Play is often a distant childhood memory for older people and not considered age-appropriate for the aged to engage in. However, a few studies in non-Chinese societies have found preliminary evidence that play and therapeutic play for the elderly produced positive effects in them. Noticing there was no standard test for measuring the perception of play among the elderly, an interdisciplinary research team has developed a Perception of Play Questionnaire for older adults, which will help further studies on the efficacy of therapeutic play as a potential basis for health and well-being interventions for older people.

People's bodies and brains change as they age, as do their familial, social and economic circumstances over time. Some older people who have problems coping may be prescribed medication or cognitive-behavioural therapy to assist them, but these treatments may be unsuitable for those with cognitive or physical impairments and who are unable to express themselves clearly. Play therapy has been extensively studied as an intervention for young children with emotional, behavioural or mental health problems to develop their social and communication skills, and cognitive and decision-making abilities.

The research team, featuring Assistant Professor Dr Mimi Tse Mun-yee and Assistant Professor Dr Paul Lee Hong of PolyU's School of Nursing, outlined a few previous studies that found play produced positive effects in older people. Among them was a study of long-term sports and board games players in the US aged between 62 and 89 years old and their reasons why they played them, such as keeping active, having an enjoyable activity to look forward to regularly and which helped them to structure the rest of their day, the challenge of competing against someone or improving one's game, and a sense of belonging. Another study on Americans aged 82 years old on average and who were staying in independent-living flats compared those who were assigned to play Wii with a responsive research assistant and those who were assigned to watch TV with a responsive research assistant. It was found that those who had played Wii felt less lonely and had a more positive mood than those who had watched TV.

Dr Tse and her co-authors also pointed to the preliminary findings of a US study on play therapy for the elderly. The study reported that play therapy sessions for nursing home residents aged 59 to 89 years old using toys, basic art materials, and small familiar household objects that could elicit reminiscing seemed to have made them more active, less withdrawn, mentally sharper, happier, and more willing to discuss and tackle difficult issues they faced.

Despite these promising findings, the various studies used different tools and techniques to gauge the effect of play or therapeutic play on the elderly. Thus Dr Tse, Dr Lee and their collaborator decided to devise a questionnaire that could function as a standard instrument to accurately record how the elderly view play and their level of acceptance of play.

To generate their prototype Perception of Play Questionnaire, the research team conducted a comprehensive literature review and consulted experienced experts in play, resulting in the creation of 17 positive and negative sentences that examined one of the 'subthemes' of "liking to play," "age factor," "play as social development," and "play as personal development." The sentences, written in traditional Chinese characters, described views about play from a first-person perspective ("I …"). Each of the 17 sentences or items was accompanied by a 5-point Likert scale ranging from "1 Not agree at all" to "5 Agree most" written in traditional Chinese to enable users to rate how they feel about the view espoused in each item. A panel of experts experienced in play and the care of the elderly then evaluated the questionnaire for content validity by rating each item for clarity, relevance, and completeness. The content validity was judged to be good and none of the items were rejected.

A pilot study of the questionnaire was then carried out on 179 mentally capable nursing home residents in Hong Kong aged 65 years or older who could read traditional Chinese and speak Cantonese and who gave their informed consent to participate. Their demographic characteristics, mobility, pain situation, frailty, life satisfaction, happiness, and loneliness were recorded in the pilot study using existing methods. The questionnaire and other methods were administered to the residents at the beginning of the pilot study and again 2 weeks later.

The questionnaire and the results of its pilot study were then statistically analysed. The items were found to have satisfactory correlations with other items within the same 'subtheme' and with items elsewhere in the questionnaire, giving the questionnaire good internal consistency. The questionnaire also had high test-retest reliability. Statistically significant correlations were found between the perception of play as measured by the questionnaire and the 'psychological' measurements of the nursing home residents, namely their life satisfaction, happiness, and loneliness. Significant correlations were also present between the perception of play and the residents' 'physical' measurements of mobility, frailty, and their pain situations.

Given these, the Perception of Play Questionnaire is a suitable tool to investigate how Hong Kong Chinese elderly view and accept the concept of play, which will ultimately aid in the study and potential planning of health and well-being interventions based on therapeutic play for the aged.