Introducing virtual reality therapy for inpatients with dementia admitted to an acute care hospital: learnings from a pilot to pave the way to a randomized controlled trial

Abstract

Background Behavioural and psychological symptoms of dementia (BPSD) are difficult to manage, particularly in acute care settings. As virtual reality (VR) technology becomes increasingly accessible and affordable, there is growing interest among clinicians to evaluate VR therapy in hospitalized patients, as an alternative to administering antipsychotics/sedatives or using physical restraints associated with negative side effects. Objectives Validate and refine the proposed research protocol for a randomized controlled trial (RCT) that evaluates the impact of VR therapy on managing BPSD in acute care hospitals. Special attention was given to ascertain the processes of introducing non-pharmacological interventions in acute care hospitals. Methods Ten patients 65 years or older (mean = 87) previously diagnosed with dementia, admitted to an acute care hospital, were recruited over 3-month period into a prospective longitudinal pilot study. The intervention consisted of viewing 20-min of immersive 360° VR using a head-mounted display. Baseline and outcomes data were collected from the hospital electronic medical records, pre/post mood-state questionnaires, Neuropsychiatric Inventory (NPI) score, and standardized qualitative observations. Comprehensive process data and workflow were documented, including timestamps for each study task and detailed notes on personnel requirements and challenges encountered. Results Of 516 patients admitted during the study, 67 met the inclusion/exclusion criteria. In total, 234 calls were initiated to substitute decision makers (SDM) of the 67 patients for the consenting process. Nearly half (45.6%) of SDMs declined participation, and 40% could not be reached in time before patients being discharged, resulting in 57 eligible patients not being enrolled. Ten consented participants were enrolled and completed the study. The initial VR session averaged 53.6 min, largely due to the administration of NPI (mean = 19.5 min). Only four participants were able to respond reliably to questions. Seven participants opted for additional VR therapy sessions; of those providing feedback regarding the VR content, they wanted more varied scenery (animals, fields of flowers, holiday themes). Few sessions (4/18) encountered technical difficulties. Conclusion The pilot was instrumental in identifying issues and providing recommendations for the RCT. Screening, inclusion criteria, consenting, data collection, and interaction with SDMs and hospital staff were all processes requiring changes and optimizations. Overall, patients with dementia appear to tolerate immersive VR, and with suggested protocol alterations, it is feasible to evaluate this non-pharmacological intervention in acute care hospitals.

Virtual reality to promote wellbeing in persons with dementia: A scoping review

“…22 We recently conducted a randomized controlled trial at an acute care hospital, evaluating the effects of VR on BPSD including the need for sitters (people who provide supervision of challenging patients), refusal of care, and use of drugs. 23,24 We found that VR-therapy had a statistically significant effect on reducing the cluster of "aggressiveness" as well as trended towards reducing length of stay.…”

“…Moreover, there is added difficulty in recruiting participants at advanced disease stage, as usually the substitute decision maker (SDM) is required to provide consent. 55,56 The few studies that did include this population 23,41,44 reported a positive impact, and others recommended this as future research. Some studies actively excluded those with moderate to severe cognitive impairment, "late-stage dementia," as well as particular subtypes of dementia, like Lewy body (due to higher probability of developing hallucinations), which identify additional areas for future research.…”

Testing the Feasibility of Virtual Reality With Older Adults With Cognitive Impairments and Their Family Members Who Live at a Distance

“…Most research on VR only examines individual older adults’ satisfaction, cognitions, and emotions on isolated tasks (e.g., Appel et al, 2020 ; Manera et al, 2016 ; Repetto et al., 2016 ). What is unique about the current study is older adults and family members engaging in the VR experiences together from a distance.…”

“…Rather than simply chatting with family via a video screen, VR provides rich sensory stimuli that can make older adults feel as if they are actually inside the virtual world engaging in real activities with their loved ones ( Cummings & Bailenson, 2016 ). VR could allow older adults with cognitive and/or physical impairments to continue to grow, experience new sensations, travel, and live life outside senior living communities (see also Appel, Appel, et al, 2020 ; Appel, Kisonas, et al, 2020).…”

“…VR has been used successfully with older adults with MCI and mild-to-moderate AD/ADRD to enhance cognition, navigation, spatial orientation, attention, spatial memory, mobility, and balance ( Manera et al, 2016 ; McEwen et al, 2014 ; Repetto et al, 2016 ). Research on residents with and without dementia suggests that VR is safe, enjoyable, and can induce positive affect (Appel, Appel, et al, 2020 ; Appel, Kisonas, et al, 2020). For instance, virtual environments have been found to increase joy and relaxation in residents and reduce anxiety and sadness ( Angelini et al, 2015 ).…”