Clinical Scorecard: Collaborative Design with Frail Residents of Nursing Homes to Enhance a VR-Based Physio-Cognitive Intervention through Gamification

At a Glance

Key Highlights

• Co-designed gamification strategies based on livingness, familiarity, and presence to enhance playfulness and adherence
• Integration of four gamified modules increased duration adherence from 14.56 to 23.76 minutes and improved retention and voluntary enrollment
• Psychological benefits observed consistent with global dementia care improvement efforts

Guideline-Based Recommendations

Diagnosis

• Identify frail older adults in nursing homes who may benefit from physio-cognitive interventions

Management

• Implement self-directed VR-based physio-cognitive interventions using stationary bike simulators integrated with life-size VR environments
• Incorporate gamification elements emphasizing playfulness, livingness, familiarity, and presence to enhance engagement and adherence

Monitoring & Follow-up

• Track duration and retention adherence to the VR intervention
• Monitor psychological benefits and voluntary participation rates

Risks

• Consider participant privacy and data security when handling intervention data

Patient & Prescribing Data

Frail older adults residing in nursing homes

Gamified VR physio-cognitive interventions increase adherence duration and retention, promote voluntary engagement, and yield psychological benefits

Clinical Best Practices

• Engage frail nursing home residents in co-design processes to tailor digital interventions to their preferences and needs
• Focus on gamification strategies that enhance playfulness and happiness to improve intervention adherence
• Use multisensory and familiar virtual environments to support reminiscence therapy and natural locomotion
• Ensure secure data management respecting participant privacy

References

• Liu, S. et al. Mapping the landscape of digital health intervention strategies: 25-year synthesis. J. Med. Internet Res. 27, e59027 (2025).
• Kwan, R. Y. C. et al. Effects of virtual reality motor-cognitive training for older people with cognitive frailty: Multicentered randomized controlled trial. J. Med. Internet Res. 26, e57809 (2024).
• Borda, M. G. et al. Assessment and management of frailty in individuals living with dementia: expert recommendations for clinical practice. Lancet Healthy Longevity. 6, 1 (2025).