UCSF

Introduction: The number of older adults with a serious mental illness (SMI) is predicted to more than double to 15 million by the year 2030. Older adults with SMI tend to have multiple medical problems in addition to serious psychiatric symptoms. Although the concept of healthy aging in SMI is gaining further attention, it has not historically been a common framework for mental illness treatment, rehabilitation, or recovery. Healthy aging includes the promotion of interconnected aspects of physical, emotional, and psychological wellbeing. The burgeoning field of inquiry about the effects of exergames on physical health and psychological wellbeing in older adults has found that exergames are safe, effective, enjoyable, and may improve depressive symptoms. Methods: We conducted qualitative interviews with 15 older adults with SMI who participated in a 10-week group exergame program. Data were collected and analyzed using grounded theory methodology within a symbolic interactionist framework. Results: Three important and interrelated concepts emerged from the data: Competence, Social Connectedness, and Energy. Play and playfulness became the vehicle for interacting social processes to take place. In the context of play, the participants experienced themselves in relationship to one another, gave and received empathy and positive social contact, engaged in social attunement, and became motivated to take risks and to face cognitive and physical challenges. In social environments where higher playfulness was cultivated, participants were more willing to engage in competition and described a sense of subjective wellbeing. Play and playfulness is strongly associated with increased social connectedness, which in turn supports intrinsic motivation, self-determination, and fulfills certain innate psychological needs that support wellness, growth, and recovery. Conclusion: Social disconnectedness and perceived isolation among older adults with SMI is complex and involves factors including organic psychopathology, physical effects of medications and/or other substances, medical co-morbidity, disability, and social stigma. Group play exergames for older adults with SMI may have the potential to promote recovery and healthy aging by increasing social integration, improving self-efficacy, and promoting physical health through exercise.