Keywords older adults - immersive VR - review - intervention - mental health - geriatric rehabilitation - aging care
Schlüsselwörter ältere Erwachsene - immersive Virtual Reality - geriatrische Rehabilitation - aging care - mentale Gesundheit - scoping review
Introduction
Over the past few decades, the proportion of the aging population has increased
rapidly. The demographic shift poses a challenge to the health and social systems of
many countries [1 ]. It is the responsibility
of the social system to take care of and support the lives of older people. The
aging of society is resulting in an increasing demand for geriatric rehabilitation.
The aging process necessitates support from the society for seniors. As age
increases, age-related physical and psychological changes might cause an increasing
range of disorders for the elderly, both physically [2 ] and psychologically [3 ].
Consequently, seniors need treatment in order to maintain or regain function, as
well as to improve their quality of life and well-being. In the mental health field,
it is essential to develop innovative and engaging interventions [4 ]. Therefore, research regarding innovative
technologies for mental health is growing rapidly, for example, virtual reality (VR)
[5 ]
[6 ].
Virtual Reality
VR can broadly be defined as a computer-enhanced simulation experience, which
creates a virtual environment. There are three types of VR: non-immersive,
semi-immersive, and fully immersive. Non-immersive VR-based products have become
part of our daily lives, such as digital maps (e. g. Google Maps) and video
games (e. g. Dota 2). Using a computer-generated interface, they provide a
virtual representation of the real world [7 ]. Semi-immersive VR can provide a partial immersive environment
with three-dimensional (3D) graphics, but the view field is limited. By using a
high-resolution display, projector, or hard simulator allow the user to focus on
the more realistic visual effects [7 ]. The
semi-immersive VR is used for educational and training purposes, such as flight
simulators for flight training of airborne firefighters (e. g. [8 ]) or social ability training for children
(e. g. [9 ]). Fully immersive VR provides
visual and auditory stimulation in full 3D effect. Moreover, tactile (e. g.
[10 ]) and haptically stimuli (e. g.
[11 ]) are possible with the fully
immersive VR technique [12 ]. The complete
immersive environment makes the user feels like they have stepped into the
computer-synthesized world [13 ] and
creates a sense of presence, the sensation of being there [14 ]. This artificial world is assessable
through the head-mounted displays (HMD, e. g. Oculus Rift) or a Cave Automatic
Virtual Environment (CAVE). The user can manipulate hand consoles or use the
hand-tracking technique to interact with the VR-environment (e. g. [15 ]). These properties provide the
possibility for more sophisticated simulations [7 ]
[12 ]
[16 ].
VR-based mental health intervention in seniors
Immersive VR is increasingly being used in a variety of clinical settings as well
as in mental health settings due to the characteristics described above [5 ]
[6 ]. For example, a considerable amount of evidence supports the
effectiveness of virtual reality exposure therapy of anxiety disorders and
posttraumatic stress disorders [17 ],
addiction (e. g. [18 ]), the therapy of
eating disorders (e. g. [19 ] ), as well as
social skills and cognitive training in children with high-functioning autism
(e. g. [20 ]). Immersive virtual reality is
expected to become important in the field of mental health in the future [6 ]
[17 ].
In terms of its application to older adults, immersive virtual reality has also
been shown to have several benefits. A fully immersive environment and the
sensation of presence can provide a sensitive treatment comparable to that
available in the real world [21 ].
Moreover, VR offers a safer approach to therapy [22 ], and it can prevent for example exposure to adverse conditions
(e. g. high noise or high temperature) in exposure therapy [23 ]. This feature is especially important
for individuals who are vulnerable, such as the elderly. In addition, the
interaction in the immersive virtual environment is natural and straightforward.
Senior citizens can easily get started by putting on the headset or entering the
CAVE environment. They can interact with the VR environment by using a console
or, if hand tracking technology is available, by using their hands directly.
This is more natural to use this method than, for example, a keyboard.
Furthermore, immersive VR requires just the HDM (e. g., when using hand tracking
technology), and it can be used almost anywhere, regardless of the time, place,
or object [17 ]
[24 ]. As a result of this adaptability,
there may be considerable opportunities to address the challenges faced by
elderly individuals with mobility concerns, such as in the rehabilitation and
assisted living of physically disabled individuals in a nursing home.
Moreover, according to the Technology Acceptance Model (TAM), user acceptance of
technology is influenced by perceived usefulness and ease of use [25 ]. Personal attributes and environmental
factors, such as self-efficacy and facilitation, play a more significant role in
technology acceptance than perceived advantages [26 ]. In geriatric populations, perceived usefulness, perceived ease
of use, and perceived enjoyment also positively impact the acceptance of VR
interventions [27 ]
[28 ]
[29 ]. Numerous studies have indicated that immersive VR is
well-received by the geriatric population [5 ]
[29 ]
[30 ]. For example, older adults'
initial experiences with head-mounted VR were followed by positive participant
feedback indicating a positive shift in attitude towards the technology [5 ]. Additionally, cybersickness is a
possible side effect that needs to be considered in VR interventions.
Participants were more susceptible to cybersickness when exposed for 20 minutes
compared to 10 minutes [31 ], however, the
detected symptoms were only moderate and did not lead to dropouts. In a
systematic review about cybersickness in fully immersive VR [32 ], it was found that most of the included
39 studies reported only minor instances of cybersickness among older adult
participants. This indicates that cybersickness is not a significant barrier to
the application of VR and can be managed through careful design and regulation
of the time spent wearing the head-mounted display (HMD). Nevertheless, it is
necessary to implement changes in order to provide a user experience that is
optimal for older individuals [30 ].
Currently, VR applications in physical rehabilitation, such as motor control and
balance training for the elderly, are the most extensively researched (e. g.
[33 ]). It is important to note,
however, that most of these studies used a non-immersive or semi-immersive VR
experience [23 ]
[34 ]. The number of immersive VR-based
psychological studies conducted on the geriatric population is still limited,
especially in terms of the improvement of well-being and mood [6 ]
[35 ]. A systematic review of the VR intervention on mental health in
seniors was published by Skurla et al. [6 ].This review focused on the evidence and experimental methods used in
these studies, as well as on the mental disorders that they investigated.
Furthermore, they identified three categories of VR indications in these
studies: screening, testing, and training. In this present review, we focus on
VR-based interventions that are classified as training initiatives, due to the
fact that they are relevant for geriatric rehabilitation. Otherwise, Skurla et
al. [6 ] covered all of the immersion
gradations, including non- immersive and semi-immersive, of VR-interventions for
seniors. For this scoping review, we will focus on immersive VR interventions
that use HMDs or CAVEs.
Review question
The review question is: Which types of intervention studies and evidence exists
regarding immersive VR-interventions supporting mental health of the elderly?
This review provides an in-depth analysis, systematization, and classification of
immersive VR-intervention studies, and assess their effectiveness for mental health.
We are interested whether there has been any advancement in VR interventions not
only training functions, but enhancing well-being and quality of life of seniors,
which could be utilized in geriatric rehabilitation. The systematized information
may also serve as a reference for future research in this area.
Inclusion Criteria
This scoping review will concentrate on research that focuses on older adults. The
age of participants in the reported studies was on average older than 60 years. The
studies point out that they focus on the older population or age-related effects.
This scoping review examines VR-interventions and its outcomes for elderly people
with the intention of improving their mental health, such as psychotherapies,
cognitive function training, or well-being and quality of life. HMD or CAVE
environment should be used in the VR intervention to provide a fully immersive
experience. To assess how different interventions and how these factors affect
different outcomes, we obtained detailed findings regarding experimental design,
content of VR interventions, and forms of VR interaction from the studies. This will
enable us to observe the development of VR-based interventions that will be used in
the future for the ageing care.
The focus is on VR-interventions or therapies to improve the mental health of seniors
worldwide in a variety of settings, such as a nursing home, or rehabilitation
centre.
This scoping review will consider designs including randomized controlled trials,
non-randomized controlled trials, before and after studies, and interrupted
time-series studies. In addition, analytical observational studies including
prospective and retrospective cohort studies, case-control studies and analytical
cross-sectional studies will be considered for inclusion. Qualitative studies,
reviews, and text and opinion papers will not be considered (adapted from
JBL-Manual, [36 ]).
Methods
The proposed scoping review is conducted in accordance with the JBI methodology for
scoping reviews [36 ]
[37 ].
Search strategy
We used a Boolean search following: (“virtual” OR “virtual reality”) AND (
“older” OR “older adults” OR “geriatric” OR ”elderly” OR “senior”). The year of
publications was not filtered to ensure all relevant studies are included.
The databases to be searched include PubMed, Scopus, PsychNet, PsyJournals,
PubPsych (a database synthesized from nine portals: PSYNDEX, PASCAL,
ISOC-Psicologia, MEDLINE, ERIC, NARCIS, NORART, PsychOpen, PsychData), and
Google Scholar published up to 2022. Based on the language skills of the
authors, studies published in English, German, and Chinese are included. The
reference list of all included sources of evidence were screened for additional
studies (adapted from JBL-Manual). When the full text of possible targeted
studies was not available, we contacted the authors to request it.
Evidence selection
Once the search has been conducted, all identified citations were uploaded into
Zotero [38 ]. Duplicates were removed.
After deduplication, the authors screened and selected the titles of the
records. The excluded studies were rechecked independently by trained research
assistants. We created a matrix and re-examined records that had the potential
to be targeted with more details from the abstract or detailed information from
the main text.
The articles we selected need to have fulfilled the following conditions: 1) Use
of immersive virtual reality, environment, or game application, 2) primary
outcomes in the area of mental health (e. g. cognitive training, psychological
therapy, well-being, etc.), 3) focus on older adults population, average
age>60 years, 4) peer-reviewed journal article and presenting experimental
data. The exclusion criteria were as follows: 1) review and meta-analyse, 2)
full-text not available, 3) article not available in English, German or Chinese,
4) not focus on the geriatric population, 5) Use non- or semi-immersive VR, 6)
outcome does not focus on mental health, 7) VR indication as screening and
testing, not for training and intervention, 8) result or with less quantitative
analysis.
Data extraction
Following the selection process, author 1 extracted data from the full text of
the articles included in the review. Microsoft Excel [39 ] was used for the initial data
extraction and a matrix was developed for categorizing the evidence collected.
This data extraction will included specific information about the participants,
the year of publication, the concept, the context, the study methods, the
VR-Intervention, and the key findings relevant to the review question. Whenever
we were unable to locate certain information in the full text, we contacted the
research team directly. At the end, author 2 rechecked all the data. If there
were disagreements between the reviewers at any stage of the selection process,
they were resolved through discussion. The results of the search and the study
inclusion process will be presented in a Preferred Reporting Items for
Systematic Reviews and Meta-analyses extension (PRISMA) flow diagram which was
adapted from Moher et al. [40 ].
Results
Search results
[Fig. 1 ] shows the complete selection
process in a PRISMA flowchart. A total of 2697 records were collected from the
seven databases during the phase of literature research until 2022. There were
759 duplicate records that were removed. As a result of examining the headlines
and information in the abstracts, 1834 records have been excluded due to misfit
to the inclusion criteria. Excluded were studies which did not contain VR
interventions, or VR was focused on physical training, young populations,
caregivers for the elderly, or screening and assessment. Overall, 104 articles
were determined to be potentially eligible. The full-text of four of those
reports was not available despite full-text requests sent to the authors.
Consequently, 100 full-text reports were reviewed to ensure that they were in
accordance with our objectives "VR-based interventions focusing on mental
health outcomes for the elderly”. Additionally, 60 articles were removed because
they were not published in peer-reviewed journal articles (25), the population
studied was not suitable (6), immersive VR training or intervention was not
provided (9), mental health outcomes were not reported (14), outcomes were not
statistically analysed (5), and no results were reported (1). In the end, 40
articles were selected for review.
Fig. 1 The PRISMA flow chart of the article selection adapted from
Moher et al. [40. ]
Inclusion of sources of evidence
All 40 selected studies were peer-reviewed and published between 2010 and 2022.
Throughout these studies, fully immersive VR technology was used with a major
focus group of seniors recruited from clinical settings, nursing homes, or
source portals of universities or organizations. The study locations include
North America, South America, Asia, Australia, and Europe (details are provided
in Online-Table 1
2 ). Different types of studies are
included, such as randomized controlled trials, quasi-experiments, and case
studies. Inclusion is limited to studies that provide quantitative measurements
and outcomes.
The articles were classified based on whether they focused on entertainment
(e. g. relaxation, for fun) or function training (e. g. cognitive training). We
extracted and summarized the 40 included reports based on the above required
information (see data extraction and analysis). In Online-Tables 1 (entertainment-oriented)
and 2 (function-oriented) with detailed descriptions of the content and
procedures of each study, as well as outcomes. In total, 12 studies reported
applications for seniors that were entertainment-oriented, while 28 papers
reported applications that were function-oriented.
Included studies: Publications years
In the research area of entertainment-oriented VR, all studies were published
since 2019 and their number is growing. In the function-oriented area, there is
a sharp increase from five in 2020 to fourteen in 2021.
Included studies: Methods and study designs
VR applications that were designed for senior citizens were primarily targeted at
those aged 65 to 80. A total of 18 studies reported the mean age within this
range. There were only four out of 28 papers that examined the age group below
65 (mean age) years, and four papers that examined the age group over 80 (mean
age).
One out of twelve studies for entertainment used a special sample group
consisting of individuals suffering from dementia or mild cognitive impairment
[49 ]. In these entertainment-oriented
studies, the majority of participants were from nursing homes (83%), and the
remaining participants came from university recruitment portals (17%). There
were no studies that recruited seniors from a clinical setting in order to
conduct entertainment-oriented research.
There were 19 out of 28 studies in the function-oriented category that focused on
therapies or training for the elderly with depression, cognitive decline, or
pain. In the function-oriented study, participants were recruited from clinical
settings (32%), nursing homes (25%), or announcements on university portals
(43%).
Only ten studies used a randomized controlled trial design. Among
entertainment-oriented studies, the rate of experimental design is 17%, while in
function-oriented studies, the rate is 29%. There were only eleven follow-up
sessions scheduled for 40 studies. In 30 out of 40 studies, a comparison between
two groups was conducted. The proportion of studies with a comparison group in
the entertainment-oriented category is 58% compared to the total number of
studies in this category, while 82% in the function-oriented category. A total
of 20 studies compared a control group with an experimental group. In other
studies, comparisons have been made between younger and older individuals, or
between seniors with mild cognitive impairment and those with dementia (Online-Table 1
2 ).
Included studies: VR intervention content and measurement
Nearly all of the studies used a HMD for immersive experiences, with the
exception of Sultana et al. [49 ] that used
a special projector to create immersion in a room. In the entertainment
category, all twelve projects shared the same goal of relaxation and enjoyment
for older people. They used majorly rating scales for well-being, mood, and
quality of life. There were 15 of 28 programs that focused on cognitive training
in the function-oriented studies. There were two programs designed specifically
for the purpose of memory training (e. g. [54 ]). Eleven other studies focused on different treatment goals, such
as fear of falling (e. g. [56 ]),
depression (e. g. [58 ]), vestibular
rehabilitation exercises (e. g. [59 ]), or
pain management (e. g. [67 ]). A total of
five out of twelve (42%) entertainment-oriented studies contained only one VR
session, while there is only one study on function-oriented VR interventions
[61 ](Online-Table 1
2 ).
In eight entertainment-oriented VR studies, the interaction form was passive,
which means that seniors did not need additional control over other technical
devices to complete the VR session. In contrast, 21 of 28 function-oriented
studies utilized the active interaction method. In general, 14 of the 21 studies
chose hand consoles as their primary interaction device. Moreover, other active
VR applications interacted with motion trackers (e. g. [72 ]), pedals and wheels (driving games
[70 ]), or control pads [69 ]
[81 ].
Included VR studies: Mental health outcomes
All twelve entertainment-oriented VR studies had significant positive effects on
the mental health of seniors. According to seven of these studies, VR sessions
had a positive impact on mood, well-being, or quality of life. Four of these
results were examined in follow-up sessions. Of the 28 function-oriented
studies, 24 showed at least one positive effect for the achievement of the
treatment goal. Among those articles with positive outcomes, six were examined
by a follow-up session. Moreover, seven studies involving function-oriented
interventions assessed whether mood, well-being, or quality of life had changed.
However, only two of them showed significant improvements. There was no
long-term follow-up on any of them.
Discussion
General result
This scoping review investigated recent studies that applied fully immersive VR
technology to mental health in older adults. Following an extensive literature
search in the databases, as well as subsequent selection and filtering, we
reviewed 40 relevant full articles. According to the purpose of the
interventions, we classified the evidence into two categories: function-oriented
and entertainment-oriented VR interventions. Twelve of the 40 studies are
entertainment-oriented, while 28 are function-oriented.
Publications year
By the end of March 2020, Carroll et al. [82 ] reported that only six studies had utilized fully immersive VR
technology in both the physical and psychological domains among older adults. As
a result of the increasing number of studies presently available, it is apparent
that research into immersive VR for the health of older people is becoming
increasingly popular. Additionally, the findings confirm the limitation of the
review presented by Skurla et al. [6 ] that
VR intervention research is a rapidly developing field and may require updating
as more studies are published. Moreover, Skurla et al. [6 ] found that there was limited research on
VR techniques for older adults to improve well-being and mood until 2019. As
shown in our present review, the number of studies on immersive VR interventions
for the elderly that are specifically targeted at improving their mood,
well-being, and quality of life increased sharply after 2020. Thus, the research
gap on VR for improving well-being in older adults has been filled. Further,
VR-interventions for seniors are becoming increasingly important in recent years
to enhance their mental capabilities as well as their level of well-being.
Evidence of VR interventions
There was evidence that VR interventions enhanced at least one study target in 36
out of 40 selected papers, both in functional and entertainment areas. This
suggests that the use of fully immersive technology in geriatric rehabilitation
and ageing care could be a viable and effective method of intervention in the
future.
Only four out of the function-oriented VR studies reported on mood and well-being
after training. Among these, only two showed a significant impact of
function-oriented VR training on mood and well-being. There may have been a lack
of attention paid by VR designers to the enjoyment of the task in
function-oriented training. Combining joy of the task with functional training
effects may, however, be beneficial, it may reduce potential aversion to intense
training on the part of the participant [83 ]. Thus, in developing function-oriented VR training programs, VR
designers should also consider the task enjoyment and the senior-centred design
in addition to the training effects.
Moreover, the stability of the results of VR interventions needs to be
demonstrated, particularly in entertainment-oriented studies that aim to improve
well-being and quality of life. As well-being may be strongly influenced by the
environment [84 ], it may be that the
positive impact of VR on well-being disappears once the intervention is
completed. Long-term follow-ups have been done only in a few studies. Until now,
there is insufficient evidence on positive long term-effects.
Furthermore, it's important to note that only a limited number of studies in
this review employed an experimental design, many of the studies reviewed did
not meet the quality criteria expected for rigorous research. Therefore, it is
imperative that future research on VR interventions in geriatric rehabilitation
places a stronger emphasis on conducting randomized controlled trials (RCTs).
This approach would not only enhance the validity of the evidence but also
provide a more robust foundation for assessing the true impact and effectiveness
of VR interventions in improving the well-being and cognitive abilities of older
adults.
Function-oriented and entertainment-oriented VR studies
Two critical aspects of geriatric mental health rehabilitation are the
maintenance of mental and cognitive function and the improvement of well-being
and quality of life. Thus, we classified VR studies as function-oriented and
entertainment-oriented. In this section, we provide a scoping view by
summarizing and discussing the current state of affairs in these two
categories.
As a result of our scoping review, referred to as function-oriented research, VR
efforts are aimed at improving a function or reducing an impairment. In these
studies, the primary objective is to evaluate whether abilities can be enhanced
in result of a VR intervention or training. The primary objective of this study
is to identify the training effect. An example of a function-oriented VR
intervention task is memory training [54 ].
In an exemplary VR supermarket scenario, the elderly participants are provided
with a shopping list containing six objects. Following this, the virtual cashier
engages them in a conversation to interference them by asking short questions
such as "How is the weather today?" After this interaction, the
elderly participants are tasked to remember the objects from the list and to
locate them within the virtual supermarket environment. Our results indicate
that the assessment of mood and well-being of older people is rarely and merely
a by-product of this function-oriented study (e. g. [70 ]). Compared to studies focused on
entertainment-oriented VR, studies focused on function-oriented VR appeared
earlier and are currently more numerous in geriatric research. Conversely,
entertainment-oriented VR interventions do not have a clearly defined goal for
functional improvement, but rather prioritize relaxation and enhancing positive
emotions among seniors. An example of such an intervention task is a virtual
travel experience. For example, seniors were immersed [41 ] in a virtual environment for a VR tour
of Hong Kong. The seniors reported their levels of positive and negative
emotions before and after the virtual tour. Important for rehabilitation is that
until now, entertainment-oriented VR interventions have not taken into account
functional improvements, such as social participation.
Furthermore, the results indicated the content of function-oriented VR is usually
more practice-oriented than that of entertainment-oriented VR. Function-oriented
VR interventions are always designed with a clear purpose. There is a more
specific target population for them. The recruitment may focus only on one
gender or on seniors suffering from specific diseases, such as dementia, and may
also occur within a clinical setting. In contrast, entertainment-oriented VR
interventions are always aimed at seniors in general. VR sessions geared towards
entertainment are less intense, with approximately half containing only one
session. Eight of twelve entertainment-oriented VR studies used a passive
interaction model in terms of VR content and interaction. In this sector, VR
applications do not require the older user to interact with the VR scene or use
an interaction device. Even when interacting with the VR environment was
required, the remaining four studies used very simple task content with no
training objectives and fewer challenges, for example, gardening games [52 ]. Only hand consoles were used for
interaction. It was more common for function-oriented VR research to involve
active interaction with the VR environment. Among the 28 function-oriented VR
studies, 21 chose this format. When used, interactive devices can be of a
variety of types. Aside from the consoles, there are also motion trackers,
steering wheels, pedals, and infrared lasers. It can be concluded that most of
the entertainment-oriented VR studies rely on passive interaction with lower
technical requirements, while most of the function-oriented VR studies use
active interaction with a variety of interactive devices. Indeed, the precise
selection of VR intervention tasks and interaction forms, whether they are
function-oriented or geared towards entertainment, plays a pivotal role in the
successful application of VR design in geriatric rehabilitation. Striking the
right balance in interaction form and complexity is an important factor. On one
hand, it is essential to recognize that human cognitive capacity is limited, and
seniors often have reduced cognitive function. Therefore, VR designs should be
mindful of the cognitive load placed on seniors. Complex interactions or an
overload of information can overwhelm users, especially seniors with reduced
cognitive function. Designers should strive to minimize unnecessary complexity
to ensure that seniors can process information and complete tasks effectively.
On the other hand, selecting suitable interaction forms and complexity levels
can enhance the perceived ease of use for seniors. This is significant because
an interface that is perceived as easy to use can substantially improve the
acceptance of VR interventions among seniors. In essence, striking the right
balance in interaction design is a key factor in making VR interventions more
accessible, effective, and well-received by older adults in geriatric
rehabilitation.
VR intervention design in geriatric rehabilitation
Two reviewed studies have compared the impact of VR cognitive training between
younger and older adults. VR is a feasible and powerful tool for engaging the
physical and cognitive abilities of older adults [73 ], with seniors reporting a similar level
of enjoyment compared to younger adults. The average cognitive function of
seniors was lower than that of younger people [61 ]. VR cognitive training had a greater impact on the older group
than the younger one, coming along with significant activation of the parietal
lobe. These studies comparing age groups suggest that seniors may have stronger
requirements for and improvement after cognitive training. There was also a
comparative study to explore the differences in technology acceptance between
older and younger adults [85 ]. The results
showed that both groups reported similar perceived usefulness and perceived ease
of use, and that these play significant roles in technology acceptance. These
findings highlight that the success of such studies is not solely dependent on
the age of the participants, but on their specific requirements. Whether
it's for functional training or entertainment, understanding and meeting
the unique needs of seniors is crucial for designing effective VR interventions
in geriatric rehabilitation. For example, VR training for seniors with dementia
should take their cognitive level into account and avoid complex interactions.
Seniors living in nursing homes may benefit more from meaningful activities and
group events that enhance social engagement against inactivity and loneliness
[86 ]
[87 ]. Careful consideration should be given to the social context and
cultural background of the participants. Many of the studies included in our
review had a global scope, and while most did not explicitly emphasize cultural
backgrounds, language use, or daily habits, some incorporated culturally
specific content into their designs. For example, Chan et al. [41 ] created a VR tour of Hong Kong tailored
to seniors in that region, providing entertainment that resonated with their
cultural experiences. Another study introduced traditional Chinese Tai Chi as a
form of cognitive training, aligning with the cultural background of the
participants [57 ].
In sum, the design of VR interventions for geriatric rehabilitation should take
into account both the individual requirements and the socio-cultural context of
the seniors participating in the program. This personalized and culturally
sensitive approach can enhance the effectiveness and acceptance of VR
interventions among older adults.
Limitations
Despite our literature search lasting until 2022, the number of studies in the
field of immersive VR for geriatric mental health continues to grow. It is
therefore possible that some articles published recently in 2023 have not been
considered. The list of articles will need to be updated regularly as suggested
by Skurla et al.[6 ]. Moreover, in order to
enhance the focus on our core research question, other interesting topics have
been given less attention. A VR-intervention may have different effects on older
people depending on their age (e. g., the youngest, the middle-aged, the
oldest). Additionally, it is important to examine the influence of experimental
design aspects, such as the type of control group or cluster randomization.
Conclusions and recommendations
Conclusions and recommendations
Conclusions
During the last few years, research on immersive VR for the mental health of
older people has surged rapidly, with an increased number of function-oriented
and newly emerging entertainment-oriented fields aimed at enhancing well-being.
Most VR interventions showed a positive effect on mental health among older
adults. Using immersive virtual reality (VR) technology can be an innovative and
promising method for maintaining mental and cognitive functions, as well as for
promoting well-being, activity and quality of life in geriatric rehabilitation
and in retirement homes. It is common for function-oriented VR interventions to
target specific populations of seniors and make use of active interaction as
well as a variety of interactive devices. Conversely, entertainment-oriented VR
interventions are aimed at the general senior population and use less active
interaction, i. e. older persons are less likely to interact with VR
environments. Moreover, the VR intervention design in geriatric rehabilitation
should consider the clinical requirements of the target population, not only
focusing one the age.
Implications of the findings for research
Recent research studies on VR mental health interventions for seniors provide a
first attempt to combine seniors with VR technology, demonstrating the
significance of this topic. In order to gain a better understanding of how VR
can be used for rehabilitation purposes, more studies focusing on social
interaction and participation outcomes are needed. Follow-up measurements are
needed in determining whether there are long-term effects or whether the effects
are limited to the VR sessions themselves in the elderly. Also, interventions
should integrate both function-orientation and wellbeing/entertainment. In the
case of functionally oriented VR training, research should also focus on how the
exercises affect the well-being of older people, namely how much enjoyment they
receive during the functional training. As a result, training may also be more
effective. Further, the study or meta-analysis of the effective intensity and
duration of VR-intervention may provide useful advice for future studies, more
specifically according to different categories (function- and
entertainment-oriented). Finally, VR design concepts that focus on the
experience of older users should be explored and adopted in special populations
and their social context, for example, the seniors in nursing home.
Implications of the findings for practice
The findings of this scoping review underscore the value of VR as a tool in
geriatric rehabilitation. It is evident that VR interventions in this field are
still relatively novel, with only a limited number of studies conducted,
including one in Germany. While the reviewed VR interventions provide valuable
insights into the design of such programs, it is essential to emphasize the
importance of conducting a thorough needs task analysis before embarking on VR
interventions in aging care. Careful consideration should be given to the design
of interactions and language use, ensuring they are adapted to the specific
needs of older adults. Additionally, the successful implementation of VR
interventions in geriatric rehabilitation necessitates an understanding of how
these interventions can be effectively integrated into the cultural and social
contexts of the target population. In conclusion, VR holds great promise as a
tool for improving the well-being and cognitive abilities of older adults in
geriatric rehabilitation. However, to maximize its benefits, a thoughtful and
contextually relevant approach to VR intervention design is crucial. For
example, in requirement for the senior in nursing home, VR mental health
interventions for older adults may combine entertainment and function aspects
and emphasize social interaction. A potential of VR intervention could be
offered in a nursing home as a group event in which seniors participate in
activities they cannot perform anymore (e. g. gardening, making pizzas, setting
up a holiday home). In this way, cognitive functions can be practiced in an
enjoyable manner, the well-being can be improved as well, experiences can be
exchanged, and social interaction can be enhanced within a group. It is also
possible that this will reduce the work-load of nursing home staff. With these
novel concepts, more options will be available for geriatric rehabilitation,
thereby preventing seniors from being left behind by advances in technology.
Data availability
Data are the 40 original articles on which this review is based on. They are
accessible via public databases or from the authors upon request.
Statement of Ethics
Ethical approval was not obtained, because no human beings have been investigated
directly.
Description of authors’ roles
Description of authors’ roles
Y. L. conducted literature search and literature analysis, prepared the tables, and
wrote the manuscript. B. M. designed the research question and supervised the
research process, and contributed to writing and revision of the manuscript.
