technology acceptance model with \"cognitive ability\" as the core, exploring the differences in toy use between elderly people with normal cognition and mild cognitive impairment. It can be found that MCI older adults play with toys to make friends, while cognitively normal older adults play with toys because of perceived enjoyment. Compared with cognitive promotion, \"social promotion\" is more critical and direct in affecting the behavioral intention of older adults; it even directly impacts behavioral intention among older adults in the MCI group. Based on the research results, the \"Toys for the Elderly Cognitive Function Assessment Form\" was created, and further practical suggestions for transforming toy design elements were put forward.\u003c/p\u003e\u003cp\u003eThe theoretical contribution of this study is to confirm that the constructed UTAUT model can effectively predict the behavioral intention of toy use among cognitively normal and MCI elderly people; the creation of an evaluation form fills the integration gap between \"cognitive training\" and \"design specifications\", provides a systematic path from evaluation to design, and promotes industry standardization. In terms of practical implications for industrial applications, the \"Toys for the Elderly Cognitive Function Assessment Form\" was established to provide practical application value in the field of elderly care with different cognitive abilities; combined with the Toys for the Elderly design guidelines, the toy industry is supplied with a reference for innovative design and application of children's toy design conversion Toys for the Elderly based on the actual needs of older adults.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eStatement of Ethics\u003c/h2\u003e\u003cp\u003eThis study protocol was reviewed and approved by the Research Ethics Committee, Tatung University. Written informed consent was obtained from all the participants prior to any testing in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003c/div\u003e\u003ch2\u003eConflict of Interest Statement\u003c/h2\u003e\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding Sources\u003c/h2\u003e\u003cp\u003eThis study was financially supported by the National Science and Technology Council of Taiwan (NSTC 113-2410-H-036-002-MY3). We sincerely appreciate their investment and support.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eChih-Fu Wu conceptualized and designed the study. Hsi-Nao Tsai assisted in interpreting the data and critically edited the manuscript. Hsiang-Ju Chen collected, analyzed the data, and wrote the first draft. 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(2022). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/s22041614\u003c/span\u003e\u003cspan address=\"10.3390/s22041614\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 2","content":"\u003cp\u003eTable 2 is not available with this version.\u003c/p\u003e\n\u003cp\u003eTable 2 Toys for the Elderly cognitive function assessment form\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"older adults, MCI, UTAUT, acceptability of toys, MoCA","lastPublishedDoi":"10.21203/rs.3.rs-6712672/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6712672/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eAs global aging accelerates, cognitive decline has become a critical issue in elderly care. Although toys are increasingly recognized as tools to enhance cognitive and social functions among older adults, most commercially available toys are designed for children, lacking consideration for the cognitive diversity of the elderly. This study investigates toy acceptance among older adults with normal cognition and mild cognitive impairment (MCI), aiming to develop an evidence-based model and assessment tools that inform senior-friendly toy design.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eDrawing from literature and theoretical frameworks such as the Unified Theory of Acceptance and Use of Technology (UTAUT), this study developed a modified UTAUT model incorporating additional constructs like perceived need and enjoyment. A mixed-methods approach was used, including cognitive screening with the Montreal Cognitive Assessment (MoCA), toy game experience workshops, participant observation, and pre- and post-experiment questionnaires. Toy categories were refined through expert interviews and cluster analysis. SPSS statistical tools were used for regression and factor analysis to validate the model and evaluate toy design elements.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eData from 129 valid participants (aged 51–86) revealed significant differences in toy acceptance between cognitively normal and MCI groups. Among cognitively normal elders, perceived enjoyment and social promotion were key drivers of toy usage. In contrast, for MCI participants, social promotion was the primary motivator, influenced strongly by community support. The revised model showed that the easier a toy was to use, the lower the perceived enjoyment, suggesting that cognitively normal elders preferred more challenging toys. The study also developed the \"Toys for the Elderly Cognitive Function Assessment Form\" and a corresponding set of design guidelines to evaluate and adapt children's toys for elderly users.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study demonstrates that cognitive ability significantly influences older adults’ toy acceptance patterns. Social promotion emerged as a dominant factor across cognitive groups, particularly for those with MCI. The revised UTAUT model effectively predicts behavioral intention and use of toys among older adults. The proposed assessment form and design guidelines offer practical value for eldercare professionals and the toy industry, bridging cognitive evaluation with product design to support healthy aging and dementia prevention.\u003c/p\u003e","manuscriptTitle":"The Study of Toy Acceptance among Older Adults with Normal Cognition and Mild Cognitive Impairment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-30 06:50:16","doi":"10.21203/rs.3.rs-6712672/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"56659878634569496045705620263173589708","date":"2025-11-29T19:38:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-23T07:05:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191479855833649698370109530647731526264","date":"2025-10-17T03:31:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-16T04:32:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-03T04:04:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-28T06:58:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-23T16:52:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-05-23T16:50:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f3a4b6e-b842-4292-8b43-755c3cf3786e","owner":[],"postedDate":"October 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":56880655,"name":"Health sciences/Health care"},{"id":56880656,"name":"Health sciences/Health occupations"}],"tags":[],"updatedAt":"2025-10-30T06:50:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-30 06:50:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6712672","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6712672","identity":"rs-6712672","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}