Serious games (exergames) have the potential to be effective for postural balance and increasing muscle strength. Several games have been developed to increase physical fitness and balance among older adults. However, it is unclear to which degree usability and acceptability of exergames for older adults have been evaluated. The aim of this study was to summarize usability evaluation and acceptability of studies in older adults. We conducted a scoping review on studies focusing on usability of exergames for older adults. The result shows that older adults consider usability and acceptability of exercise video games good. The review shows that longitudinal studies mainly use off-the-shelf exergame and evaluated game effectiveness and acceptability, whereas cross-sectional studies focus on interactional experience. Studies varied in their approaches to measure usability and acceptability of exergames for older adults. There is a need for a systematic developmental approach to involve older adults in development of exergames for longitudinal studies.