Enhancing VR-Based Physio-Cognitive Intervention for Frail Nursing Home Residents via Gamification

Overview

A co-design study with frail nursing home residents (mean age 80.42) gamified a physio-cognitive VR intervention prototype, resulting in increased adherence and psychological benefits. Key gamification strategies focused on livingness, familiarity, and presence, improving engagement with the stationary bike VR simulator.

Background

Frailty and dementia are prevalent among older adults in nursing homes, necessitating effective physio-cognitive interventions to mitigate decline. Digital interventions remain underutilized in this population, often facing adherence challenges. Virtual reality (VR) offers immersive opportunities for combined physical and cognitive stimulation, but requires user-centered design to enhance playfulness and engagement. This study aimed to co-design gamification elements with frail residents to optimize a VR-based physio-cognitive intervention.

Data Highlights

Key Findings

• Three design requirements—livingness, familiarity, and presence—were co-identified with frail nursing home residents to guide gamification.
• Four gamification strategies were developed and integrated into the physio-cognitive VR intervention (aPCVRi) prototype.
• Post-gamification, participants’ average duration adherence increased from 14.56 to 23.76 minutes.
• Retention adherence and the number of voluntary enrollments also increased following gamification.
• Participants experienced psychological benefits, indicating enhanced engagement and well-being.
• The study emphasizes playfulness and happiness as core principles for improving dementia care through digital interventions.

Clinical Implications

Incorporating user-centered gamification into VR-based physio-cognitive interventions can significantly improve adherence and engagement among frail nursing home residents. Clinicians and care providers should consider integrating familiar and immersive elements to enhance the effectiveness of digital therapies targeting frailty and cognitive decline. Such approaches may contribute to better physical and psychological outcomes in this vulnerable population.

Conclusion

Co-designed gamification strategies effectively enhanced adherence and psychological benefits of a VR-based physio-cognitive intervention in frail nursing home residents. Emphasizing playfulness and presence may optimize digital health interventions for dementia care.

References

1. Chen, Q. et al. (2024) Silvercycling: Exploring the impact of bike-based locomotion on spatial orientation for older adults in VR.
2. Kwan, R. Y. C. et al. (2024) Effects of virtual reality motor-cognitive training for older people with cognitive frailty: Multicentered randomized controlled trial.
3. Maggio, M. G. et al. (2025) The overlooked role of exergames in cognitive-motor neurorehabilitation: a systematic review.
4. Yang, Q. et al. (2025) Virtual reality interventions for older adults with mild cognitive impairment: Systematic review and meta-analysis of randomized controlled trials.
5. Borda, M. G. et al. (2025) Assessment and management of frailty in individuals living with dementia: expert recommendations for clinical practice.