Surprise Findings from Tower of Hanoi Research on Executive Cognitive Function in Older Adults: Assess, Intervene, or Both?

Friday, 3 August 2012: 10:15 AM

Whitney G. Mildren, RN, BSN1
Mary A. Cazzell, RN, PhD1
James D. Holland, MA2
(1)College of Nursing, University of Texas at Arlington, Arlington, TX
(2)Educational Psychology, Dallas Independent School District, Dallas, TX

Learning Objective 1: identify the importance of obtaining psychometric and item analysis data on the Tower of Hanoi for use in older adult populations.

Learning Objective 2: understand the contradictory Tower of Hanoi research findings between statistical results and participantsí responses as framed by the Scaffolding Theory of Aging and Cognition.

Purpose: The purpose was to determine feasibility, reliability, and item difficulty of the 22-task Tower of Hanoi (TOH), an executive cognitive function (ECF) puzzle game, in adults > 65 years. Neuroimaging research has documented prefrontal cortex (PFC) changes in aging: deficits in abstract thinking, problem solving, and loss of inhibitory control over irrelevant information. The 22-task TOH, a 4-disk transfer game across 3 vertical pegs, has never been administered to or scored on older adults nor has TOH psychometrics been established in this population.

 Methods: In this quantitative descriptive design, a convenience sample of 50 cognitively-intact independent-living older adults (> 65 years) completed 22 TOH tasks, 22 different start and end configurations. Eligibility included a pre-screening score of >26 score on the Montreal Cognitive Assessment. Rasch analysis was completed on: (1) item-difficulty estimation, (2) item characteristic curves, (3) item-and-person-fit statistics of predicted functioning, and (4) test information function on precision of TOH in differentiating ability levels. 22 tasks were scored for correct/incorrect, total moves, number of moves beyond minimal moves, and gender differences. Cronbach’s alpha was obtained for reliability.

 Results: All participants completed 22 tasks. Older adults demonstrated a lower ability to solve even the easiest tasks. Most TOH items were more difficult than the demonstrated problem-solving skills needed to achieve expected number of moves. TOH reliability alpha was 0.69. Approximately 21% of all 22-items were performed correctly/participant. Females completed significantly more correct items than males (p<0.001). All incorrect moves were analyzed and number of extra moves beyond correct solution ranged from 2.8 to 11.4.

 Conclusion: Despite TOH’s level of difficulty, participants reported increased self-confidence, improved perception of cognitive abilities, and greater motivation to further practice on TOH. This study introduces TOH as both a cognitive assessment tool and intervention. Interpretation of the results was guided by the Scaffolding Theory of Aging and Cognition.