Co-designing with frail nursing home residents to gamify a VR-based physio-cognitive intervention

Improving adherence to physio-cognitive interventions is crucial for mitigating frailty and dementia in older adults, many of them staying in nursing homes. Digital interventions for nursing home residents, however, are often overlooked in both the academic community and the marketplace, let alone for adherence. This article presents a three-phase co-design study with frail nursing home residents (mean age: 80.42 years) to gamify "a physio-cognitive virtual reality intervention" (aPCVRi) prototype, a self-directed stationary bike simulator for physical activity controlling the integrated life-size VR local streets for reminiscence therapy and multisensory natural locomotion. To co-design gamification for playfulness, three design requirements (livingness, familiarity, and presence) were co-identified with participants and then translated into four strategies, which were then developed into four gamified modules. After integration, we found increases in participants' duration adherence (from 14.56 to 23.76 minutes), retention adherence, the number of voluntary enrollments, and psychological benefits. The four proposed guidelines for aPCVRi, therefore, emphasize playfulness and happiness, consistent with global efforts to improve dementia care.