UNO STACKO: A GAME TO INCREASE THE ELDERLY COGNITIVE FUNCTION - EURASIAN JOURNAL OF BIOSCIENCES
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EurAsian Journal of BioSciences
Eurasia J Biosci 14, 1703-1707 (2020)
Uno stacko: a game to increase the elderly cognitive
function
Eka Mishbahatul M. Has 1*, Muhammad Roziqin 1, Sylvia Dwi Wahyuni 1
1
Faculty of Nursing, Universitas Airlangga, Surabaya, INDONESIA
*Corresponding author: eka.m.has@fkp.unair.ac.id
Abstract
The elderly experience physical, mental, and social decline gradually, one of which is a decline in
cognitive function. Efforts to improve the cognitive function in the elderly can given by Uno Stacko
game intervention. This study aimed to determine the effect of the Uno Stacko game on improving
cognitive function in the elderly. This research used a quasy-experiment pre-post-test with a control
group design. The sampling technique used in this study is purposive sampling. The samples in this
study were 36 respondents who were divided into two groups; the treatment group (n=18) and the
control group (n=18). The independent variable was the uno stacko game. The dependent variable
was the cognitive function. The instrument in this study was the mini-mental state exam (MMSE)
questionnaire. The data were analyzed using paired t-test dan independent t-test (α=0.05). Data
analysis by paired T-test in the treatment group obtained p=0.000, which means there was an
increase in cognitive function before and after the intervention of the uno stacko game, while in the
control group p= 0.542, which means there was no change in cognitive function in the elderly.
Independent T-test statistical test results obtained p= 0.000. Namely, there was a significant
difference between the post-test of the treatment and the control group. The results of the study are
an influence of the uno stacko game on the improvement of cognitive function in the elderly. Uno
stacko game has powers that can stimulate aspects of cognitive function in the elderly. Nurses can
apply the game as a non-pharmacological alternative therapy to improve the cognitive function of the
elderly who live in nursing homes.
Keywords: cognitive function, elderly, game, MMSE, uno stacko
Has EMM, Roziqin M, Wahyuni SD (2020) Uno stacko: a game to increase the elderly cognitive
function. Eurasia J Biosci 14: 1703-1707.
© 2020 Has et al.
This is an open-access article distributed under the terms of the Creative Commons Attribution License.
INTRODUCTION improving cognitive function in the elderly still needs
more explanation.
The elderly are part of the process of growth and The growing proportion of the elderly also increases
development. Everyone will experience the process of the risk of cognitive decline in the elderly. Old aged 65
growing old, and being early is the period of one’s life years and over, around 15%-20%, will experience a
where someone will experience physical, mental, and decline in cognitive function (Defrancesco et al., 2009).
social decline gradually (Depkes, 2013; Zavidić and The growth of the elderly population in the world in 2010
Lovrinić, 2018; Prawesti et al., 2018; Mariani et al., is approximately 524 million people and predicted to
2019). These changes cause consequences, one of increase by about 1.5 billion people in 2050 (World
which is the decline in cognitive function (Kozier, 2015). Health Organization, 2011). The increased number of
Decreased cognitive function in the elderly can be life expectancy causes an increase of the elderly in
prevented through activities related to thought Indonesia, which has reached 20.24 million people,
processes (Tadjudin et al., 2018; Anto et al., 2019; equivalent to 8.03 percent of the entire population of
Rambe and Fitri, 2017). Many board games can Indonesia. The elderly population in Indonesia aged 60
increase cognitive stimulation, such as chess, uno years and over in 2013 reached 8.9% and is expected
stacko, and tic-tac-toe (Harada et al., 2013). One of the to increase in 20150 to 21.4% of the people in Indonesia
board games that can be used to stimulate the cognitive (Infodatin Kemenkes, 2016). The data of the elderly in
function of the elderly is the uno stacko game. The uno East Java province in 2016, age 65 years, and over
stacko game has several things that can boost the amounted to 4,640,440 people (Statistik, 2015). Data on
thought process of the elderly such as concentration,
calculation, and socialization with others (Caporusso et Received: July 2019
al., 2009). But, the effect of the Uno stacko game on Accepted: April 2020
Printed: June 2020
1703EurAsian Journal of BioSciences 14: 1703-1707 (2020) Has et al.
the people of the elderly in Surabaya in 2015 amounted Table 1. The distribution of respondents’ characteristics of
to 2,848,583 people, with the number of elderly aged 60 the treatment group and control group in Griya Werdha
years is up to 219,164 people (Surabaya, 2015). Surabaya
Variables Treatment Control
The results of a preliminary study conducted by Group group
researchers at Griya Werdha Surabaya shows that there n % n %
are 156 elderly. They consist of 67 men and 89 women. Age
60-65 years 3 16.7 2 11.1
From the results of the study, the researcher used a 66-70 years 3 16.7 6 33.3
mini-mental state exam (MMSE) questionnaire for ten ≥71 years 12 66.7 10 55.6
Total 18 100.0 18 100.0
elderly, seven older people who experienced cognitive Gender
impairment. A decrease in cognitive function includes a Female 12 66.7 12 66.7
reduction in the ability to concentrate, attention, and Male 6 33.3 6 33.3
Total 18 100.0 18 100.0
memory decline. Risk factors that cause a reduction of Marital status
cognitive function include increasing age, family history Widow/widower 18 100.0 18 100.0
of suffering from dementia, smoking, conditions that Total 18 100.0 18 100.0
Living Period in nursing home
increase the risk of cardiovascular disease, 0-5 years 18 100.0 18 100.0
environment, and mental health (Anto et al., 2019; Fitri Total 18 100.0 18 100.0
Education
and Rambe, 2018; Effendy et al., 2019; Miller, 2018; Elementary 5 27.8 6 33.3
Rilianto, 2015; Utari et al., 2018). The result of the Junior High 3 16.7 3 16.7
decline in cognitive function causes slower thought Senior High 7 38.9 7 38.9
Undergraduate 3 16.7 2 11.1
processes, a lack of ability to learn, and memory Total 18 100.0 18 100.0
disorders. Decreased cognitive function in the elderly Occupation before living in a nursing home
has a higher risk of developing dementia and Entrepreneur 2 11.1 5 27.8
Government employee 2 11.1 1 5.6
Alzheimer’s disease. Actions that can reduce the impact Housewife 9 50.0 8 44.4
of the severity of cognitive decline is to provide activities Others 5 27.8 4 22.2
Total 18 100.0 18 100.0
that increase cognitive stimulation, such as dancing and
playing game (Harada et al., 2013; Khanmurzina et al.,
2020; Miller, 2018; Yusuf et al., 2017; Yusuf et al., 2017). groups, namely the control group and the
One of the games that can stimulate one’s cognitive treatment/intervention group. The population in this
function is board games. Board games are also useful to study was the elderly who live in Griya Werdha
delay cognitive decline in the elderly and can also help Surabaya. The total sample in this study were 36 people
the elderly to socialize and interact with peers who had been divided into 18 intervention groups and
(Caporusso et al., 2009). The uno stacko game is one of 18 control groups. The independent variable in this study
the board games. Uno stacko game is a game of was the uno stacko game. The dependent variable in
arranging blocks to form a tower by taking blocks from this study was cognitive function. The research
the bottom or middle of the tower then placed to the top instrument for the independent variable was to use a unit
of the tower alternately between players without event activity (SAK). The research instrument for the
dropping the other blocks (Dartigues et al., 2013). dependent variable was to use a questionnaire. The
Most of the negative functional impacts (decreased questionnaire used to measure the dependent variable
ability to think, reduced concentration, often forgetting) in this study was a mini-mental state exam (MMSE).
that occur in the elderly can be overcome through The analysis of the data in this study used a paired t-
interventions that are directed to mitigate or modify the test (α=0.05) to determine differences in cognitive
effects of risk factors (Miller, 2018; Idrus et al., 2019). function before and after the uno stacko game
Nurses can support the well-being of the elderly through intervention and independent t-test (α=0.05) to
other cognitive function stimulation interventions such as determine differences in cognitive function between the
uno stacko game to overcome negative functional treatment and control groups. This research has
impacts. Nursing interventions cause positive practical received research ethics permit from the research ethics
effects (the welfare of the elderly), which enables the committee.
elderly to function at their highest level despite changes
in age and risk factors. This study aimed to determine RESULTS
the effect of the uno stacko game on improving the Table 1 shows the distribution according to the age
cognitive function of the elderly in nursing home Griya of the respondents that most of the age of respondents
Werdha Surabaya. were above 71 years in the treatment and control
groups, respectively 66.7% (12 people) and 55.6% (10
METHODS people). The gender of the respondents based on the
This research used quasy–experiment pretest- distribution of the data shows that most respondents in
posttest with group control design. This study has two the treatment and control group were women with a
1704EurAsian Journal of BioSciences 14: 1703-1707 (2020) Has et al.
Table 2. The distribution of cognitive function values in the and supported by risk factors (Miller, 2018). The
treatment and control group at Werdha in Surabaya decrease of cognitive function in the elderly is
Cognitive Function Score
Treatment Group Control Group
characterized by changes in memory in the brain as we
Pre Post Pre Post get older. Older people tend to have less memory ability
n 18 18 18 18 compared to younger people. As we get older, the brain
Min 13 17 14 14
Max 22 27 22 22 cells will be exhausted in carrying out brain functions,
Mean 18.61 22.50 18.56 18.44 including the speed of learning, the rate of processing
SD 2.704 2.956 2.281 2.406
new information, and the rate of reacting to simple or
Paired t test p = 0.000 α < 0.05 p = 0.542 α > 0.05
Independent t test post-test p = 0.000 α < 0.05 complex stimuli (Tadjudin et al., 018; Situmeang et al.,
2016; Handayani and Rachma, 2013; Wade et al., 2014;
prevalence of 66.7% (12 people). The delivery of Catani et al., 2013). Also, the decline in cognitive
respondents’ marital status in the treatment and control function in the elderly is characterized by decreased
group was 100% (10 people). The distribution of the visual, tactile, and orientation abilities such as personal,
length of stay in the nursing home in the treatment and time, and place (Catani et al., 2013; Ulfa and Nurjannah,
control group was mostly 0-5 years in the treatment 2013; Rolls, 2015).
group by 100% (20 people). The latest education of Uno stacko game has been proven to be effective in
respondents shows that the treatment and control group improving cognitive functions in the aspects of attention
were senior high school, with the same prevalence of and calculation. It is because the game can stimulate the
38.9% (7 people). Respondents’ occupations before work of the brain to avoid deterioration and forgetfulness
inhabiting the nursing home in the treatment and control (Kushariyadi, 2017; Putra, 2008; Nugroho, 2009;
group were mostly housewives with a prevalence of Lumbantobing, 2008). Uno stacko is classified into a
50.0% (9 people) in the treatment group and 44% (8 practical game, where continuous practice can improve
people) in the control group. the potential that existed, including enhancing the
Based on Table 2, the results of the Paired T-test on cognitive function of the elderly. Besides, this game can
the variable level of cognitive function in the pretest and also improve cognitive aspects of remembering.
post-test treatment groups indicate that in the treatment Everyone can respond to the stimulus provided by their
group, there are significant differences in the level of environment, such as the ability to recognize a small
cognitive function (p=0.000). Independent T-test shows amount of information in less than 30 seconds and be
that there are differences in the results of the cognitive able to rerelease it (Budson and Price, 2005). Memory
function level (p=0.000). It means that there are is an aspect that is influenced by the uno stacko game,
significant differences in the results of the post-test data this game stimulates the elderly to remember the rules
in the two groups (the treatment and control groups). of the game and the time contract of playing the game.
DISCUSSION CONCLUSION
Uno stacko game is proven to improve cognitive Based on research that has been done, there is an
function in the elderly. It is determined by the results of increase in cognitive function in the elderly after they are
the analysis showing that the group given the given the intervention of the uno stacko games. Uno
intervention experienced an increase in cognitive stacko games can improve cognitive functions
function compared to the control group who did not especially in aspects of memory. There were differences
experience an increase in cognitive abilities. Game in cognitive function between the treatment group and
intervention can improve cognitive function (Clemenson the control group after being given a game intervention.
and Stark, 2015). Functional consequences theory The Uno stacko game improves cognitive function in the
proposed by Miller in 2012 explains that the decline of treatment group while there is no significant change of
cognitive function in the elderly is a form of negative cognitive function score in the control group.
practical consequences caused by age-related changes
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