Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study

Virtual reality-based reminiscence therapy for older adults to improve psychological well-being and cognition: A systematic review

BACKGROUND

Virtual reality-reminiscence therapy (VR-RT) has increasingly been applied to older adults to improve psychological well-being and cognition.

OBJECTIVE

This review aims to identify (1) the design characteristics of conducting a VR-RT and (2) the effects of VR-RT on the user experience, cognitive outcomes and psychological well-being.

DESIGN

Systematic review.

METHODS

Eligible studies were sourced across nine electronic databases, trial registries, grey literature and hand-searching of the reference list. A narrative synthesis was conducted. Twenty-two studies were included, and most were appraised as high quality. Most of the VR-RTs were highly immersive and personalised, with participants having the autonomy of control. VR-RT has the potential to improve anxiety and depression, and cognitive outcomes for older adults. Overall, VR-RT was reported to be an enjoyable experience for older adults.

CONCLUSIONS

VR-RT is a promising innovation that can improve older adults' psychological well-being and cognition without significant side effects, including cybersickness and with the potential for scalability across various settings. More randomised controlled studies are needed to evaluate the effectiveness of VR-RT and its features and treatment dosage. These studies could also examine the effectiveness of VR-RT as an intervention to promote independence in activities of daily living and physical rehabilitation.

RELEVANCE TO CLINICAL PRACTICE

VR-RT is a promising intervention for older adults in community settings to enhance psychological well-being and cognition. VR's versatility enables personalised experiences within dynamic virtual environments, possibly enhancing engagement and therapeutic outcomes.

NO PATIENT OR PUBLIC CONTRIBUTION

This systematic review did not directly involve patient or public contribution to the manuscript.

Seeking residents' views regarding Australian residential aged care: A scoping review

OBJECTIVE

This scoping review aimed to explore topics on which the views of residents of Australian residential aged care facilities (RACFs) have been sought.

METHODS

Scoping review methodology as outlined by Arksey and O'Malley was used to identify, explore and report on the range of literature regarding views of RACF residents. Seven electronic databases were searched using broad search terms relevant to the RACF context. Descriptive numerical analysis was completed for publication year, journal name and target profession, research methods and participant types. Thematic analysis then focussed on the aims of the included studies.

RESULTS

Four thousand two hundred and ninety studies were screened, and 104 publications met the inclusion criteria. A broad range of topics were explored by researchers, with the largest number of papers focused on residents' views of systems within RACFs (n = 24) and new programs and interventions (n = 21). Smaller topic areas included health conditions and health-care services (n = 13), socialisation (n = 13), physical activity (n = 3), self-care (n = 4), leisure (n = 4), general everyday life (n = 20) and aspects of the residential aged care environment (n = 15). There was limited exploration of meaningful activity (n = 13). The inclusion of residents with cognitive impairment was inconsistent, and the voices of other stakeholders were often privileged.

CONCLUSION

Voices of residents must be heard in order to prioritise the health and well-being of this population. More research which focuses on what is important to residents is needed and must include residents with cognitive impairment more effectively. Identification of optimal research methods with this population would make an important contribution in this area.

Acceptability of virtual reality to screen for dementia in older adults

BACKGROUND

Early detection of dementia and cognitive decline is crucial for effective interventions and overall wellbeing. Although virtual reality (VR) tools offer potential advantages to traditional dementia screening tools, there is a lack of knowledge regarding older adults' acceptance of VR tools, as well as the predictors and features influencing their adoption. This study aims to (i) explore older adults' perceptions of the acceptability and usefulness of VR diagnostic tools for dementia, and (ii) identify demographic predictors of adoption and features of VR applications that contribute to future adoption among older adults.

METHODS

A cross-sectional study was conducted involving community-dwelling older adults who completed online questionnaires covering demographics, medical history, technology acceptance, previous usage, and perceived usefulness and barriers to VR adoption. Multiple linear regression was employed to assess relationships between sociodemographic factors, prior technology use, perceived ease, usefulness, and intention to adopt VR-based diagnostic tools.

RESULTS

Older adults (N = 77, Mage = 73.74, SD = 6.4) were predominantly female and born in English-speaking countries. Perceived usefulness of VR applications and educational attainment emerged as significant predictors of the likelihood to use VR applications for dementia screening. Generally, older adults showed acceptance of VR applications for healthcare and dementia screening. Fully immersive applications were preferred, and older adults were mostly willing to share electronic information from screening with their healthcare providers.

CONCLUSIONS

The field of research on VR applications in healthcare is expanding. Understanding the demographic characteristics of populations that stand to benefit from healthcare innovations is critical for promoting adoption of digital health technologies and mitigating its barriers to access.

3R Nursing Combined with Dietary and Nutritional Interventions Enhances Self-care Ability in Elderly Patients with Vascular Dementia

BACKGROUND

Vascular dementia (VD) is an extremely common neurological dysfunction in the elderly population, and greatly affects the patient's ability to take care of themselves. Recent research suggests that VD patients need more targeted and individualized nursing during treatment, so as to enhance cognitive function and therapeutic efficacy. The objective of this study is to observe the effect of reminiscence, reality, and remotivation (3R) nursing combined with dietary and nutritional interventions on elderly patients with VD, so as to provide clinical evidence for the management of VD in older adults.

METHODS

120 elderly VD patients admitted between December 2022 and December 2023 were selected, including 64 cases receiving 3R nursing combined with dietary and nutritional interventions (the research group) and 56 cases receiving routine nursing (the control group). The two groups were compared in terms of neurological function, self-care ability, and nutritional status before and after nursing, as well as nursing compliance. After the completion of the care, patients' quality of life and family satisfaction were investigated.

RESULTS

In comparison with the control group, the research group displayed higher scores on the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), greater self-care ability, and higher levels of nutritional proteins and grip strength (p < 0.05). In addition, patients in the research group displayed greater nursing compliance and quality of life of patients, as well as higher family satisfaction (p < 0.05).

CONCLUSIONS

3R nursing combined with dietary and nutritional interventions can effectively improve the neurological function of VD patients and enhance their self-care ability.

Virtual reality-based simulation intervention for enhancing the empathy of informal caregivers of people with dementia: A mixed-methods systematic review

Dementia is a long-term and progressive syndrome that not only influences the person with dementia (PWD) but also the caregiver. However, informal caregivers are not always empathic and understand the symptoms of dementia, leading to destructive caregiving relationships and poor quality of caregiving. VR-based simulation interventions can provide a more realistic and memorable learning experience for caregivers to walk in PWDs' shoes. This review aimed to provide practitioners and researchers with insights on developing and/or adopting an effective VR-based simulation intervention for enhancing the empathy of informal caregivers of PWD. A mixed-methods systematic review was conducted. Quantitative, qualitative, and mixed-methods studies were searched from MEDLINE, PsycINFO, CINAHL, Scopus, Embase, and Cochrane Library updating. Standard JBI critical appraisal instruments were used for the quality appraisal. A convergent segregated approach was used to synthesize and integrate the data. A total of seven studies were included. Inconsistent quantitative results were reported on the effects of VR-based simulation on empathy enhancement. Significant effects were reported on knowledge of dementia and emotion-focused coping strategies. Two themes were generated from the qualitative studies, including "Informal caregivers gained better insight into problems encountered by older people with dementia" and "Thinking from the perspective of older people with dementia, leading to changes in attitudes and behaviours towards dementia". The qualitative synthesized evidence showed that informal caregivers gained better insight into problems encountered by PWD, but the quantitative synthesized results are inconsistent. Yet, informal caregivers experienced a change in attitude by thinking from the perspective of PWD.

Potential of virtual reality to meaningfully engage adults living with dementia in care settings: A scoping review

INTRODUCTION

Older adults living with dementia in residential aged care homes receive physical care but may have limited access to meaningful engagement. Due to its multimodal and versatile nature, virtual reality (VR) is speculated to be an effective means of meaningfully engaging residents individually and/or in groups. However, there is little evidence regarding its efficacy as a means of meaningfully engaging older adults living with dementia. The objective of this scoping review is to identify and synthesise published research investigating the use of VR technology in promoting the meaningful engagement of older adults living with dementia in residential aged care facilities.

METHODS

A scoping review following Arksey and O'Malley's (2005) established process was conducted and included identifying and selecting relevant studies from seven databases (i.e., AgeLine, CINAHL, Medline, Cochrane, Embase, PsycINFO and Scopus), data charting, and collating, summarising and reporting findings. Two independent reviewers used Covidence and Excel to support data extraction and analysis.

RESULTS

The 20 eligible studies revealed discrepancies in the classification of VR and strengths, weaknesses, opportunities and threats associated with its implementation. Findings indicate that the most influential factor in eliciting meaningful engagement is when VR use facilitates interpersonal interactions and opportunities for human connection.

CONCLUSION

Although VR seems to be a promising medium in engaging older adults living with dementia, the efficacy of implementing VR technology within care facilities should be considered alongside potential environmental enablers and barriers. The apparent strength of implementing VR as a means of encouraging restoration, pleasure and productivity in older adults living with dementia lies in the fact that it creates opportunities for meaningful engagement on social and occupational levels.

Immersive virtual reality in the promotion of health and well-being for people in residential aged care without cognitive impairment: A scoping review

Objective

Sustaining the health and well-being of older people living in residential aged care (RAC) requires new means of providing safe and stimulating recreational and therapeutic programs such as using virtual reality (VR). The aim of the scoping review was to investigate the utility of immersive VR interventions using head-mounted display technology to promote the health and well-being of people without cognitive impairment living in RAC.

Method

The following databases were searched from inception until January 2024: PubMed, PsycINFO, Scopus, Cochrane and CINAHL. The eligibility criteria were quantitative, qualitative or mixed methods studies published in English, conducted in RAC, using VR with head-mounted display with people without cognitive impairment.

Results

Of the 274 articles identified, 9 articles with a total of 310 residents and 50 staff met the inclusion criteria. Seven factors to either impede or enable the use of VR with head-mounted displays in RAC were: residents' agency; the nature of the VR experience; the content of the experience; the ease of use and comfort of the technology; the role of RAC staff; and the role of residents' family members.

Conclusion

Immersive VR has potential as a tool to promote the health and well-being of people without cognitive impairment living in RAC. Small sample sizes, variations in study design, and selection bias mean that generalisability of the results is limited. Further research is recommended to inform the design and implementation of immersive VR programs tailored specifically for this population.

In too deep? A systematic literature review of fully-immersive virtual reality and cybersickness among older adults

BACKGROUND

Virtual reality technology holds great promise in improving the health and well-being of older adults; however, this technology is associated with potential risks that may outweigh the benefits. The purpose of this systematic review is to synthesize and critique the existing literature on fully-immersive virtual reality interventions for older adults and the associated risk of cybersickness.

METHODS

We searched eight databases for studies that utilized fully-immersive virtual reality, stated the population as older adults, provided outcomes related to cybersickness, and were written or translated into the English language. Our search generated 332 articles, 39 of which were selected for inclusion in this systematic synthesis and appraisal.

RESULTS

We found that the majority of studies utilized a one-time session. The studies generally had weak sample generalizability and methodological design, but strong data collection and participant retention. The studies nearly all used the Simulator Sickness Questionnaire to measure cybersickness, but the scoring for the Simulator Sickness Questionnaire varied or was not mentioned. Most included studies reported only minor cybersickness among older adult participants.

CONCLUSION

Researchers might conclude that the benefits of virtual reality interventions outweigh the risk of cybersickness in this population. Going forward, researchers should concentrate on the efficacy of virtual reality interventions among older adults, using larger samples and randomized controlled study design, along with measuring dosage effects.

The Application of Fully Immersive Virtual Reality on Reminiscence Interventions for Older Adults: Scoping Review

BACKGROUND

The increasing number of older adults with mental, behavioral, and memory challenges presents significant public health concerns. Reminiscence is one type of nonpharmacological intervention that can effectively evoke memories, stimulate mental activities, and improve psychological well-being in older adults through a series of discussions on previous experiences. Fully immersive virtual reality (FIVR) may be a useful tool for reminiscence interventions because it uses realistic virtual environments connected to a person's significant past stories.

OBJECTIVE

This review aims to examine empirical evidence regarding the application of FIVR in reminiscence interventions, its usability and acceptability, and its effectiveness in assisting the intervention to achieve optimal outcomes.

METHODS

We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach for scoping reviews. The PubMed, PsycINFO, Embase, CINAHL, Web of Science, ACM, and IEEE Xplore electronic databases were used for the search. We included peer-reviewed studies that used FIVR as an assistive tool for reminiscence interventions; were published between January 1, 2000, and August 1, 2022; reported empirical research; involved older adults as participants; and addressed health- and behavior-related outcomes or the feasibility and usability of FIVR. We used Endnote X9 to organize the search results and Microsoft Excel for data extraction and synthesis.

RESULTS

Of the 806 articles collected from the databases and other resources, 11 were identified. Most of the studies involved participants aged between 70 and 90 years. Only 1 study did not involve those with cognitive impairments, whereas 3 specifically targeted people living with dementia. The results indicated that FIVR reminiscence interventions enhanced engagement and reduced fatigue. Although some studies have observed positive effects on anxiety, apathy, depression, cognitive functions, and caregiver burden reduction, these findings were inconsistent across other research. In addition, FIVR showed overall usability and acceptability with manageable side effects among older adults across various health conditions during reminiscence sessions. However, 1 study reported adverse feelings among participants, triggered by unpleasant memories evoked by the virtual reality content.

CONCLUSIONS

The role of FIVR in reminiscence interventions remains nascent, with limited studies evaluating its impacts on older adults. Many of the reviewed studies had notable limitations: small sample sizes, absence of rigorous research design, limited assessment of long-term effects, lack of measures for health and behavior outcomes, and quality of life. Beyond these limitations, this review identified a list of future research directions in 6 categories. On the basis of the review findings, we provide practical recommendations to enhance FIVR reminiscence interventions, covering topics such as virtual reality content, device choice, intervention types, and the role and responsibility of facilitators.

Offering Outworld Experiences to In-Patients With Dementia Through Virtual Reality: Mixed Methods Study

Background

Research has suggested that institutionalization can increase the behavioral and psychological symptoms of dementia. To date, recent studies have reported a growing number of successful deployments of virtual reality for people with dementia to alleviate behavioral and psychological symptoms of dementia and improve quality of life. However, virtual reality has yet to be rigorously evaluated, since the findings are still in their infancy, with nonstatistically significant and inconclusive results.

Objective

Unlike prior works, to overcome limitations in the current literature, our virtual reality system was co-designed with people with dementia and experts in dementia care and was evaluated with a larger population of patients with mild to severe cases of dementia.

Methods

Working with 44 patients with dementia and 51 medical experts, we co-designed a virtual reality system to enhance the symptom management of in-patients with dementia residing in long-term care. We evaluated the system with 16 medical experts and 20 people with dementia.

Results

This paper explains the screening process and analysis we used to identify which environments patients would like to receive as an intervention. We also present the system's evaluation results by discussing their impact in depth. According to our findings, virtual reality contributes significantly to the reduction of behavioral and psychological symptoms of dementia, especially for aggressive, agitated, anxious, apathetic, depressive, and fearful behaviors.

Conclusions

Ultimately, we hope that the results from this study will offer insight into how virtual reality technology can be designed, deployed, and used in dementia care.

Affective Out-World Experience via Virtual Reality for Older Adults Living with Mild Cognitive Impairments or Mild Dementia

Older adults with cognitive impairments may face barriers to accessing experiences beyond their physical premises. Previous research has suggested that missing out on emotional experiences may affect mental health and impact cognitive abilities. In recent years, there has been growing research interest in designing non-pharmacological interventions to improve the health-related quality of life of older adults. With virtual reality offering endless opportunities for health support, we must consider how virtual reality can be sensitively designed to provide comfortable, enriching out-world experiences to older adults to enhance their emotional regulation. Thirty older adults living with mild cognitive impairment or mild dementia participated in the study. Affect and emotional behavior were measured. The usability and the sense of presence were also assessed. Finally, we assessed the virtual reality experiences based on physiological responses and eye-tracking data. The results indicated that virtual reality can positively enhance the mental health of this population by eliciting a positive affective state and enhancing their emotional regulation. Overall, this paper raises awareness of the role of virtual reality in emotion elicitation, regulation, and expression and enhances our understanding of the use of virtual reality by older adults living with mild cognitive impairments or mild dementia.

Fully Immersive Virtual Reality Using 360° Videos to Manage Well-Being in Older Adults: A Scoping Review

OBJECTIVE

The development of negative behavioral and psychosocial factors (depression, anxiety, apathy, etc) is associated with poor well-being, which can contribute to health issues in ageing, especially in the context of COVID-19. Despite its relative novelty, fully immersive virtual reality (VR) interventions through 360° immersive videos are becoming more accessible and flexible and constitute an emerging method to potentially enhance well-being. The aim of this scoping review is to assess the effectiveness of 360° interventions on well-being in older adults with or without cognitive impairment, as well as cybersickness and attitudes toward this technology.

DESIGN

Scoping review.

SETTING AND PARTICIPANTS

Older adults with or without cognitive impairment.

METHODS

The PRISMA-SR guideline was followed. Four databases were used, and we selected articles published until April 2022. We have analyzed the effect of 360° videos on the well-being of older adults with respect to the study design, the population, the contents, the duration of intervention, and the outcomes.

RESULTS

A total of 2262 articles were screened, of which 10 articles were finally included in this review. Most of them are pilot studies and used mixed methods including scales and interviews. The material and content of VR are diversified. Many behavioral and psychological outcomes were assessed, including anxiety, apathy, loneliness, depression, social engagement, quality of life, and emotions. The results were positive or mixed, according to the outcomes. We recorded few adverse events, and the interviews show contrasting results concerning the participants' feelings (ie, degree of immersion, familiarity with technology, and VR content).

CONCLUSIONS AND IMPLICATIONS

The use of VR 360° videos seems feasible in community-dwelling older adults or residential aged care facilities, as they are safe and provide enjoyment. It constitutes an emerging and promising therapeutic tool to manage psychosocial disorders. This review provides key considerations for the design and implementation of interventions using VR 360° video in clinical practice.

Facilitators and Barriers to Using Virtual Reality and its Impact on Social Engagement in Aged Care Settings: A Scoping Review

Aim: This scoping review aims to identify the facilitators and barriers to the implementation of VR technology in the aged-care setting. Background: Virtual reality (VR) offers the potential to reduce social isolation and loneliness through increased social engagement in aged-care settings. Methods and Analysis: This scoping review followed the Joanna Briggs Institute scoping review methodology and took place between March and August 2022. The review included a three-step search strategy: (1) identifying keywords from CINHAL, Embase, Medline, PsycInfo, Scopus, and Web of Science (2) conducting a second search using all identified keywords and index terms across selected databases; and (3) searching the reference lists of all included articles and reports for additional studies. Results: The final review included 22 articles. The analysis identified factors affecting the VR technology implementation in aged care settings to reduce isolation and loneliness: (a) key facilitators are local champions and staff training. (b) barriers include technological adaptability, video quality, and organizational culture. Conclusion: Existing evidence points to VR as a promising intervention to decrease loneliness and feelings of isolation and improve social engagement in older people living in aged-care settings.

Effectiveness of life story book intervention on apathy and verbal fluency in people with dementia

OBJECTIVES

This study determined whether the individual intervention of using life story books (LSBs) improves apathy and verbal fluency in people with dementia (PWD).

METHODS

The intervention group (n = 43) underwent 3 interviews in the 10 weeks following an initial assessment. Based on the information obtained, LSBs were developed; participants received individual interventions weekly, five times for four weeks. They also received a final assessment 12 weeks after the end of the intervention. Primary outcome measures comprised the Categorical Verbal Fluency Test (CFT) and the Neuropsychiatric Inventory-Nursing Home Apathy sub-item. The control group (n = 32) underwent initial and final assessments at intervals of 28 weeks while receiving the best care services.

RESULTS

CFT scores for participants with mild to moderate dementia increased from 4.3 to 5.3 (P < .05) and the interaction effect of group and data collection timing was significant (p < .05). Apathy score for participants with severe dementia also improved from 4.5 to 2.5 (P < .05) immediately after the intervention period.

CONCLUSIONS

LSB is a comprehensive communication tool that encourages apathy and verbal fluency.

CLINICAL IMPLICATIONS

The use of LSB may allow caregivers to achieve intervention effects on apathy and verbal fluency in PWD.

Veterans Affairs Health Care Provider Perceptions of Virtual Reality: Brief Exploratory Survey

Background

Virtual reality (VR), a simulated experience that can be similar to or completely different from the real world, has become increasingly useful within the psychiatric and medical fields. This VR technology has been applied in medical school trainings, exposure therapy for individuals with posttraumatic stress disorder (PTSD), and reminiscence therapy associated with mood disorders for older adults. Perceptions of VR through the lens of the health care provider require further exploration. VR has grown in popularity; however, this modality continues to be underused in most Veterans Affairs (VA) hospitals.

Objective

A web-based survey was used to explore health care provider perceptions of immersive VR availability and use for older adults and identify potential barriers for immersive VR use in older adults with cognitive impairment.

Methods

An 8-item web-based survey was developed to obtain health care provider feedback. This survey was disseminated throughout a single Veterans Integrated Services Network (VISN). The VR survey was developed via the Survey Monkey platform and distributed through the secure VA email network. Providers were asked to voluntarily participate in the brief, anonymous survey and offer their perceptions of immersive VR use within their patient population. Survey data were reviewed and interpreted using descriptive statistics.

Results

A total of 49 respondents completed the survey over a 15-day period. Of them, 36 respondents (73%) had heard of a VR device, though the majority (n=44, 90%) had never used or prescribed a VR device. Respondents identified several potential barriers to immersive VR use in older adults with cognitive impairment (eg, hearing difficulties, perceptions of technology, cognitive concerns, access to resources, and visual impairment). Despite the barriers identified, providers (n=48, 98%) still reported that they would feel comfortable prescribing immersive VR as an intervention for their patient population.

Conclusions

Survey findings revealed that health care providers within this VISN for VAs have heard of VR, although they may not have actively engaged in its use. Most of the providers reported that they would prescribe the use of an immersive VR intervention for their older adult patients. This key point highlights the desire to implement VR strategies for patient use by their providers. If underlying barriers can be addressed and relatively resolved, this technological intervention has the potential to create substantial breakthroughs in clinical care.

The Long-term Effects of Immersive Virtual Reality Reminiscence in People With Dementia: Longitudinal Observational Study

Background

Novel nonpharmacological therapies are being developed to prevent cognitive decline and reduce behavioral and psychological symptoms in patients with dementia. Virtual reality (VR) reminiscence was reported to improve anxiety, apathy, and cognitive function immediately after intervention in individuals at residential aged care facilities. However, its effect on elderly patients with dementia and how long this effect could last remain unknown.

Objective

The aim of this paper is to investigate the effect of immersive VR reminiscence in people with dementia both immediately after and 3-6 months after intervention.

Methods

A pilot study was conducted in 2 dementia care units. VR reminiscence therapy sessions were conducted twice per week for a 3-month period. Cognitive function, global status, depressive symptoms, and caregiver burden were assessed before and immediately after VR intervention in 20 participants. Subsequently, 7 participants were reassessed 3-6 months after the VR intervention. Wilcoxon sign-rank test was used for statistical comparisons of the changes.

Results

There were no significant changes in cognitive function, global status, and caregiver burden immediately after the VR intervention, but there was a significant reduction in depressive symptoms (P=.008). Moreover, compared with the cognitive function immediately after VR, it kept declining 3-6 months after.

Conclusions

Immersive VR reminiscence can improve mood and preserve cognitive function in elderly patients with dementia during the period of the intervention. Studies using a control group and comparing the use of VR with traditional forms of reminiscence should be conducted in the future to confirm and expand on these findings.

A Virtual Reality Intervention to Reduce Dementia-Related Agitation Using Single-Case Design

OBJECTIVES

The primary objective of this study was to use a single-case design to evaluate the utility of a VR intervention to reduce agitation behaviors in two female participants with a diagnosis of dementia.

METHODS

A single-case research design with an ideographic approach was selected given the novelty of this intervention. A blended single case experimental design was used combining the Multiple-baseline design across individuals with a reversal design to examine the effects of VR nature scenes on agitation. Visual analysis was used to determine changes in mean, level, and latency of the behaviors.

RESULTS

For both participants, a significant decrease in their respective agitation behaviors was observed during intervention phases.

CONCLUSIONS

This study provides preliminary evidence of the utility of VR as a brief and effective intervention to decrease agitation in individuals with dementia.

CLINICAL IMPLICATIONS

These initial, promising results may help caregivers improve the quality of life for dementia patients. Further, the brevity of the intervention makes this a practical tool for care providers working in clinical settings. The primary objective of this study was to use a single-case design to evaluate the utility of a VR intervention to reduce agitation behaviors in two female participants with a diagnosis of dementia.

Virtual Reality in Palliative Care: A Systematic Review

Background: Virtual reality (VR) using head-mounted displays (HMDs) has demonstrated to be an effective tool for treating various somatic and psychological symptoms. Technological advances and increased affordability of VR technology provide an interesting option for delivering psychological interventions to patients in palliative care. The primary aim of this systematic review was to synthesise the available research on the use of VR for enhancing psychological and somatic outcomes for palliative care patients. Secondary aims included assessing general satisfaction and overall usability. Method: A pre-registered systematic literature search was conducted according to PRISMA guidelines using OVID Emcare, Cochrane Library, Embase, Medline, PsycINFO, and PubMed Care Search: Palliative Care Knowledge Network. Peer-reviewed experimental, quasi-experimental, observational, case, and feasibility studies consisting of single or multiple VR sessions using HMDs that reported psychological and/or somatic outcomes were included. Results: Eight studies published between 2019 and 2021 were included, representing 138 patients. While the reported quantitative psychological and somatic outcomes were ambiguous, the qualitative outcomes were largely positive. Participants were generally satisfied with VR, and most studies reported the VR interventions as usable, feasible, and acceptable. Conclusions: VR shows promise in palliative care and generally addresses a range of symptoms with few adverse effects. Future research should consist of adequately powered RCTs evaluating dosage and focusing on providing meaningful activities to enhance outcomes further.

Virtual Reality in Health Care: Bibliometric Analysis

BACKGROUND

Research into the application of virtual reality technology in the health care sector has rapidly increased, resulting in a large body of research that is difficult to keep up with.

OBJECTIVE

We will provide an overview of the annual publication numbers in this field and the most productive and influential countries, journals, and authors, as well as the most used, most co-occurring, and most recent keywords.

METHODS

Based on a data set of 356 publications and 20,363 citations derived from Web of Science, we conducted a bibliometric analysis using BibExcel, HistCite, and VOSviewer.

RESULTS

The strongest growth in publications occurred in 2020, accounting for 29.49% of all publications so far. The most productive countries are the United States, the United Kingdom, and Spain; the most influential countries are the United States, Canada, and the United Kingdom. The most productive journals are the Journal of Medical Internet Research (JMIR), JMIR Serious Games, and the Games for Health Journal; the most influential journals are Patient Education and Counselling, Medical Education, and Quality of Life Research. The most productive authors are Riva, del Piccolo, and Schwebel; the most influential authors are Finset, del Piccolo, and Eide. The most frequently occurring keywords other than "virtual" and "reality" are "training," "trial," and "patients." The most relevant research themes are communication, education, and novel treatments; the most recent research trends are fitness and exergames.

CONCLUSIONS

The analysis shows that the field has left its infant state and its specialization is advancing, with a clear focus on patient usability.

Virtual Reality Experience Intervention May Reduce Responsive Behaviors in Nursing Home Residents with Dementia: A Case Series

BACKGROUND

People with advanced dementia often exhibit responsive behaviors such as apathy, depression, agitation, aggression, and psychosis. Non-pharmacological approaches (e.g., listening to music, watching television, doing arts and crafts) are now considered as a first-line strategy to manage responsive behaviors in clinical practice due to the potential risks associated with the antipsychotic medications. To date, no evaluations of immersive non-head mounted virtual reality (VR) experience as a non-pharmacologic approach for people with advanced dementia living in nursing homes have been reported.

OBJECTIVE

To evaluate the feasibility (acceptance and safety) of VR experience.

METHODS

A single site case series (nonrandomized and unblinded) with a convenience sample (N = 24; age = 85.8±8.6 years; Cognitive Performance Scale score = 3.4±0.6) measuring depression and agitation before and after the intervention. The intervention was a 30-min long research coordinator- facilitated VR experience for two weeks (10 sessions).

RESULTS

The intervention was feasible (attrition rate = 0% ; adverse events = 0). A reduction in depression and in agitation was observed after the intervention. However, we suggest extreme caution in interpreting this result considering the study design and small sample size.

CONCLUSION

This study provides the basis for conducting a randomized controlled trial to evaluate the effect of VR experience on responsive behaviors in nursing homes. Since our intervention uses a smart remote-controlled projector without a headset, infectious exposure can be avoided following the COVID-19 pandemic-induced physical distancing policy in care homes.

The Effect of Reminiscence Therapy Using Virtual Reality on Apathy in Residential Aged Care: Multisite Nonrandomized Controlled Trial

Background

Apathy is a frequent and underrecognized neurological disorder symptom. Reduced goal-directed behavior caused by apathy is associated with poor outcomes for older adults in residential aged care. Recommended nonpharmacological treatments include person-centered therapy using information and communication technology. Virtual reality (VR) in the form of head-mounted displays (HMDs) is a fully immersive technology that provides access to a wide range of freely available content. The use of VR as a therapy tool has demonstrated promise in the treatment of posttraumatic stress disorder and anxiety. In addition, VR has been used to improve conditions including depression, anxiety, cognitive function, and balance in older adults with memory deficits, Alzheimer disease, and Parkinson disease. Research using VR for the symptoms of apathy in older adults living in residential aged care facilities is limited.

Objective

This study aims to examine whether using HMDs as a tool for reminiscence therapy improves the symptoms of apathy compared with using a laptop computer and physical items with older adults living in residential aged care.

Methods

In this multisite trial, 43 participants were allocated to one of three groups: reminiscence therapy intervention using VR in the form of HMDs, reminiscence therapy using a laptop computer supplemented by physical items if required (active control), and a usual care (passive control) group. The primary outcome was apathy, and the secondary outcomes included cognition and depression. The side effects of using HMDs were also measured in the VR group.

Results

Mixed model analyses revealed no significant group interaction over time in outcomes between the VR and laptop groups (estimate=−2.24, SE 1.89; t₄₀=−1.18; P=.24). Pooled apathy scores in the two intervention groups compared with the passive control group also revealed no significant group interaction over time (estimate=−0.26, SE 1.66; t₄₀=−0.16; P=.88). There were no significant secondary outcomes. Most participants in the VR group stated that they would prefer to watch content in VR than on a flat screen (Χ²₂=11.2; P=.004), side effects from HMD use were negligible to minimal according to the Simulator Sickness Questionnaire cutoff scores.

Conclusions

Although there were no significant results in outcome measures, this study found that participants engaged in the research and enjoyed the process of reminiscing using both forms of technology. It was found that VR can be implemented in an aged care setting with correct protocols in place. Providing residents in aged care with a choice of technology may assist in increasing participation in activities. We cannot dismiss the importance of immediate effects while the therapy was in progress, and this is an avenue for future research.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12619001510134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378564.

International Registered Report Identifier (IRRID)

RR2-DOI: 10.1136/bmjopen-2020-046030

Feasibility of Group-Based Multiple Virtual Reality Sessions to Reduce Behavioral and Psychological Symptoms in Persons Living in Residential Aged Care

OBJECTIVES

To assess the feasibility of using group-based fully immersive virtual reality (VR) across multiple sessions to reduce behavioral and psychological symptoms (BPSs), including depression, anxiety, and agitated behaviors, in cognitively diverse aged care residents.

DESIGN

A 6-session feasibility trial was conducted within a residential aged care facility using convenience sampling to recruit N = 25 residents of varying cognitive capacity. Groups of 5 residents viewed 360-degree videos on a wireless head-mounted display to provide fully immersive VR experiences.

SETTING AND PARTICIPANTS

Half of the participants recruited from the 160-bed facility had a diagnosis of dementia (48%), whereas assessment with the Psychogeriatric Assessment Scale for cognitive impairment revealed that 64% experienced cognitive impairment (mild 20%, moderate 16%, and severe 28%). Additionally, 32% of participants had an existing anxiety or depression diagnosis.

MEASURES

The Cornell Scale for Depression in Dementia, Generalized Anxiety Disorder 7-item, and Cohen Mansfield Agitation Inventory-Short were used to assess changes in persisting BPS pre- to postintervention period. The Person-Environment Apathy Rating apathy subscale, Observed Emotions Rating Scale, and a visual analog scale (Smileometer) were used to assess immediate mood responses from residents at every VR session. VR tolerability and resident feedback was also recorded.

RESULTS

Pleasure (z = -5.892, P < .001) and general alertness (z = -2.455, P = .014) of participants improved at VR sessions, whereas apathy diminished (z = -5.275, P < .001). Compared to baseline, post-intervention depression was significantly lowered (z = -2.60, P = .009), whereas agitation increased (z = -2.98, P = .003). No significant changes in anxiety were observed. The quality of 360-degree videos and the device used did not induce any major VR-related negative side effects.

CONCLUSIONS AND IMPLICATIONS

Overall group-based VR reduced depressive symptoms and apathy, and induced a positive emotional response in most residents, with few observed side effects. Results indicate feasibility of group-based VR technological innovation within RAC.

Virtual Reality Therapy for Depression and Mood in Long-Term Care Facilities

Virtual reality (VR) describes a family of technologies which immerse users in sensorily-stimulating virtual environments. Such technologies have increasingly found applications in the treatment of neurological and mental health disorders. Depression, anxiety, and other mood abnormalities are of concern in the growing older population-especially those who reside in long-term care facilities (LTCFs). The transition from the familiar home environment to the foreign LTCF introduces a number of stressors that can precipitate depression. However, recent studies reveal that VR therapy (VRT) can promote positive emotionality and improve cognitive abilities in older people, both at home and in LTCFs. VR thus holds potential in allowing older individuals to gradually adapt to their new environments-thereby mitigating the detrimental effects of place attachment and social exclusion. Nevertheless, while the current psychological literature is promising, the implementation of VR in LTCFs faces many challenges. LTCF residents must gain trust in VR technologies, care providers require training to maximize the positive effects of VRT, and decision makers must evaluate both the opportunities and obstacles in adopting VR. In this review article, we concisely discuss the implications of depression related to place attachment in LTCFs, and explore the potential therapeutic applications of VR.

Ambient assisted living technology-mediated interventions for older people and their informal carers in the context of healthy ageing: A scoping review

BACKGROUND AND AIMS

There is a growing demand for health and social care services to provide technology-mediated interventions that promote the health and well-being of older people with health or care needs and of their informal carers. The objectives of this study were to scope and review the nature and extent of prior intervention studies involving ambient assisted living technology-mediated interventions for older people and their informal carers, and how and in what ways (if any) the goals and aims of these interventions reflected the domains of the World Health Organization framework for healthy ageing.

METHODS

We conducted a scoping review. Data were collected between June and October 2018 with an updated search in October 2020. A total of 85 articles were eligible for inclusion.

RESULTS

Nine categories described the aims and content of the included studies. The healthy ageing domain "Ability to meet basic needs" was mirrored in four categories, whereas "Ability to contribute to society" was not addressed at all.

CONCLUSION

The ways in which domains of healthy ageing are mirrored suggest that there is an emphasis on individual factors and individual responsibility, and a lack of attention given to broader, environmental factors affecting healthy ageing. Only a few of the studies used a dyadic approach when assessing health outcomes concerning older people and their informal carers.

Virtual reality intervention to improve apathy in residential aged care: protocol for a multisite non-randomised controlled trial

INTRODUCTION

Apathy is a prevalent neuropsychiatric symptom for older adults residing in aged care. Left untreated, apathy has been associated with accelerated cognitive decline and increased risk of mortality. Reminiscence therapy is commonly used in aged care and has demonstrated to reduce apathy. Traditional methods of reminiscence use physical objects and more recently technology including tablets and laptop computers have demonstrated potential. Virtual reality (VR) has successfully been used to treat psychological disorders; however, there is little evidence on using VR for behavioural symptoms such as apathy in older adults. Using VR to deliver reminiscence therapy provides an immersive experience, and readily available applications provide access to a large range of content allowing easier delivery of therapy over traditional forms of therapy. This study aims to identify changes in apathy after a reminiscence therapy intervention using head-mounted displays (HMDs).

METHODS AND ANALYSIS

Participants will be allocated to one of three groups; reminiscence therapy using VR; an active control using a laptop computer or physical items and a passive control. A total of 45 participants will be recruited from residential aged care (15 in each group). The three groups will be compared at baseline and follow-up. The primary outcome is apathy, and secondary outcomes include cognition and depression. Side effects from using HMDs will also be examined in the VR group. Primary and secondary outcomes at baseline and follow-up will be analysed using linear mixed modelling.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the University of South Australia Human Research Ethics Committee. The results from this study will be disseminated through manuscript publications and national/international conferences.

TRIAL REGISTRATION NUMBER

ACTRN12619001510134.

Effects of a Combination of Three-Dimensional Virtual Reality and Hands-on Horticultural Therapy on Institutionalized Older Adults' Physical and Mental Health: Quasi-Experimental Design

Background

Institutionalized older adults have limited ability to engage in horticultural activities that can improve their physical and mental health.

Objective

This study explored the effects of a combination of 3D virtual reality and horticultural therapy on institutionalized older adults’ physical and mental health.

Methods

The study used a quasi-experimental design. A total of 106 older adults from 2 long-term care facilities were recruited and assigned to the experimental (n=59) or control (n=47) group. The experimental participants received a 9-week intervention. Both groups completed 3 assessments: at baseline, after the intervention, and 2 months later. The outcome variables included health status, meaning in life, perceived mattering, loneliness, and depression.

Results

The experimental group demonstrated significantly improved health status (P<.001), meaning in life (P<.001), and perceived mattering (P<.001) as well as significantly reduced depression (P<.001) and loneliness (P<.001) compared to the control group immediately after the intervention; these effects persisted for up to 2 months.

Conclusions

This study verified the beneficial effects of a combination of 3D virtual reality and hands-on horticultural therapy on older adults’ health. These results could support the future successful implementation of similar programs for institutionalized older adults on a larger scale.