# From Adherence to Happiness: Co-designing with Frail Nursing Home Residents to Gamify Tech-based Intervention

## TL;DR

Researchers worked with elderly nursing home residents to create a fun VR game to improve their physical and mental health.

## Contribution

The study introduces a co-design approach to gamify VR interventions for frail older adults, emphasizing happiness and adherence.

## Key findings

- Gamification increased adherence to VR interventions from 14.56 to 23.76 minutes.
- Residents showed improved retention, with voluntary enrollment lasting several weeks.
- The intervention provided significant psychosocial benefits (p-value < 0.001).

## Abstract

Improving adherence to physio-cognitive interventions is crucial for mitigating frailty and dementia in older adults. Nursing home residents, often overlooked in both academic community and the marketplace, lack access to game-like experiences and report mental illness and poor adherence to interventions. To increase adherence, this article presents a three-phase co-design study with frail nursing home residents (medium age: 79 years) to gamify a physio-cognitive virtual reality (VR) intervention system, incorporating playful games in life-size VR streets and an indoor bike for self-directed, multisensory navigation. By addressing their needs for livingness, familiarity, and presence in VR-based gamification, the study demonstrates how playfulness effectively increases adherence (from 14.56 to 23.76 minutes), retention (from handful times to several weeks), and greater numbers of voluntary enrollment, while providing psychosocial benefits (p-value < 0.001). Design guidelines for VR-based interventions are proposed, with an unexpected emphasis on happiness, consistent with global efforts on dementia prevention.