Abstract
This chapter provides a review of pilot studies and clinical trials which have been performed to date on serious gaming (exergaming) for the elderly. It is a novel pre-emptive approach to help maintain seniors physically and mentally fit, maximising the time for which they are capable of living independently at their own residence. Several studies are reviewed which show that this is a beneficial arrangement for both the elderly and the national healthcare system. We argue that by using exergaming it may be possible to pre-empt and delay the most common ailments that typically force the elderly to -often reluctantly- leave their residence and seek admission to a nursery home: dementia, arthritis, stroke and cardiovascular disease. Finally, we suggest possible next steps and focal points for pre-emptive exergaming geriatric research and conclude that much larger clinical trials are required to obtain conclusive results about the efficacy of this novel approach.
TopBackground
An Ageing Population
Elderly adults over the age of 65 are the fastest growing demographic group globally, expected to reach 1.5 billion by the year 2050, out of a total of approximately 9 billion people. The proportion of elderly citizens is non-homogenous across different nations: statistical data show that three out of the top four most aged populations in the world can be found in Europe (Beard J. R et al., 2012).
In 2010 Japan had the most aged society with 23% of its population being over 65 while Italy, Germany and Greece follow it in the global ranking. Seniors in these European countries account for 21%, 20% and 19% of the total population, respectively. At the other end of the European spectrum, Slovakia, Cyprus and Ireland are the least aged European countries with an elderly percentage of 13%, 12% and 11% respectively.
By comparison the USA, the world’s largest economy, has a ratio of 13% elderly citizens. The three largest emerging economies, China, India and Brazil, are among the world’s least aged countries: seniors account for 8%, 5% and 7% of the population, respectively. (UK Office for National Statistics, 2011)
While the phenomenon of population ageing is global, a total of 18 countries appear to be bucking the trend altogether. The UN Development Programme (UNDP) however considers these countries to be statistical outliers, given that the generations which are currently alive constitute the most aged human population in history ((United Nations Development Programme, 2005).
The aforementioned UNDP report portrays a clear correlation between the level of economic development in a country and the percentage of elderly citizens in the population. For instance, countries in the “Low Human Development” category clearly have the lowest elderly population share on average, out of a total of 177 countries listed. This is the result of multiple factors, among the most significant of which are an increasing life expectancy (including lower infant mortality) and reduced birth rates.
Increasing Strain on National Healthcare Systems
The implications of a rapidly ageing population are socioeconomically significant: a proportionally smaller workforce has to sustain increasing numbers of pensioners, while medical and social insurance infrastructures will necessarily have to adjust placing more emphasis on diseases of old age. Even in western countries where population ageing is not the primary concern, rising healthcare costs, increasing demand and mounting expectations pose novel challenges for policy makers, at a time when various other factors are placing a strain on public budgets (Commission on the future of health care, 2001).
Part of the solution to these and future aging-related social challenges is likely to involve helping senior citizens to maintain their physical and cognitive skills (graceful ageing), while empowering them to continue living independently within the community (Bovenschulte M & Huch M, 2010). Apart from the obvious benefits of better targeted healthcare delivery, the required technological developments and infrastructure changes can be combined to help provide more efficient personalised healthcare for elderly citizens (Cristiano Codagnone, 2009).
Key Terms in this Chapter
Ageing Population: A global demographic trend according to which the elderly (senior citizens over 65 years of age) constitute a consistently increasing share of the general population. It is a result of a combination of factors, including increased life expectancy –including reduced infant mortality- and a reduced birth rate. Population ageing has been observed for decades in all economically advanced countries and more recently in less economically developed ones as well. It is currently a global phenomenon, which means the human generations currently alive constitute the most aged human population that has ever existed in human history. While the trend is global, it is not even. Several countries, such as Japan, Germany, Italy and Greece have populations significantly more aged than the global average, while a few countries buck the trend altogether (designated as statistical outliers by the UN Development Programme).
Physical Fitness (Elderly): A general state of physical health and well-being, generally achieved through correct nutrition and exercise. The elderly have specific requirements with respect to physical fitness, relevant to both evaluation and training. As a person progresses into old age physical fitness is increasingly associated with quality of living standards and the ability to perform daily tasks, rather than absolute physical performance measures. Consequently, fitness parameters such as mobility, dexterity, body balance, motor coordination, reaction time and flexibility generally gain more significance over parameters such as muscular strength, endurance and speed.
Exergaming: The employment of serious games as motivation to perform physical or mental exercise. Exergames often exploit the entertainment value of gaming to maximize user motivation and gather data about user performance in order to adjust the level of difficulty to maximize exercise efficiency.
Serious Games: Games developed for purposes beyond mere entertainment. Serious games are considered useful to those who wish to use simulation for training and education e.g., flight simulations, exploit entertainment as motivation e.g. to perform physical and mental exercise (see exergaming).
Mental Fitness (Elderly): A state of psychosocial well-being, the capacity of a person to meet the various cognitive demands of life. From the point of view of self-determination, it means having a positive sense of how they feel, think and act, which improves their ability to enjoy life. Mental fitness is evident in a person’s ability to assimilate information, comprehend relationships, be creative, self-aware of their strengths and limitations. A mentally fit person is additionally capable of judging when to seek help, aware of their interests and goals, capable of drawing reasonable conclusions and developing plans which they can follow through, despite difficulties of opposition. The evaluation criteria of a person’s mental fitness vary with age. Several tests which focus on evaluating mental fitness for the elderly are proposed and cited in scientific literature, most aiming at early detection of neurodegenerative diseases (e.g. dementia) and mild cognitive impairment (MCI).
Elderly: For statistical and public administrative purposes, old age is frequently defined as 65 years of age or older. This is not consistent in international literature: occasionally a 60 year threshold is used. The term also implies that the person described is a retiree.
Senior Citizens: For statistical and public administrative purposes, senior citizens are frequently defined as 65 years of age or older. The term also implies that the person described is a retiree.