Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study
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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.
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People with cognitive impairment in the study by Saredakis et al. observed decreased apathy among residents with cognitive impairment while staff reported positive changes in their mood and behavior.
“People with cognitive impairment in the study by saredakis et al. (2020) observed decreased apathy among residents with cognitive impairment while staff reported positive changes in their mood and behavior.”
From Facilitators and Barriers to Using Virtual Reality and its Impact on Social Engagement in Aged Care Settings: A Scoping Review (2023) · cites this paper as saredakis et al. (2020)
The Discussion (page unavailable) reports anecdotal positive mood changes from staff, but says positive behavior changes were reported by family members, not staff. It also says the study did not establish whether other aspects of apathy were reduced. The Methods describe participants with and without cognitive impairment, but the cited findings are not reported specifically for the cognitively impaired subgroup. (LLM, conf=0.91)
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“For example, Saredakis et al. (2020) provided personalized video, while Rose et al. (2021) shared that some participants preferred a large screen over VR. Fiocco et al. (2021) further suggested a way to improve the VR/AR experiences of older adults by having culturally appropriate music.”
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- Authors
- Saredakis, D., Keage, H. A., Corlis, M., & Loetscher, T.
- Affiliations
- University of South Australia (AU)
- South Australian Water Corporation (AU)
- Corresponding author
- Saredakis, Dimitrios
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2020-06-26
- Volume
- 22
- Issue
- 6
- Pages
- e17632
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7380990
- OpenAlex
- W3031937696
- Cited by
- 82
- References
- 101
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 19 · 2023: 17 · 2022: 10 · 2021: 8 · 2020: 4
- FWCI
- 7.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- PsyArXiv (OSF Preprints) (submittedVersion)
- UniSA Research Outputs Repository (University of South Australia) (submittedVersion, other-oa)
- Funders
- Australian Government
- Medical Research Council
- National Health and Medical Research Council (1135676, 1136269)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Demography › Technology Use by Older Adults
- Keywords
- virtual reality, apathy, reminiscence therapy, head-mounted displays, nursing homes, older adults, dementia, verbal fluency, Apathy Evaluation Scale, non-pharmacological treatment, feasibility
- MeSH terms
- Virtual Reality, Aged, Aged, 80 and over, Aging, Feasibility Studies, Female, Humans, Male, Nursing Homes, Quality of Life, Apathy
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