Effectiveness of gamification to improve depressive symptoms among older adults with cognitive impairment: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVES: Cognitive impairment, a growing public health issue linked to aging, is often accompanied by depressive symptoms in older adults. We conducted a systematic review and meta-analysis to assess the effectiveness of gamification in improving depressive symptoms in older adults with cognitive impairment. RESEARCH DESIGN AND METHODS: Randomized controlled trials investigating the effectiveness of gamification in improving depressive symptoms in older adults with cognitive impairment were included in this study. Methodological quality of included studies was assessed using The Cochrane Risk of Bias Tool version 2, while overall certainty of evidence was evaluated through the GRADE system. Data synthesis was conducted using meta-analysis for quantitative data synthesis, complemented by narrative synthesis where appropriate. RESULTS: Twenty-one randomized controlled trials involving 1385 participants were included in this study. Gamification was modestly but significantly effective in improving depressive symptoms of older adults with cognitive impairment (standardized mean difference = -0.92, 95% CI = -1.25 to -0.60, P < 0.00001). Subgroup analyses based on different depression scales, forms of gamification interventions, intervention durations, and gamification design elements showed that the interventions may reduce depression scores compared with the control condition. The evidence level for depression scores as the primary outcome was rated as moderate. DISCUSSION AND IMPLICATIONS: Gamification shows promise as a supplementary intervention for reducing depressive symptoms in clinical settings. Future studies should focus on optimizing intervention design and ensuring real-world applicability. Identifying key features linked to symptom improvement can guide the development of more effective therapeutic tools.