Lifespan is increasing, and it is estimated that nearly one-fifth of the population in the United Kingdom (UK) is 65 years or older. Nutrition plays a crucial role in mediating the ageing trajectory and can significantly impact the prevalence of chronic diseases. Improving dietary intake is key to optimizing health and quality of life, potentially increasing the number of disability-free life years.
Alarmingly, around 1.3 million people in the UK over the age of 65 suffer from malnutrition, with the vast majority (93%) residing in the community. The prevention of malnutrition is vital as it can lead to physical decline, frailty, musculoskeletal conditions, and immune senescence. A 2020 Priority Setting Partnership by the James Lind Alliance identified early intervention in vulnerable groups as the top research priority for preventing malnutrition.
Digital Innovation in Nutrition for Older Adults
Digital technology is increasingly being promoted to complement clinical approaches, potentially making health systems more efficient and sustainable. While individual action and motivation are important, a framework rooted in behavioral and social science can encourage sustained engagement and maximize impact. Digital tools that incorporate behavior change theories are particularly effective in promoting positive lifestyle changes, considering social, emotional, and cognitive factors.
The digital tool “Keep on Keep up” (KOKU) offers strength and balance exercises based on the Otago exercise programme and the EAST (easy, attractive, social, timely) framework to support behavior change. Trials in the UK and US have shown that KOKU is highly usable, improving balance, health status, and confidence after six weeks of independent use.
Developing KOKU-Nut: A Person-Centred Approach
Recognizing the lack of digital tools to support nutritional status in relation to fall prevention among older adults, researchers aimed to develop an educational game within KOKU. This game, KOKU-Nut, is designed to inform users about malnutrition and healthy eating in line with UK dietary guidelines.
The development process followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines, focusing on the views and feedback of potential end users. This person-centred approach involved three phases: focus groups with older adults, application development, and initial application testing.
Phase 1: Focus Groups with Older Adults
Focus groups were conducted to determine the product features and educational content required for the nutrition component of the digital intervention. Participants, aged 65 and above, were recruited from assisted living facilities across Greater Manchester. These discussions revealed insights into dietary behaviors influenced by physiological ageing and psychosocial factors such as retirement and bereavement.
“I don’t know whether other people find this but I’ve found that as I’ve got older, I don’t get hungry” – Female participant, aged 65–74
Participants expressed a preference for home-cooked meals over pre-packaged foods, reflecting nutrition messages promoted by the media rather than evidence-based advice. Personal preferences, ease of preparation, and taste were key determinants of food and fluid intake.
Phase 2: Application Development
The second phase focused on designing a nutrition game to educate and prompt older adults to improve their nutritional intake. An agile design sprint methodology encouraged collaboration and innovation. The research team, alongside designers, developed mini-games tailored to raise awareness of evidence-based nutrition and nudge users towards healthier diets.
The chosen game, a matching pairs card game, was designed to be engaging and educational, providing nutritional information and encouraging older adults to choose healthier foods. The educational content was based on the UK dietary guidelines and findings from the focus groups.
Phase 3: Initial Application Testing
Participants from phase one were invited to test the beta version of the app. The testing revealed positive feedback, with users finding the game enjoyable and the content informative. The System Usability Scale (SUS) score was 87.5, indicating excellent usability.
“It’s sticking to it; it’s the willpower that’s hard” – Female participant, aged 85+
Implications and Future Directions
This study demonstrates the effectiveness of a person-centred approach in developing digital health interventions for older adults. By involving users in the design process, the research team ensured the final product was user-friendly and addressed the specific needs of the target audience.
While the study sample was relatively homogeneous, future research should aim to engage a more culturally diverse group to improve the generalizability of findings. Additionally, exploring the perspectives of other stakeholders, such as dietitians and community outreach teams, could further enhance the intervention.
As digital tools continue to evolve, they hold the potential to engage hard-to-reach and vulnerable groups, offering personalized health advice and easier meal planning. The integration of gamification in health interventions may increase user engagement and promote healthy behaviors through goal setting and feedback mechanisms.
Moving forward, researchers should consider the combined effect of digital interventions on health indicators and quality of life, potentially paving the way for more comprehensive solutions to support healthy ageing in older adults.
