The World Health Organisation has estimated that the global population of older adults will grow by 223% by the year 2050 [
1]. In 2050 it is estimated that there will be 2 billion older adults, of which 80% are expected to be living in developing countries [
1]. Due to the increasing time spent in old age and the high level of disability in older adults, there is an increasing need for residential aged care facilities, community care, and flexible care services [
2].
Older adults in residential care are at an increased risk of a number of mental health disorders when compared to community samples. Research indicates that 40.5% of residents in high level care and 25.4% of residents in low level care experience depression [
3]. Older adults are also at risk of experiencing loneliness, with approximately 10% of older adults in care reporting frequent loneliness [
4]. Harper [
5] has found that the aged care environment does not promote well-being or the formation of meaningful friendships even though residents are often with other people. Loneliness in older adults is strongly associated with higher levels of depression, even after controlling for variables such as gender, age, ethnicity, education, income, marital status, social support, and perceived stress [
6,
7]. Older adults in residential care are at an increased risk of a number of mental health disorders even though residents are in an environment that has been designed to provide social support, alleviate boredom, and decrease loneliness along with providing medical support. Knight and Mellor [
8] have proposed that a combination of unfulfilling social activities and constant interactions with unfamiliar people can lead to the development of poor mental health in aged care residents.
Low levels of sense of belonging have been implicated in the poor mental health of older adults who live in aged care facilities [
9]. Recent research has shown that sense of belonging partially mediates the relationship between place of residence and depression in older adults, with living in assisted living facilities being associated with lower levels of belonging [
9]. Lower levels of belonging is, in turn, associated with higher levels of depressive symptoms [
9]. Other research has indicated that residents feel that they do not fit in with those around them, despite aged care providers believing that the provision of a range of social activities facilitates a sense of belonging among residents [
8]. The above research highlights the importance of sense of belonging to the well-being of aged care residents and emphasises the need for interventions to enhance a sense of belonging within the aged care environment. Increasing the levels of sense of belonging should be associated with an increase in the overall psychological health and wellbeing of residents [
10].
Gaming
Video games can provide older adults with a number of physical and psychological benefits. Video games are not just used for fun and entertainment. The term “serious gaming” has been used to identify games used for purposes such as education, training, advertising, research, and health promotion [
11]. Recently, games have been developed that also incorporate the use of the whole body. These games have been termed “exergames” as they can improve health, physical fitness, and coordination through the combination of physical activity and game play [
11]. A systematic review of the physical and cognitive effects of older adults playing physically interactive computer games was conducted [
12]. Across 12 studies it was found that interactive computer games were safe, and are an effective way to increase physical activity in older adults. The use of the computer games was also associated with improvements in a range of physical and cognitive outcomes, including self-esteem [
13], confidence [
14] and balance [
15].
A popular game console that is used with older adults is the Nintendo Wii. The Wii is able to track spatial movements and incorporate this into game play [
16]. The cost effectiveness of commercial systems such as the Wii make this a feasible option for aged care facilities [
17]. Marston [
18] found that the Wii console was easier for older adults to use when compared to other more traditional digital games.
The Wii has been shown to be of benefit to older adults who are suffering from sub-syndromal depression. Rosenberg et al. [
19] conducted a pilot study with community living older adults with sub-syndromal depression. At the end of three months, participant’s levels of depression decreased and there was an increase in quality of life. Kahlbaugh, Sperandio, Carlson, and Hauselt [
20] investigated the effects of playing the Wii on physical activity, loneliness, and mood with older adults in a residential facility. Residents were asked to either play Wii games of their choice or watch television with an undergraduate student. It was found that the group playing Wii had a decrease in loneliness whereas the group watching television had an increase in loneliness by the end of week 10. There was no overall change in negative mood or physical activity levels over the 10 weeks, however during each week there was a non-significant increase in reported positive mood [
20].
Playing Wii has also been found to improve the physical activity levels and psychological quality of life when compared to a control group [
21]. Residents were asked to play a variety of Wii sports games over 8 weeks. Analyses of the group interview data indicated that residents found the games fun and provided an avenue for greater socialization. By week 8, residents' overall quality of life had improved in the domains of psychological and physical health [
21]. In another study using the Wii, participants were divided into three groups, playing Wii with others, playing Wii alone, and a control group who played board games [
22]. At the conclusion of the study, the residents in the Wii conditions scored significantly higher on self-esteem, physical activity, and positive affect, and significantly lower on loneliness when compared to the control group. No difference was found between the groups playing Wii alone and with others [
22].
No previous study has systematically measured the effect of using the Wii on depression, sense of belonging, or social support. Social interaction has been measured previously at the conclusion of the intervention, but not throughout the intervention [
21]. Depression is a significant issue for residents' well-being, along with a lack of social support and belonging within care facilities. Playing the Wii console is a potential intervention to increase the overall psychological health of residents. Further, no study has utilised a control group to test the use of the Wii console in care facilities measuring depression, social support, and a sense of belonging as the outcome measures.
Study aims
The aim of the current research is to investigate the mental health of aged care residents (aged 65 years or older) who are encouraged to participant in a group activity involving the Wii console. Participants will be allocated to either an intervention group that involves playing Wii bowling with other residents or to a control group who do not participate. The primary aim of the study is to examine the effectiveness of the Wii to decrease the level of depressive symptoms and increase a sense of belonging, increase self-reported mood, and increase social support at post-intervention and 2-month follow up. A secondary aim of the intervention is to increase the level of social interaction between participants.