Promoting Mental Acuity in Elderly Populations Through Incentive for Technology Use

The proposed study, a 4-arm randomized control trial, tests three novel incentive systems
intended to promote the daily use of computer programs designed to improve memory and mental
acuity among residents of retirement communities. Three outcome measures will be used to
assess the effectiveness of the incentive programs: number of activities completed using the
software (primary outcome of interest), performance on the activities, and differences
between pre and post measures of mental acuity (using a standardized test of mental
functions). Incentives to use the software will be offered to individuals in the
experimental conditions for the first month of the 4 month study. After the initial month of
incentives, all individuals will have continued access to the software, however, no
incentives will be provided for use.

Incentives: Three incentive structures will be tested against one control group:

1. Control: Access to software programs, but no rewards for use.

2. Atomistic: Each individual is rewarded for his or her individual participation

3. Altruistic: Participants will be paired with an individual at a different retirement
community and will be rewarded according to the other individual's participation

4. Combination cooperative/competitive: Individuals will be paired in teams which will
compete against each other. Each team will be rewarded according to relative
participation, but members within a team will receive the same amount.

Pairs will be matched on gender, age, and education, and then pairs will be randomly
assigned to the different incentive conditions. Rewards in all incentive conditions will
range to a maximum of $5 per day, and will be awarded differently depending on the incentive
condition. Although participants will be informed of their winnings each day (to give
frequent positive reinforcement), they will be paid cumulated amounts once a month (to
reduce transactions costs and to ensure that actual payments are substantial). The number of
activities completed using the software (up to 10 daily, or approximately 30 minutes of use)
will be the basis for daily incentive payments to reward effort and avoid discouraging those
who are not highly skilled. Cognitive testing will be done with the NueroTrax Mindstreams
cognitive testing software.

Subjects: 400 participants will be recruited from local retirement communities which offer
computing services to their residents. Subjects will be between the ages of 55 and 85 and
will be required to sign informed consent forms before they are admitted to the study. Due
to our focus on a population facing cognitive declines, extra care will be taken to ensure
that all participants understand the information provided in the informed consent document.
We will not enroll potential participants who are not able to verbalize understanding of the
contents of the consent form. Participants will be trained in basic computer use and
operation of the software using the Carnegie Mellon University mobile research van (see
http://www.cmu.edu/news/archive/2007/June/june20_datatruck.shtml).

This pilot study will serve as the basis for a larger-scale study of financial incentives
for elderly individuals to engage in mentally challenging tasks that help them improve
cognitive function. In addition, this research will help us determine the relative
effectiveness of different types of incentive designs that could be used in further studies
of the use of financial incentives to encourage the elderly to engage in a variety of other
healthy behaviors.

Inclusion Criteria:

- Age between 55 and 85

- Resident in participating retirement community

Exclusion Criteria:

- Unstable medical conditions that would likely prevent the subject from completing
the study

- Severe depression

- Inability to read or severe cognitive deficits that would preclude ability to read
consent form or fill out surveys