Key Stakeholders’ Experiences and Perceptions of Virtual Reality for Older Adults Living With Dementia: Systematic Review and Thematic Synthesis

Abstract

Background Technology is increasingly being used and evolving in the dementia care landscape. One such technology that has gained traction over the last decade is virtual reality (VR). VR is being applied in many areas of dementia care, including cognitive assessment and training, reminiscence therapy, music therapy, and other recreational VR applications. Despite the plethora of applications, they are often not shaped by the experiences and perceptions of older adults living with dementia. Currently, there is no qualitative evidence synthesis (QES) to explore this area. This review aimed to provide qualitative evidence supporting existing systematic reviews in this area. Objective The aim of this QES was to explore key stakeholders’ experiences and perceptions of VR for older adults living with dementia. It aimed to explore the barriers and facilitators to VR use and provide recommendations for future design and implementation. Methods QES was used, which involved a systematic search of 6 databases to identify studies that qualitatively explored key stakeholders’ experiences and perceptions of VR for older adults living with dementia. Thematic synthesis was used to integrate the findings of 14 studies (from 15 reports). The Critical Appraisal Skills Programme tool was used to assess the methodological quality of the included studies. The confidence placed in the review findings was assessed using the GRADE-CERQUAL (Confidence in the Evidence from Reviews of Qualitative research). Results A total of 15 reports from 14 studies were included in the review, consisting of a range of levels of VR immersion, stages of dementia, and care contexts. Three analytical themes were generated: stepping into virtuality, a virtual world, and returning to reality. The results indicate the importance of sensitively designing and introducing VR to this population, as older adults living with dementia often have no prior experience of using this technology. VR can be a positive experience for older adults living with dementia and can provide meaningful interactions, positive expressions, and long-term impacts on everyday functioning. However, it should be acknowledged that some negative associations must be accounted for before, during, and after use. Conclusions This review highlights the positive implications as well as negative associations of VR use. It emphasizes the need for VR design and implementation driven by the needs and views of older adults living with dementia as well as with other key stakeholders. Future research needs to explore the vital role that older adults living with dementia can play in the design process and how they can be empowered to meaningfully design and use this technology.

Introducing and Familiarising Older Adults Living with Dementia and Their Caregivers to Virtual Reality

“…The research team coupled the available passive library of lobbies and aimed to address the lack of a suitable active VE by designing one to accompany them. Both the active and passive VEs contributed to the technology probe and enabled a graded experience from the passive VE to the active which is advocated for people living with dementia and their caregivers [ 14 ].…”

“…VR is growing in prevalence in the Human-Computer Interaction (HCI) community [ 10 ] and has a myriad of applications in dementia care contexts [ 10 , 11 , 12 , 13 ] including residential aged care facilities (RACF), acute inpatient settings, community day centres and home environments [ 14 ]. Traditional non-pharmacological interventions such as Reminiscence Therapy and Cognitive Stimulation Therapy are also being successfully incorporated into VR applications [ 15 , 16 , 17 , 18 , 19 ].…”

“…VR has shown promise in supporting the emotional, social, health and functional wellbeing of people living with dementia. However, most research to date has been exploratory [ 13 , 14 , 20 ]. A recent focus has been the use of Social VR to promote social health outcomes [ 13 , 14 , 20 ].…”

“…However, most research to date has been exploratory [ 13 , 14 , 20 ]. A recent focus has been the use of Social VR to promote social health outcomes [ 13 , 14 , 20 ]. COVID-19 accelerated this shift in focus toward social technologies as physical distancing measures increased feelings of social isolation and loneliness for older adults with and without dementia [ 21 , 22 ].…”

“…COVID-19 accelerated this shift in focus toward social technologies as physical distancing measures increased feelings of social isolation and loneliness for older adults with and without dementia [ 21 , 22 ]. In such circumstances, VR can provide a means of staying socially connected and facilitate engagement in meaningful activities for people living with dementia [ 14 ]. Due to its relatively novel commercial availability and previously high cost to acquire, older adults typically do not have direct experience of VR [ 23 , 24 ].…”