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

Abstract

Background Apathy is a common symptom in neurological disorders, including dementia, and is associated with a faster rate of cognitive decline, reduced quality of life, and high caregiver burden. There is a lack of effective pharmacological treatments for apathy, and nonpharmacological interventions are a preferred first-line approach to treatment. Virtual reality (VR) using head-mounted displays (HMDs) is being successfully used in exposure- and distraction-based therapies; however, there is limited research on using HMDs for symptoms of neurological disorders. Objective This feasibility study aimed to assess whether VR using HMDs could be used to deliver tailored reminiscence therapy and examine the willingness to participate, response rates to measures, time taken to create tailored content, and technical problems. In addition, this study aimed to explore the immediate effects between verbal fluency and apathy after exposure to VR. Methods A mixed methods study was conducted in a sample of older adults residing in aged care, and 17 participants were recruited. Apathy was measured using the Apathy Evaluation Scale (AES), and verbal fluency was used as a proxy measure of improvements in apathy and debriefing interviews to assess feedback from participants. Side effects that can occur from using HMDs were also measured. Results We recruited participants from a high socioeconomic status setting with a high education level, and the participation rate was 85% (17/20); most responses to measures were positive. Access to a wide range of freely available content and the absence of technical difficulties made the delivery of a VR reminiscence intervention highly feasible. Participants had improved semantic scores (t14=−3.27; P=.006) but not phonemic fluency scores (t14=0.55; P=.59) immediately after the intervention. Those with higher levels of apathy demonstrated the greatest cognitive improvements after a VR reminiscence experience, which was indicated by a strong positive relationship between the AES and semantic verbal fluency change scores postminus pre-VR (r=0.719; 95% CI 0.327 to 0.900; P=.003). All participants enjoyed the experience despite 35% (6/17) of participants experiencing temporary side effects. Conclusions This study provides initial evidence that it is feasible to use VR with HMDs for therapy to treat symptoms of apathy in older adults in residential aged care. However, there is a need to closely monitor the side effects of HMD use in older adults. Further research is needed using an active control group to compare the use of VR with traditional forms of reminiscence therapy.

Virtual reality intervention to improve apathy in residential aged care: protocol for a multi-site trial

“…Other studies using VR and looking at apathy have also been single session studies, therefore, not examining changes in apathy (Benoit et al, 2015;Manera et al, 2016). A recent feasibility study (Saredakis, Keage, Corlis, & Loetscher, 2020), found that participants with varying levels of cognitive decline ranging from minimal to moderate impairment could tolerate the use of VR with HMDs in agreeance with previous research (Huygelier, Schraepen, van Ee, Vanden Abeele, & Gillebert, 2019). The VR reminiscence experience in this study was specifically tailored for each participant.…”

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

“… 27 Other studies using VR and looking at apathy have also been single-session studies, therefore, not examining changes in apathy. 28 29 A recent feasibility study, 30 found that participants with varying levels of cognitive decline ranging from minimal-to-moderate impairment could tolerate the use of VR with HMDs in agreeance with previous research. 31 The VR reminiscence experience in this study was specifically tailored for each participant.…”

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

“…18% (n = 15) offered interventions focusing on activities for social engagement, entertainment or comfort ( 41‐52,54,55 ; Van der 53 ). The interventions aimed at increasing older people's QoL through encouraging communication and offering positive experiences and thereby relieving and managing psychogeriatric symptoms such as behavioral and psychological symptoms in dementia (BPSD) or depression.…”

“…Interventions used robotic pets, 41,43,45,48‐50 social robots, 44 tablets for apps or videos, 46,47,54 videoconferences (Van der 53 ), virtual reality technology, 42,51,52 and light therapy 55 …”

“…Of these, seven were RCTs. [29][30][31][32][34][35][36] One study used strong control, that is, comparing the intervention to groupbased exercise 35 whilst Hong et al 30 Interventions used robotic pets, 41,43,45,[48][49][50] social robots, 44 tablets for apps or videos, 46,47,54 videoconferences (Van der 53 ), virtual reality technology, 42,51,52 and light therapy. 55 Study duration was 4 months or shorter, except Chu et al 44 who followed up after 5 years.…”