Virtual Reality (VR), borne out of the gaming and electronics world, provides an otherworldly escape. It can transport participants far away from stressful, or seemingly hopeless, environments. Older adults living in long-term care and seniors’ residences often experience reduced mobility, which can lead to their being confined indoors and isolated, and this can trigger depression, anxiety and loneliness.
Faculty of Health Professor Lora Appel suspected that VR could enable these older adults to escape from their restricted physical realities and be transported to stimulating and calming places. To prove this, she launched a feasibility study that investigated the idea of using VR to help those with dementia: PrescribingVR (VRx). She led a team from OpenLab, University Health Network, the University of Toronto, Ryerson University and KITE (Toronto Rehabilitation Institute).
This was a first: “There haven’t been any rigorous evaluations of VR with the subset of seniors who are frail and have cognitive, mobility and sensory impairment. Often, these are individuals living with dementia,” Appel says.
Lora Appel
“It’s noteworthy that this niche population is growing. This is a major concern and challenge for Canada,” she adds. Dementia is a major cause of disability and dependency among older people worldwide. More than half a million Canadians live with dementia.
The results of Appel’s study were resoundingly positive. Eighty per cent of participants wanted to try again. “Being exposed to immersive VR is a feasible, safe approach to providing beneficial experiences to frail older adults with mobility, sensory and/or cognitive impairments,” Appel concludes.
The study was funded by the Toronto General & Western Hospital Foundation, part of University Health Network (UHN), the Centre for Aging + Brain Health Innovation (CABHI), powered by Baycrest, and Spark, powered by CABHI. The findings were published in Geriatric Medicine (2020).
An example of what VRx looks like to viewers. The otherworldly escape is truly immersive.
Appel’s work bridges health innovation, technology and design thinking
Appel is the lead investigator at UHN’s OpenLab, an innovation centre dedicated to finding creative solutions that transform the way healthcare is delivered and experienced.
Her research focuses on VR interventions for healthcare consumers and providers including caregivers, as well as educational tools for patients and caregivers navigating the healthcare system.
Study undertaken to evaluate immersive VR technology as therapy
The goal of Appel’s study was to establish whether it is feasible to use immersive VR technology as therapy for frail older adults living in long-term care who may be experiencing age-related health conditions including reduced mobility and/or impaired cognition.
Appel presented VRx at Harvard Medical School in 2018. She also presented to The Royal College of Physicians in London, England.
Researcher recruited 66 frail older adults with varying cognitive abilities
Appel recruited 66 frail older adults, with an average age of 81 and varying ranges of cognitive abilities. Nearly half of participants were in a wheelchair, 39 had limited body mobility and 15 had limited head mobility.
VRx was invited to Baycrest for the Centre for Aging and Brain Health Innovation’s Showcase. This woman gives it a try.
The study took place in four sites across Canada:
- a mental health day clinic for older adults living with complex medical and psycho-social issues;
- a rehabilitation and complex continuing care hospital;
- a long-term care facility for people with Alzheimer’s disease and dementias; and
- a day center for adults with memory loss due to mild to moderate dementia.
Each participant viewed a 360-degree VR-footage of nature scenes for five to 20 minutes using Samsung GearVR Head Mounted Display (HMD). After this, information was gained from participants in three ways: (1) a survey before and after they watched the VR footage; (2) standardized observations conducted by two research assistants during the VR watching; and (3) a semi-structured interview after watching the video that included custom-developed questions and open-ended questions regarding the VR experience.
Feedback was positive; most participants reported feeling more relaxed
More than three-quarters of the study participants experienced at least one full round of VR (six minutes). All participants reported no negative side effects, such as nausea, dizziness, disorientation or interference with/by hearing aids. They tolerated the VR headset very well. Some said they forgot they had it on and others reported “it was worth the mild discomfort.”
A patient at Runnymede Healthcare Centre tries VRx. Image reproduced with permission.
Most participants reported feeling more relaxed and adventurous and 80 per cent wanted to try VR again. “The majority of participants reported positive emotional changes following the intervention, were enthusiastic about trying VR again and would recommend the experience to others,” Appel explains.
Application in variety of other settings
Appel sees this as just the beginning. She pushes for further research to evaluate the potential psychological and bio-physiological benefits of longer-term use of VR and optimizing/customizing VR experiences for this user population. To pursue this, she has received additional funding and is currently running trials at Perley Rideau Veterans Health Centre in Ottawa and Michael Garron Hospital in Toronto.
This work could point the way to future studies in different types of healthcare institutions and community care, from acute care hospitals to private homes. Appel is also studying the potential benefits of VR in alleviating hospital staff burnout and nursing and allied health professional training.
Additionally, she sees VR’s application in palliative care, during lengthy dialysis treatments, and for those with autism.
To read the article, “Older adults with cognitive and/or physical impairments can benefit from immersive Virtual Reality experiences: a feasibility study,” in Geriatric Medicine, visit the website.
To learn more about Appel, visit her faculty profile page. To read more about this project, visit the website. To watch CBC coverage of this project, visit the website. To watch Global News coverage of this research, visit the website.
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By Megan Mueller, senior manager, Research Communications, Office of the Vice-President Research & Innovation, York University, muellerm@yorku.ca