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Volume 2, 2017, Issue 1, Pages 1-5; Paper doi: 10.15412/J.JCC.02020101; Paper ID: 20017.
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The Effect of Playing Game on General Health in Elderly Visiting the Daily Nursing Homes
(Research Paper)
  • 1 Student in Geriatric Nursing, Center for students’ Research, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
  • 2 Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
  • Correspondence should be addressed to Mostafa Javadi, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Tel: ; Fax: ; Email:


General health is one of the most important subjects in the elderly. Participation in recreational activities such as games is recommended for maintaining and improving general health. The present quasi-experimental study was conducted with the aim of exploring the effect of brainteaser on general health in elderly visiting daily nursing homes in the city Yazd. The research environment included four daily nursing homes and 30 individuals were selected randomly as the experimental group from 2 centers and another 30 individuals were selected randomly as control group from another 2 centers. The elderly in the experimental group participated in the brainteaser sessions two days a week for one month. The general health was explored at three stages: before, immediately after and one month after the intervention using GHQ28. General health status in the experimental group was improved immediately after the end of the brainteaser, compared with before the brainteaser (P=0.002). The comparison of the scores in the experimental and control groups immediately after the end of the interven-tion and one month after the end of the intervention indicated significance statistical difference (P=0.005). Doing brainteaser by the elderly in the daily nursing homes in Yazd resulted in the improvement of their general health. This intervention is recommended to be done at the nursing homes and at homes as it is cheap, simple, portable and usable for all age groups.


Brainteaser, Game, Play, Elderly, General Health, Nursing Home


he world population is aging more rapidly, compared with the past. The population of the elderly individuals aged over 60 years old will be nearly doubled between 2015 and 2050. According to the World Health Organization (WHO) the elderly population in the world will be more than the population of the children under the age of 5 years by 2020 and thus, all countries have been prepared with adapt their health and social systems with this change in the population structure (1). According to 2011 census in Iran the elderly population in Iran is over 6 million individuals. The elderly population growth mean in Iran will be higher than the elderly growth mean in the world by 2045 and 5 years after that, it will be higher than the elderly growth mean in Asia (2). The elderly population growth is so considerable that it has become one of the general health challenges (3). Different societies determine their health-related planning based on the physical and mental conditions of their age groups. In this regard, the elderly as one of the main vulnerable groups in the society needs a special attention as these individuals are susceptible to different chronic diseases and problems due to their physical and mental conditions. On the other hand, due to their different conditions such as marriage of their children, losing spouse or friends or retirement, elderly individuals feel loneliness more which in turn results in increasing problems in their mental and social conditions (4, 5). One of the main health issues is mental health-related problems, and assessment of different psychological conditions such as anxiety, social function and depression is necessary. According to studies depression and cognitive dysfunction are common among elderly problems (6, 7). In addition, different studies have indicated that general health in the elderly is more unfavorable, compared with other individuals in the society (4). Therefore, in order to maintain general health, participation in educational programs, having group activities and interaction with others are recommended. The more appropriate the physical, social and psychological functions towards himself and others are in the individual, the better the general health will be (8). Nowadays WHO considers health, recreation and entertainment, in addition to long life, housing, social welfare, income, transportation, education and job, as indices of social development (2). Recreational activities such as game results in the spare time being accompanied with joy and prepares the individual for other activities in life (9). Game is used as a tool for increasing social and communication skills, reducing fear of health problems and as a positive contributor to coping skills (10). Charles Aboucher et al believe that recreation and game result in the strengthening of human relations, increase of social relationship development skills, increase of physical and mental health and increase of creativity (11). Though game and spare time may be used interchangeably for the adults, game is considered as a major aspect of spare time for all age groups. According to new psychological studies game has a highly effective role in the development of personality and improvement of general health in children and adults (11). Considering the significant role of games in increasing the morale and life quality, different mental and physical games have been designed for the elderly and of course due to the physical and movement limitations in the elderly the mental type has been focused on. The game Gobblet is a brain teaser designed for two individuals to play simultaneously. As the elderly, due to loneliness and retirement, spend the day often without any activity, their spare time can be optimally used by appropriate planning. The feeling of loneliness and the lack of social relationships in life can have a negative role on general health (12). Therefore, the present study was conducted with the aim of exploring the impact of brain teaser on general health in the elderly visiting the daily nursing homes in the city Yazd.


The present study is a quasi-experimental study using pretest-posttest method with a follow-up period. The researchers visited the nursing homes after the research process was verified by the Research Committee of Shahid Sadoughi University of Medical Sciences and Health Services with identification No. IR.SSU.REC.1395.14 and registration in IRCT website with No. IRCT2016042427559N1. The population of the present study was consisted of all elderly individuals visiting daily nursing homes in Yazd in the first half of 2016. In this study, among four existing daily nursing homes, two nursing homes were selected as the experiment group and two others as the control group using simple random sampling. In the centers belonging to the experimental groups, 30 individuals were selected as the sample among the elderly individuals who were willing to participate in the study. In addition, 30 individuals were selected as the sample for the control group randomly in the control group centers. The inclusion criteria for this study were the history of at least 3 month of visiting the nursing home, and having ability to participate in the game sessions. Major depression, the use of narcotic drugs, having dementia, severe hand movements, and vision problems was considered as exclusion criteria. The researchers explained to participants about the voluntariness of participating in the study and confidentiality of information. Then the written informed consent of the sample members for participating in the study was obtained. Pretest was conducted on both groups before the intervention. Then the elderly in the experimental group underwent intervention for a month. The intervention involved the participation of at least two one-hour sessions in a week in which the game was included in the programs in the center. The time for playing the game was recorded and registered by one of the researchers. Playing the game was continued for a month. The study questionnaires were completed again immediately after the end of intervention and one month after the end of the intervention. The data collection tool in this study was a two-part questionnaire. The first part of the questionnaire was related to demographic information and the second part was related to general health in which General Health Questionnaire-28 (GHQ28) was used. This questionnaire measures the status of the individual’s general health in the past month and includes four dimensions: physical symptoms, anxiety, social dysfunction and depression symptom. Moreover, it is scored in a four-point Likert style (from 0 to 3). The minimum score for the test is 0 and the maximum is 84. The cut-off point in this test is considered as 23 and obtaining a lower score indicates a better general health. The studies conducted in Iran have reported the reliability of this questionnaire to be 84 to 91 percent (13). The software SPSS version 19 was used for data analysis. Independent t-test was used for comparing the general health mean score in the experimental and control groups before and after the study. Repeated measure ANOVA was used for both groups for exploring the impact of brainteaser in different times in the study.


The minimum age of the subjects was 60 years and the maximum was 87 years with the mean age of 69.93±6.88 year. Table 1 show that sex and education level in the experimental group and the control group have significant difference.

Table 1. The comparison of frequency distribution of the demographic characteristics of the units explored in the experimental and the control groups

Independent t-test indicated that the mean scores of general health in the experimental and control groups before doing the brain teaser were not significantly different (P=0.351). However, the mean score of general health in the experimental group become lower immediately after the end of the brainteaser (P=0.005) and one month after that (P<0.001) and the difference was statistically significant. The repeated measure ANOVA indicated the existence of significant statistical difference in the general health score between the experimental group (P=0.005) and the control group (P=0.002) in the times studied (Table 2).

Table 2. Mean and standard deviation of the general health scores in the in the experimental and the control groups at different stages in the study

The post hoc test LSD indicated that the general health score in the experimental group was reduced by 3.40 units immediately after doing the brain teaser, compared with before the brain teaser, and the difference was statistically significant (P=0.002). The general health score was reduced by 2.47 units (P=0.176) one month after the end of the game, compared with before the game; and by 0.93 unit (P=0.561) one month after the end of the game, compared with the immediately after the end of the game but the reduction was not statistically significant (Table 3).

Table 3. Changes in mean general health score in the experimental group in different times during the study*

*The cases above the breaking line are related to the mean difference absolute value in different times during the study. The cases under the breaking line are related to p-value and the statistical difference between different times in the study.

This study explored the impact of brain terser on general health in the elderly visiting the daily nursing homes in the city Yazd. The general health score in the experimental and control groups before the intervention was higher than the cut-off point that indicated that the elderly individuals did not have an appropriate general health. The studies conducted on the general health in the elderly indicate that the general health of these individuals is lower compared with the other individuals in the society due to lack of movement, lack of social communications and chronic physical and mental diseases (16). The results of the study by Shirbeigi et al indicated that the general health in active individuals is significantly higher than inactive individuals (14). In this regard, measures should be taken to achieve a favorable level of general health in these individuals. One of the measures is doing recreational activities and entertainment. In the study by Khodadadi et al it was shown that a significant number of elderly individuals have depression (17). In addition, a study conducted on the importance of paying attention to one’s health, shows that the elderly in the city of Yazd do not pay attention to their health much which is consistent with the results of the present study (18). Therefore, paying attention to the general health in the elderly is important. Training appropriate recreational activities such as games in the living environment of the elderly can impact their general health. Mean score of general health of the elderly who did the brainteaser was reduced as a sign of improvement but the score did not reach the favorable range. Therefore, doing these activities is recommended to be designed and implemented in a long-term period to achieve the favorable result. One month after the intervention, the elderly individuals were explored again and it was observed that their general health moved towards deterioration again and this indicates the necessity of continuation of doing brainteaser. In a study conducted by Seddigh et al, it was concluded that skill in chess was inversely related to depression severity and the severity of depression was reduced with the increase of playing the chess (19). In a cohort study conducted by Dartigues et al in France in 2013 it was revealed that depression was lower in individual who played the game, compared with others (20). In addition, the study by Faraji et al indicated that poetry therapy for 6 weeks resulted in the reduction of depression score in the elderly (21). Considering that one of the aspects of general health is related to depression, if improvement for this disorder is designed by some interventions, general health can be improved. In the study by Shoja et al it was indicated that there was a relationship between social participation and general health (22). According to the results of the study by Barati et al loneliness during the old age results in the disorder in general health (23). Playing games can be considered as one of the main activities for the improvement of general health especially as the rich Iranian culture is full of recreational activities for all age groups. Doing recreational activities is also emphasized in Islamic teachings (24). This study faced some limitations one of which was the low number of men visiting the nursing homes. In addition, playing the games by the elderly initially faced some resistances and the majority of the elderly showed willingness to play over time.


Brainteasers had a positive impact on the improvement of the general health in the elderly visiting the nursing homes in Yazd. In addition, this non-pharmacological therapy can be effective in the improvement of general health along with other psychological and pharmacological therapies. This simple and low-cost method can be implemented in most places and by all age groups in a two-person way. Therefore, this method can be used for the improvement of general health in the elderly by appropriate planning.

This paper is extracted from the Master’s thesis in geriatric nursing in the Nursing and Midwifery school in Yazd. Therefore, the researchers would like to thank the related authorities.


The researchers would like to appreciate the cooperation of Shahid Sadoughi University of Medical Sciences and Health Services, Welfare Organization of Yazd province and the managers and personnel of nursing homes Bahar, Toranj, Poroochista, and Yase Sefid and especially the dear elderly who helped us in this study by their participation in brainteaser classes.


Mostafa Javadi designed the study and performed data analysis, Hossein Tavangar developed the discussion on results and MohammadBagher Khani tried for sampling, intervention and development of related discussion.


The authors declared no potential conflicts of interests with respect to the authorship and/or publication of this paper.


1. W.H.O. Ageing and health 2016 [updated 2015]. Available from: [View at Google Scholar].

2. Nabavi S, Alipour F, Hejazi A, Rabani Z, Rashedi V. Relationship between social support and mental health in older adults. Medical Journal of Mashhad University of Medical Sciences. 2014;57(7):841-46. [View at Google Scholar].

3. Vesal M, Mollazade J, Taghavi M, Nazarinia M. Prediction of depression based on perception of pain and quality of sleep due to pain catastrophizing in elderly patient with rheumatoid arthritis. Anesthesiology and Pain. 2015;5(4):69-80. [View at Google Scholar].

4. Mortazavi SS, Ardebili HE, Mohamad K, Dorali R, editors. Assessing the mental health status of elderly in Shahrekord and relationship with sociodemographic factors. The First International & 4th National Congress on health Education & Promotion, 2011; 2011: Tabriz university of medical sciences. [View at Google Scholar].

5. Sheikholeslami F, Reza Masouleh S, Khodadadi N, Yazdani MA. Loneliness and general health of elderly. HOLISTIC NURSING AND MIDWIFERY. 2011;21(2):28-34. [View at Google Scholar].

6. Johnson JK, Louhivuori J, Stewart AL, Tolvanen A, Ross L, Era P. Quality of life (QOL) of older adult community choral singers in Finland. International psychogeriatrics / IPA. 2013;25(7):1055-64. [View at Publisher]; [View at Google Scholar]; [View at Scopus].

7. Williams K, Kemper S. Exploring Interventions to Reduce Cognitive Decline in Aging. Journal of psychosocial nursing and mental health services. 2010;48(5):42-51. [View at Publisher]; [View at Google Scholar]; [View at Scopus].

8. Taheri A, Shirani M, Zohouri M. The role of information technology in elderly’s health programs: A comparison in Sweden and France. Hospital. 2014(Special Issue):1-11. [View at Google Scholar].

9. GHhorbannejad P, Sanginpour M. Study a variety of games and entertainment and their prevalence in the court of the Abbasid Caliphate. The History Of Islamic Culture and Civilization [View at Google Scholar].

A Quarterly Research Journal. 2012;3(8).

10. Menks F. The use of a board game to simulate the experiences of old age. The Gerontologist. 1983;23(6):565-8. [View at Publisher]; [View at Google Scholar].

11. Sanaee T. conceptual geometry of leisure time: using sociological, psychological and moral approach [View at Google Scholar].

Marifat-i Akhlaqi. 2013;4(1):111-93.

12. Atadokht A, Zare R, Karamati Topraghloo N. The Relationship Between Social Interest and General Health Among Elderly Non-Resident and Resident at Geriatric Centers of Ardabil City. Iranian Journal of Health Education and Health Promotion. 2015;3(2):141-9. [View at Google Scholar].

13. Noorbala A, Mohammad K. The validation of general health questionnaire-28 as a psychiatric screening tool. Hakim Research Journal. 2009;11(4):47-53. [View at Google Scholar].

14. Shirbeigi M, Esmaili Z, Sarmadi MR, Moradi A. Study and Comparing 3 Groups of Active, Passive, and Ecotourist Old Age People on Their Mental Health and Happiness Living in Illam City, Iran. Iranian Journal of Ageing. 2016;10(4):40-9. [View at Google Scholar].

15. Matlabi H, Shaghaghi A, Amiri S. A pilot physical activity initiative to improve mental health status amongst Iranian institutionalized older people. Health promotion perspectives. 2014;4(1):68. [View at Google Scholar]; [View at PubMed].

16. Saberian M, HAJI Aghajani S, Ghorbani R. Study of the mental status of the elderly and its relationship with leisure time activities. JOURNAL OF SABZEVAR UNIVERSITY OF MEDICAL SCIENCES. 2004;10(4):53-60. [View at Google Scholar].

17. Khodadadi N, Sheikholeslami F, Reza Masouleh S, Yazdani M. Rate of depression in late-life in superannuated government employed center of Guilan University of medical sciences. Holistic Nursing and Midwifery. 2007;17(1):16-22. [View at Google Scholar].

18. Tavousi M, Sadighi J, Farzadi F, Ebadi M, Omidvari S, Azin S, et al. the viewpoint of Iranian people about importance of health Payesh. 2013;11(5):611-9. [View at Google Scholar].

19. Seddigh R, Shariat SV, Gharraee B, Azarnik S. Evaluation of relationship between severity of depression and chess skill in members with international rating scale in Chess Federation of Islamic Republic of Iran in 1389. Razi Journal of Medical Sciences. 2012;19(100):29-36. [View at Google Scholar].

20. Dartigues JF, Foubert-Samier A, Le Goff M, Viltard M, Amieva H, Orgogozo JM, et al. Playing board games, cognitive decline and dementia: a French population-based cohort study. BMJ open. 2013;3(8):e002998. [View at Publisher]; [View at Google Scholar]; [View at PubMed]; [View at Scopus].

21. Faraji J, Fallahi Khoshknab M, Khankeh HR. The effect of poetry therapy on depression in elderly residents of a nursing home in Arak-Iran. Iranian Journal of Psychiatric Nursing. 2013;1(1):55-62. [View at Google Scholar].

22. Shoja M, Rimaz S, AsadiLari M, BagheriYazdi S, Gohari M. Mental Health of Older People and Social Capital. Payesh. 2013;12(4):345-53. [View at Google Scholar].

23. Barati M, Fathi Y, Soltanian A, Moeini B. Mental Health Condition and Health Promoting Behaviors among Elders in Hamadan. Scientific Journal of Hamadan Nursing & Midwifery Faculty. 2012;20(3):12-22. [View at Google Scholar].

24. MardaniNokanda MH. The nature and quaddity of happiness in quran and the hadiths, and strategies for living happy. Habl-Ol Matin. 2013(1):35-62. [View at Google Scholar].

Paper Title: The Effect of Playing Game on General Health in Elderly Visiting the Daily Nursing Homes
Paper Details: Volume 2, Issue 1, Pages: 1-5
Paper doi:10.15412/J.JCC.02020101
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