Virtual Reality: a Potential Cognitive and Physical Training in Aging

VR and AR hold the promise that through a gaming environment and digital social interactions, a healthy lifestyle can be promoted to enhance health, and well-being, besides rehabilitation purposes.

“VR is a way to escape the real world into something more fantastic. It has the potential to be the most social technology of all time” (Palmer Luckey)

Who else thought that cutting-edge technologies were just for younger users?

However, looking at the statistics, the World Health Organization (WHO) estimates that the global population is increasing, transforming our environment into a super-aged society by 2030 [1]. Based on the U.S. Department of Health and Human Services the number of people older than 65 in the USA grew by 37.2 million from 2006 to 2016, and worldwide the number of individuals (60+ years old) will double from 600 million in 2020 to 1.2 billion by 2025 and 2 billion by 2050 [2].

Although mortality rates decreased due to higher well-being and socio-economic status, aging is accompanied by physical inactivity and limitations in mobility, cognitive decline, reduced functional capabilities, loss of autonomy and self-care, a tendency towards social isolation, and emotional fluctuations  [3, 4, 5, 6].  This fact has been complicated by a scarcity of healthcare professionals, particularly home health workers, with the consequence of confining older adults in facilities that are not designed to encounter and support their special needs. This event led to a crisis in the entire healthcare system in its role of embracing care for the aging population globally [2].

Therefore, how can technology be adopted to improve the life of senior citizens? Virtual Reality (VR) is an example. Indeed, VR gained attention and was recently implemented in the medical domain to enhance mental and physical health. Likewise, it generates a safe environment when performing daily living activities, besides promoting social interaction and integration. In other words, VR looks like a portable and user-friendly device with the comfort of using it at home!

Nevertheless, we mostly approach VR through video games and work-related 3D project visualizations. Young generations already accept and welcome the use of VR at home, at school, or in recreational activities. But what about older generations? What is their attitude toward VR technologies? Are these technologies ready to leave the Labs and be prescribed for home-based training and therapeutic interventions?

Besides its use as a virtual “answering machine” or “boots” to virtually explore spaces, I will provide evidence that VR can also be implemented as digital health technology to promote physical and mental well-being in seniors.

Virtual reality as health-enhancing technology

Recent research published in BMC Geriatrics (2019) [7] evaluated the effectiveness of VR in supporting physical functionality, and social and emotional well-being in elders, besides the acceptance and the use of this technology by the older population. The pilot study involved the participation of 30 older adults aged 60-95 years in which nine different VR applications were selected. Participants were encouraged to select any of these applications and practice them for 15 minutes twice a week for a total of six weeks. Afterward, participants completed a questionnaire based on the Technology Acceptance Model and previous study results, aimed at evaluating their rate of acceptance while being engaged in the conducted VR training. Results demonstrated the engagement of participants in the adoption of VR technology. Indeed, factors such as usefulness, easiness, social norms, or enjoyment were considered significant and contributing elements in the use and acceptance of VR as a joyful and health-enhancing technology.

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More recently, a study of 2022 from McLean Hospital (Belmont) and Harvard Medical School (Boston), MA, USA [8], conducted a systematic review to evaluate and verify objective evidence of VR implementations in clinical settings to identify promising key aspects when translating VR applications into feasible interventions targeting the geriatric population. From a database of 1554 studies and according to specific study information (e.g., sample size, study population, the goal of the research, reliability of results, VR application), only 55 were selected and included in the review analysis. Results showed that among the reviewed research studies, elders with cognitive impairments were the most relevant and target population under investigation. Besides, VR applications did involve mainly testing, training, and screening procedures across different VR environments. Therefore, VR tasks were considered effective applications in evaluating cognitive functions, comparable to the well-established paper-and-pencil cognitive assessments. Moreover, a few limitations were also highlighted. In response to the variety of VR environments when implementing simulations, standard settings should be defined to enhance the reliability and reproducibility of outcomes. In addition, factors such as usability, data privacy, and confidentiality should also be considered, as well as, the democratization and investigation of VR technology also in lower-income countries [8].

Simply wearing immersive headsets generates the assumption and the possibility of identifying novel approaches to improve various health-related physical, psychological, and social aspects. Several VR app studies targeting elders were mostly proposed as alternative approaches with rehabilitation purposes to improve gait, balance, fall prevention, pain management, and also cognitive functioning. Despite the abundance of research, most of it is mainly focused on rehabilitation purposes or other institutional settings, and less is known regarding how immersive VR headsets may enhance health (physical, mental, and psychosocial) in community-dwelling older adults [8]. Based on Joanna Briggs Institute (JBI) methodology, a systematic review published in the Journal of Medical Internet Research (2020) [9] explored this hypothesis by investigating seven peer-reviewed publications that included community-dwelling elders of ≥60 years old residing in care facilities and nursing homes.

Overall, VR apps based on immersive headsets did show to improve several health parameters from pain management, cognitive capabilities (particularly concerning Alzheimer’s diseases), and reduced risk of falls. Among the reviewed studies, six of them demonstrated a significant difference between pre- and post- VR intervention. One study reported improved navigation skills with reduced navigation errors. However, only one study confirmed that VR can be accepted and implemented as an alternative intervention to already existing practices. Besides, none of these research studies did implement a gamification function in their VR applications, potentially affecting engagement and enjoyment. Hence, despite the potential of VR effectiveness in improving health, more data is needed to reinforce the outcome of these findings, besides a closer investigation of other factors such as frailty, usability, and acceptability that might influence the adoption of VR interventions in elders [9].

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