The aging society is a phenomenon which relates to the rising median age of the population as a result of declining fertility rates and/or increased life expectancy [1]. This phenomenon was first experienced in developed countries where life expectancy has increased because of a combination of higher standard of living, better quality of life and improvements in medical technology, diagnostics and treatment. It is an effect which is now becoming more ubiquitous in less economically developed countries.

Almost every country in the world, regardless of level of development, is facing a future in which the median age of the population will continue to increase [2]. Today, the median age of the world's population is the highest in mankind's history [3]. It is projected that the number of people in the world defined as elders (age of 60 and over) will reach 2.1 billion by 2050 [45]. This will drastically increase the dependency ratio.

As the median age of the population increases, with a growing percentage of the total population over the age of 60, it also means that the percentage of the total population who are in employment and economically productive will decline. In simple terms, it will mean that there will be fewer and fewer working people supporting more and more retired and unemployed people. Therefore, it is not difficult to anticipate that the ratio of employed people under the age of 65 to retired people over the age of 65 will fall substantially, whilst the dependency ratio increases. Research [6] predicts that, in China, the number of working age adults for each person aged over 65 will fall from 7.9 in 2010 to 1.6 in 2100 and in India the ratio will fall from 11.0 to 2.1 in the same period. Conversely, in the United States and the UK, the fall is predicted to be less dramatic, at 4.6 to 1.8 in the United States and 3.6 to 1.6 in the UK. Despite a lower dependency ratio changes in the latter, the health care cost implications are much higher than in the former.

Clearly, these demographic changes, accentuated by various predictions about the impact of technologies like robotics and artificial intelligence, mean that the falling numbers of employed ‘economically productive’ people will face substantially increased burdens in supporting the population of unemployed ‘non-economically productive’ people, causing potential societal disruption and forcing fundamental policy changes in areas such as formal retirement ages and pension provisions. To reduce the aging burden in most European countries the retirement age is already increasing from 65 to 67–69 years.

The impact of the aging population on society is further augmented by the fact that, as people get older, they are more likely to require medical interventions for both physical and mental health problems such as frailty, COPD (chronic obstructive pulmonary disease), cardiovascular problems, mobility, cancer and dementia. The resources required to support and care for these problems under the conditions of established welfare systems with a public finance safety net will therefore come under increasing pressure.

In the United States in 2010, the amount of healthcare spending on senior citizens aged over 65 averaged $18,424 per person. The spending per elder is about five times the amount per person as the amount spent on children and three times the amount spent on working-age adults. The elderly over the age of 65 accounted for 13% of the population but 34% of healthcare-related spending [7].

It is against this background that this article seeks to review some of the approaches to addressing health and well-being issues in the elderly population aimed at preserving and/or enhancing physical and cognitive capabilities in their later life. Healthy aging reduces care resources utilization resulting in a double dividend of lower healthcare costs and higher quality of life for elderly people.

The expression ‘Serious Games’ refers to the Wikipedia definition [8]: “A serious game or applied game is a game designed for a primary purpose other than pure entertainment. The ‘serious’ adjective is generally prepended to refer to video games used by industries like defence, education, scientific exploration, health care, emergency management, city planning, engineering, and politics.” The phrase is often attributed to originate from the development of a video game called ‘America's Army’ [9]. This video game was originally funded by the American Military with the intention of targeting young people for a recruitment strategy. The rationale was that simulating what it was like to be a soldier in an entertaining video game would help to make a career in the army more attractive and hence boost new recruit applications.

America's Army helped to stimulate an awareness that video games and simulations could play a major role in training scenarios which could cost effectively prepare soldiers for combat and emergency situations without some of the costs and risks involved in recreating realistic real-world models. It has been this combination of reduced costs and risks that has tended to shape the sectors in which serious games have had the biggest focus of attention. Games provide an environment in which experiential learning can take place without placing the participants or subjects in danger from the consequences of mistakes [10].

For these reasons and also the fact that, especially in emergency situations, it can be impractical or impossible to recreate a real-world scenario, early serious games and simulations came to be developed for many military and medical scenarios. One of the earliest examples of a research project aimed at evaluating the effectiveness of video game simulations compared to existing methods was a serious game called ‘Triage Trainer.’ This serious game simulated the effects of a terrorist bomb in a city centre with casualties with different degrees of injury. Control groups of paramedics responding to this virtual scenario were evaluated against colleagues going through traditional training with mannequins and those trained using ‘Triage Trainer’ achieved better learning outcomes, primarily because they felt more engaged in the scenario [11].

As the technologies and mechanics used in video games have become more sophisticated and mobile devices such as smartphones and tablets have become more ubiquitous, so the range and diversity of video games and simulations has expanded across all demographic groups. In addition, wearable and embedded devices have enabled the integration of real-world data within games environments to provide mechanisms which influence behaviours that are health-related. Many serious games have been developed to address a variety of medical challenges including obesity, sexually transmitted diseases, phobias, autism and attention deficit disorders.

This paper focuses on those serious games and applications designed to influence physical and cognitive well-being amongst the elderly population.

Measuring physical and cognitive well-being and being able to clearly identify and manage the factors which most influence physical and cognitive well-being have attracted researchers' attention. As an exemplar, the National Centre for Sports Exercise and Medicine East Midlands (NCSEM-EM) has been working on sets of protocols designed to not only assess physical and mental well-being but also to assess the impact of different interventions on well-being [12]. This research indicates a positive link between physical activity amongst the elderly and both physical and cognitive well-being in this age group. In addition, ‘fun’ and ‘social contact’ were identified as important contributors to engagement and motivation.

The role of games and game mechanics to engage and motivate the elderly has been explored in various countries [131415]. This review discusses some of the approaches taken and findings. ‘Serious Games’ is a discipline which researches and explores the potential of the technologies and methodologies employed in the consumer video games industry to address ‘non-entertainment’ issues such as education, health and the environment effects [161718]. In particular, the use of games mechanics can not only engage, motivate and influence behavioural change [19202122] but can also be used as an indicator of and determinant of physical well-being [1415162023] and mental health [1417]. This review looks at some of the projects where games mechanics [13], psychologies and technologies have been applied to the some of the most common health and well-being issues within the elderly population.

The review of some of the approaches employed to address health and well-being issues in the elderly population shows evidence of a number of linkages. Various measures such as fall prevention, diet, adjusted nutrition, physical fitness, game technologies and walking exercise are aimed at preserving and/or enhancing physical and cognitive capabilities in later life. They are effective in reducing economics and social costs of aging. Hence, healthy aging which results in a double dividend of reduced cost of healthcare and improved quality of life for the elderly people is an optimal approach to face the challenges of aging.

Further research is necessary to identify what type of technologies promote healthy lifestyle behaviours, what parts of serious games increase health promotion and which one, either entertainment-based or educational-based approach is more popular, engages long-term behavioral change, and elevates player motivation [15182046]. It is also suggested to develop research designs incorporating standardized protocols to increase the scientific rigor of clinical evidence and the effectiveness of interventions for health behavioural change [143146]. This effort will translate evidence-based interventions to gaming-based approaches successfully [2046].

It does seem clear however that the rapidly maturing technologies associated with artificial intelligence, cloud computing, data analytics, Internet of Things, data visualization and mobile devices hold significant promise for creating an ecosystem of partnerships within and outside the medical profession to tackle the aging society issues identified into this paper.