Can Digital Games Help Seniors Improve their Quality of Life?

Abstract

Background

The population is aging globally. Older people living in long-term care facilities have many functional impairments, such as mobility problems and depression. Digital games and so-called exergames can offer a motivating and entertaining way to maintain older people’s physical activity and thus their ability to function. However, previous studies have reported conflicting results about the effects of digital gaming and have focused on community-dwelling older people.

Objective

To identify, critically appraise, and synthesize evidence about the effectiveness of digital games on older people’s physical, psychological, and social functioning and physical and social activity in long-term care facilities.

Methods

Five databases were systematically searched, and relevant studies were screened. Fifteen randomized-controlled trials and quasi-experimental studies (total N?=?674) were included in meta-analysis.

Results

All digital games used in interventions were exergames. Meta-analysis showed that exergame interventions have a statistically significant large effect on physical functioning [number of studies (N)?=?6, standardized mean difference (SMD)?=?0.97, p?=?0.001] measured by Timed Up and Go or Short Physical Performance Battery and self-assessed physical activity (N?=?3, SMD?=?1.20, p?<?0.001) and medium effect on social functioning (N?=?5, SMD?=?0.74, p?=?0.016) compared to alternative intervention or no intervention. Social activity was not measured in any study.

Conclusions

The results are encouraging that exergames effectively increase the functioning and activity of older adults living in long-term facilities. Successful implementation of such activities requires the competence of nursing staff and rehabilitation professionals in digitalization.

Keywords: Digital game, Older people, Functioning, Activity, Long-term care facility

Introduction

The population is aging globally, and the number of older people is estimated to more than double from 2020 to 2050, when 16% of the world’s population will be over 65?years old [1]. As the number of older people is growing, the number of people living in long-term care facilities is also increasing. Older people living in long-term care facilities are more likely to be functionally and cognitively impaired than their independent peers [2]. Living in long-term care facilities has been found to cause a decline in physical functioning [3], and it has also been found to result in experiencing symptoms of depression, loneliness, and social isolation in older people [2, 4].

The physical activity of older people is related to physical and psychological functioning and functional impairments [5, 6]. Exercise and even light physical activity have a positive effect on the physical functioning of older people and coping with activities of daily living (ADL) for older people living in assisted living facilities [7–9]. Physical activity has also been found to smooth out the worsening of depressive symptoms in care home residents [6]. Higher physical activity is also correlated with a higher quality of life of older people [10]. However, residents in long-term care environments have many barriers to physical activity, which can affect their motivation to exercise [11]. The fun, enjoyment, and sociability of training are big motivators for exercise among older people [12, 13], and digital games and exergaming enable these dimensions [14].

Digital games are games played on a digital device. A digital device can be, for example, a computer, a game console, a tablet computer, or a smartphone. According to previous reviews studying digital games, Nintendo Wii and Microsoft Kinect have been the most used gaming systems by older people [15]. Playing these kinds of active video games where the player uses one’s own body movement is often called exergaming [14]. Playing digital games that train balance, coordination, physical performance, and physical activity has been found to have a positive effect on the physical and psychological functioning of older people by reducing the experience of depression and improving balance. According to the previous studies, older people find digital games to be more motivating and entertaining than normal physical activities [16, 17]. Playing exergames is often social experience and it offers an opportunity for playfulness and social interaction [18]. This increased interaction with others during the play can decrease loneliness and strengthen social connection also among older people [18, 19]. Social isolation has been found to increase cognitive decline [20] and low cognitive skills hinder, among other things, older peoples’ coping with daily activities. There are already several systematic reviews about effects of exergaming on cognition of older adults that show the benefits of exergames having a positive influence on processing speed, working memory, and executive function [21].

Previous studies have also obtained conflicting results regarding the effects of digital gaming [22, 23]. The existing literature and earlier systematic reviews of digital gaming have focused on the home environment, and digital games have not been studied much in the long-term care environment [24]. More research is therefore needed on the effects of playing digital games on the functioning and activity of older people in long-term care.

The objective of this review was to identify, critically appraise, and synthesize evidence about the effectiveness of playing digital games on older people’s physical, psychological, and social functioning and physical and social activity in long-term care facilities. Two research questions were addressed:

1. What digital gaming interventions have been conducted for older people in long-term care facilities?
2. What is the effect of digital gaming versus usual care or conventional exercise on older people’s functioning and activity in long-term care facilities?

Methods

A systematic review and meta-analysis were conducted according to Joanna Briggs Institute guidelines [25]. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was applied for reporting the review [26]. The review was registered in PROSPERO (CRD42022307491). No protocol was published for this systematic review.

Search strategy

Data retrieval was carried out by an informant scientist. PubMed, Web of Science, CINAHL (EBSCO), Scopus, and Cochrane electronic databases were used to retrieve studies published up to November 2021. No publication period restrictions were made. Key Medical Subject Headings (MESH) terms and CINAHL headings were applied in the searches whenever possible. Search terms for research question one combined the following subject headings and keywords, formatted according to the requirements for each database: digital game, older people, and long-term care. Search terms for research question two combined the following subject headings and keywords, formatted according to the requirements for each database: digital game, older people, functioning, social activity, and physical activity. Synonyms were combined using the OR operator, and different search terms were combined using AND operator. NOT operator was used to exclude children and adolescents. The complete search terms for each database are presented in Appendix Table Table4.4. A manual search was conducted in the reference lists of the articles included. No new references were found by manual searches.

Article Original Link: https://shorturl.at/ltAFQ

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