Study on the Use of Exergames to Support Older Adults With Psychosis

Elderly patients with psychosis can be categorized into three groups: those with a history of schizophrenia, those with a new diagnosis of schizophrenia (late-onset), and those experiencing hallucinations or delusions due to other conditions such as dementia, delirium, delusional disorder, mood disorders, or paranoid personality disorders. The elderly population with schizophrenia represents a growing segment of older adults, with an estimated prevalence of 4-6% among people over 65 years old and around 10% among those over 85. Core features associated with psychosis include hallucinations, which are perceptions without external stimuli, and delusions, which are fixed false beliefs maintained despite evidence to the contrary. Other symptoms linked to psychosis include thought interference, thought disorder, apathy, social withdrawal, and blunted affect. Currently, there are no specific guidelines for managing primary psychotic disorders in adults aged 60 and older, but some general principles can be adapted from guidelines for other age groups. Existing recommendations for adults under 60 emphasize addressing not only psychiatric symptoms but also other health factors that affect overall well-being. Given the significant impact of cognitive and physical impairments, social isolation, and sensory deficits on symptoms in older adults, an integrated approach addressing both mental and physical health could improve treatment outcomes in this population. Research has shown that greater severity of schizophrenia symptoms and neurocognitive impairments are associated with reduced levels of physical activity, and that effective physical activity interventions should include components that enhance cognition and reduce psychiatric symptoms. One specific form of physical activity is exergaming, which combines physical exercise with cognitive stimulation through gameplay. Exergames involve multisensory stimuli, including auditory, visual, and somatosensory modalities, requiring engagement of various cognitive functions such as executive functions, visual and verbal memory, attention, and other multidimensional cognitive processes. Exergames offer several advantages over conventional exercise in enhancing cognitive functions by integrating cognitive demands into physical tasks. Furthermore, exergames promote better long-term adherence to exercise due to their gamified and motivational nature. Previous studies suggest that video game-based physical activity programs have higher acceptability and adherence rates among older adults with schizophrenia. Similar results were observed in chronic psychiatric inpatient populations, where full-body interaction during computerized cognitive training led to cognitive improvements and reduced depressive symptoms. Additionally, video game-based physical activity programs have increased the frequency of self-reported physical activity among older adults with schizophrenia. Meta-analytical evidence suggests that virtual reality exergames may positively influence cognition and depression in older populations. However, current evidence is limited by small sample sizes, low participant heterogeneity, inadequate training duration and frequency, and lack of control groups. To obtain generalizable findings on the feasibility and effects of exergame-based motor-cognitive training in inpatient settings for older patients with psychosis, future research should include frequent, structured training sessions, heterogeneous samples, and control groups. Technological advancements over recent decades have increased the availability of digitalized motor-cognitive training options. One such option is the use of a "step plate" for exergame training, such as the Dividat Senso. These exergames specifically target cognitive functions essential for daily living, including executive functions, attention, as well as physical abilities like balance and coordination. The games are played through body movements and weight shifting. To examine the feasibility and effects of exergame-based motor-cognitive training in older psychiatric inpatients, we plan to use the Dividat Senso device. After eligibility screening, participants undergo baseline assessment (T1) and are randomly assigned to one of two groups. The intervention group receives conventional treatment at the psychiatric hospital extended by technology-based motor-cognitive training using Dividat Senso. The control group receives conventional treatment plus strength and balance exercises from the Otago falls-prevention program. The intervention lasts four weeks, with participants requested to engage in short training sessions three times per week for 20 minutes each, totaling 12 sessions. After the intervention period, all participants undergo a post-intervention assessment (T2).