Home > RNJ > 2009 > November/December > Were Not Just Playing Games: Into Aging An Aging Simulation Game

Were Not Just Playing Games: Into Aging An Aging Simulation Game
Deborah Dillon, RN GRN Diane Ailor, MSN RN Shelly Amato, MSN RN CRRN

Note. We apologize for the confusion, but this article will not be available for CE credit.

The elderly represent the largest-growing segment of the population. Specialized training in geriatrics is essential for healthcare professionals to provide optimal health care. As part of an ongoing education program on geriatrics, the game Into Aging: Understanding Issues Affecting the Later Stages of Life, 2nd ed. (1991) was provided to staff members of a facility to help healthcare providers develop personal insight into the aging process through role play. This game has provided the staff members with a better understanding of the issues patients experience as they deal with declines in health.

The elderly represent the largest-growing segment of the population; an estimated 71 million people will be 65 years or older by 2030 (Administration on Aging, 2008). Because of this increase, the number of elderly being cared for in the hospital setting will also be increasing. The need for healthcare professionals with specialized training in geriatrics is essential for providing optimal health care. In addition, the Joint Commission requires hospitals and healthcare organizations to provide age-specific orientation and ongoing education to promote safe and effective patient care (2008). Unfortunately, many nursing programs and medical schools (Bragg & Warshaw, 2005) have limited training for care of the elderly. Given this fact, it is essential that healthcare organizations provide their staff with the knowledge and skills necessary to care for the elderly.

Because many of our rehabilitation patients encounter changes in living arrangements, functional ability, independence, and roles, we felt it was extremely important to provide our staff members with the opportunity to experience what our patients face after being discharged from our facility. As part of an ongoing education program for our patient care providers regarding geriatric issues, we added content on challenges the elderly may face as a result of aging and chronic illnesses. We used Into Aging: Understanding Issues Affecting the Later Stages of Life, 2nd ed. (1991), an interactive aging simulation game developed by Susan Dempsey-Lyle, MSN CS RN, and Therese Lemire Hoffman, MSN BSN RN. After participating in this interactive game, attitudes toward the elderly among a variety of patient care providers who attended the training program significantly improved (Pacala, Boult, & Hepburn, 2006; Thomson & Burke, 1998).

Into Aging is designed to help healthcare providers develop a personal understanding of the aging process through role playing. Players assume the identity of an elderly person and experience various life events as they “age” throughout the game. They draw cards that determine their physical disabilities, healthcare problems, social issues, changes in living arrangements, financial status, the loss of loved ones, and, possibly, their own demise (Dempsey-Lyle & Hoffman, 1991).

We chose a half-day format to present the program, which included an introduction and overview of the game, 60–90 minutes to play the game, and a 30-minute debriefing and question-and-answer session. The session ended with a 1-hour presentation that included an overview of aging, demographics, physiological changes associated with aging, and myths of aging. Due to the interactive nature of the program, we limited the program to 12 participants for each session to allow more opportunities for players to interact in the learning process. Participants signed up voluntarily based on their interest in the program and scheduling availability. Multiple sessions were offered to allow all staff members the opportunity to attend.

Six or seven game facilitators were needed to conduct the program. The game facilitators included geriatric-resource staff nurses, clinical nurse specialists, and the director of geriatric nursing. The cost of presenting the program was approximately $200 and included purchasing the Into Aging game and the cost of laminating signs, which are reusable, and props for playing the game. Many of the props were donated; other props, such as wheelchairs and walkers, were borrowed from inpatient nursing units.

Patient care providers were the “players” who interacted with “game facilitators” as they proceeded through three levels of functioning, ranging from independent to totally dependent (Dempsey-Lyle & Hoffman, 1991; Samter & Voss, 1992). Players experienced ageism firsthand as game facilitators engaged in “subtle and overt behaviors that undermined the players’ functional abilities” (Samter & Voss, p. 18). The game ended when most players were placed in a disreputable facility that used restraints and provided substandard care, or, as in real life, players died and proceeded to the cemetery.

A debriefing session was held following the game to discuss players’ experiences. Role playing allowed the patient care providers an opportunity to experience the feelings their patients might have as they aged throughout the game. Many discussed the overwhelming loss of control that occurred as they dealt with issues of aging. They also expressed feelings of anger, hopelessness, frustration, sadness, and shame. Several patient care providers commented that role playing made them identify with patients and realize “this might be us one day.”

Into Aging has been described as a “powerful learning” tool that can be played by all levels of healthcare providers (Smoyak, 1991, p. 6). Into Aging promotes self-reflection and consideration about attitudes toward caring for older adults for healthcare professionals and allows them to put themselves in their patients’ shoes. Healthcare professionals get a sense of what patients encounter when their health declines to the point of requiring frequent hospitalizations or placement in a skilled nursing facility.

This program allowed our patient care providers an opportunity to experience the impact of aging and illness on independence, self-esteem, and role changes. We received so much positive feedback regarding this program that we now offer it annually for all levels of nursing staff.

About the Authors

Deborah Dillon, RN, is a geriatric resource nurse at MetroHealth Rehabilitation Institute of Ohio in Cleveland, OH. Address correspondence to her at ddillon@metrohealth.org.

Diane Ailor, MSN RN, is a geriatric clinical nurse specialist at MetroHealth Medical Center in Cleveland, OH.

Shelly Amato, MSN RN CRRN, is a clinical nurse specialist at MetroHealth Rehabilitation Institute of Ohio in Cleveland, OH.


Administration on Aging. (2008). Statistics on the aging population. Retrieved March 12, 2008, from www.aoa.gov/prof/Statistics/statistics.asp.

Bragg, E. J., & Warshaw, G., A. (2005). ACGME requirements for geriatric medicine curricula in medical specialties: Progress made and progress needed. Academic Medicine, 80(3), 279–285.

Dempsey-Lyle, S., & Hoffman, T. (1991). Into aging: Understanding issues affecting the later stages of life (2nd ed.). Thorofare, NJ: Slack Incorporated.

Joint Commission. (2008). Comprehensive Accreditation Manuals for Hospitals: The Official Handbook. Oakbrook Terrace, IL: Author.

Pacala, J. T., Boult, C., & Hepburn, K. (2006). Ten years’ experience conducting the Aging Game workshop: Was it worth it? Journal of the American Geriatrics Society, 54(1), 144–149.

Samter, J., & Voss, B. (1992). Challenging the myths of aging. Geriatric Nursing, 13(1), 17–21.

Smoyak, S. (1991). Foreword to Second Edition. In S. Dempsey-Lyle & T. Hoffman, Into aging: Understanding issues affecting the later stages of life. Thorofare, NJ: Slack Incorporated.

Thomson, M., & Burke, K. (1998). A nursing assistant training program in a long-term care setting. Gerontology & Geriatrics Education, 19(1), 23–35.