Using Virtual Reality Recreation Therapy to Enhance Social Interaction and Well-Being in Homebound Seniors
Singapore University of Social Sciences, Singapore 599494, Singapore
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Author to whom correspondence should be addressed.
J. Ageing Longev. 2024, 4(4), 373-393; https://doi.org/10.3390/jal4040027
Submission received: 14 October 2024
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Revised: 8 November 2024
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Accepted: 20 November 2024
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Published: 25 November 2024
Abstract
:In view of Singapore’s rapidly ageing population, this study is an exploratory pilot designed to assess the feasibility and potential impact of virtual reality recreation therapy (VRRT) on homebound seniors. A tri-party research partnership was formed between the Singapore University of Social Sciences (SUSS), NTUC Health Home Care, and Vue Reality Labs. The aim was to explore the benefits of VR recreation therapy for homebound seniors, contributing to the goal of ‘aging in place’. Over two years, a 52-week VR curriculum was developed, featuring social, travel, and cultural topics tailored to the seniors. Five care associates from NTUC Health Home Care received facilitator training by Vue Reality Labs. A total of 71 homebound senior participants aged 50 to 102 engaged in over 1600 session hours during the 52-week trial; 62% had varying levels of dementia. A mixed-methods approach was adopted to explore the general impact and feasibility of VR recreation therapy, incorporating quantitative data on participants’ emotional, social, and cognitive conditions and qualitative data from facilitator interviews. The findings revealed that most senior participants enjoyed the VR sessions, perceiving them to positively impact their overall health and well-being. Caregivers reported improvements in cognitive, social, and emotional functioning of the participants. The positive effects extended to caregivers and facilitators, with renewed relationships and enhanced skills, respectively. The insights and observations gathered from this pilot study will serve as a foundation for designing a more robust study for deploying the VR recreation therapy programme in senior care.
1. Background
Globally, according to the World Health Organisation, people are expected to live longer and beyond their sixties. By 2030, one in six of the world’s population will be aged 60 years and older. In 2020, there were 1 billion people aged 60 and above. This number will more than double to 2.1 billion by 2050. In the same period, the number of people aged 80 years and older is expected to triple to 426 million globally [1]. This phenomenon is currently more prevalent in high-income countries, but it is also projected to affect low- and middle-income countries in the coming decades.
Singapore is projected to become a ‘super-aged’ nation by 2026 [2]. By 2030, around one in four Singaporeans will be aged 65 and above. This is a tenfold increase from 2010 [3]. Compounded by an increase in life expectancy from 78 years in 2000 to 83 years in 2022 [2], Singaporeans may live longer, but their quality of life will be lower. Poor health, functional disability, and psychosocial deprivation will lead to the prevalence of being homebound and the need for home care [4].
A retrospective study conducted by Jung [5] reported that most homebound seniors in Singapore are diagnosed with some level of cognitive impairment, with 54% being bed-bound and 18% on wheelchairs. Given their medical condition and limited mobility, homebound seniors, though not institutionalised, are thus often confined to their homes. A study conducted by Prince et al. [6] illustrated that the lack of social interaction and support and consequent disconnection can result in seniors becoming depressed, ill, and lonely. To support seniors with multiple medical conditions and disabilities to continue to live in their homes, a solution to engage them is needed in the community. A medical-centric-only approach is not itself completely effective: there is a need to also bridge social care to improve their quality of life.
The Study—A Tri-Party Research Partnership
This study was an exploratory pilot designed to assess the feasibility and potential impact of VR recreation therapy on homebound senior individuals. This study was facilitated by a tri-party research collaboration as presented in Figure 1. Vue Reality Labs, a private med-tech lab specialising in extended reality (XR) research and development, had over the course of two years developed a comprehensive 52-week VR recreation therapy curriculum. The programme includes a diverse range of social, travel, and culture-related topics tailored to the specific needs and preferences of homebound seniors to evoke memories and facilitate meaningful conversations. NTUC Health Home Care, an experienced home-care provider would include the VR recreation therapy as part of their home-care offerings for a period of 12 months and would provide a dedicated team of five care associates to be trained in VR recreation therapy facilitation. Subsequently, 71 homebound seniors between 50 and 102 years old were recruited by NTUC Health Home Care and agreed to participate in the study. The research was designed and analysed by an interdisciplinary team of academics from Singapore University of Social Sciences.
2. Singapore’s Ageing Population
In Asia, Singapore, Hong Kong, and Taiwan are leading the race to becoming super-aged societies. The United Nations defines a super-aged society as one whose share of the population aged 65 years and above reaches 21% [7]. Currently, Hong Kong is already considered a super-aged society, with 22.4% of its resident population aged 65 years and above [8]. Singapore is close behind, with 19.9% [9], and Taiwan has 19.2% as of 2024 [10]. They are both projected to reach super-aged society status in 2026 and 2025, respectively. This growing senior population will put immense pressure on a country’s healthcare system. The prevalence of chronic diseases and the growing need for long-term care will start to plague the system.
In 2024, the Singapore government launched the Majulah Package, a national support package targeting the population currently aged in their 50s and early 60s, defined as the ‘young seniors’ [11]. This group, numbering 784,000, are on average more highly educated and are generally in better health than their predecessors, who are now classified as seniors. As part of its preventive strategy against the growing cost of senior care, the Majulah Package includes health and long-term care benefits that are aligned with shortfalls in the individual’s projected retirement savings. This package emphasises the need for early retirement preparation and is designed to most benefit those who need it most. This study includes these ‘young seniors’ who are above 50 years of age as part of the definition of the overall ‘seniors’ population.
2.1. Ageing in Place and Ageing Well
Singapore’s health policy currently embraces the philosophy of ‘ageing in place’, where seniors are encouraged to continue living and ageing in their own homes or within the communities they live in [12]. This approach emphasises home- and community-based care to maintain autonomy and social connections. Key initiatives include the expansion of active ageing centres, which offer activities, befriending services, and care referrals, aiming to reach 225 centres by 2025. These centres are part of the ‘Live Well, Age Well’ programme, which promotes regular group exercises and social activities to keep seniors physically and mentally active. Additionally, there are efforts to make homes and public spaces more senior-friendly, such as the introduction of more Green Man+ pedestrian crossings and Silver Zones to enhance road safety.
The ‘Ageing Well’ policy is outlined in the refreshed 2023 Action Plan for Successful Ageing. It includes three key themes: care, contribution, and connectedness. Care initiatives focus on empowering seniors to take charge of their physical and mental well-being through preventive health measures, active ageing programmes, and enhanced care services. The ‘contribution’ component encourages seniors to continue contributing to society through employment, volunteerism, and lifelong learning, and ‘connectedness’ ensures that seniors remain socially and digitally connected. These policies collectively aim to create an inclusive and supportive environment for seniors, helping them to age with dignity and maintain a high quality of life.
2.2. Challenges for Homebound Seniors
However, increased life expectancy does not mean better quality of life. Poor health conditions have led to more seniors spending their later years with poor physical and cognitive capacities, putting them at greater risk of age-related illness such as dementia, diabetes, and chronic obstructive pulmonary disease [12], and this has left many of them homebound.
Based on the Singapore Census of Population, the number of seniors in resident households aged 65 years and above who had mobility issues grew from around 25,500 to 50,000 between 2000 and 2020 [13]. These homebound seniors often feel lonely and disconnected. As a result, they are led to feel like they are just waiting for their imminent death. Multiple studies have identified that among homebound patients, those who were diagnosed with depression had a larger possibility of adverse falls and becoming hospitalised [14]. Furthermore, a 2010 study identified that homebound seniors experienced a greater decline in their physical and psychological health than non-homebound seniors [15]. This phenomenon is of immediate concern, and therefore more resources are required to ensure that the welfare of all current and emerging seniors are well taken care of.
Despite being challenges, these needs also present significant opportunities in the ‘silver economy’, a rapidly growing market of products and services aimed at seniors, such as healthcare innovations, retirement planning services, leisure activities, and senior-friendly technologies [16].
3. VR and Ageing
With the advancements in XR technology in the last few years, virtual reality (VR) has been made more accessible for seniors. VR refers to an immersive virtual environment where users experience telepresence [17]. This is achieved using a combination of hardware and software interventions. In recent years, VR has moved away from being just an entertainment and gaming tool to being deployed by healthcare institutions for clinical and therapeutic use (e.g., chronic pain and trauma management) [18].
Today, VR has not only become more accessible, but it has also gained renewed prominence [19]. Key improvements such as higher-resolution video have led to significant interest in studies on how seniors can utilise VR to reminisce their lives [20]. Prior studies conducted in Canada and the United States have shown that VR experiences can improve social, cognitive, and emotional domains of seniors [21,22,23]. However, most VR research with seniors has focused predominantly on rehabilitation and balance. De Amorim et al.’s [24] systematic review and meta-analysis of virtual reality therapy found 486 articles that were related, but only 10 studies that were directly relevant. Their study concluded that there is a shortage of intervention studies in seniors using virtual reality as a therapy. Most recently, in 2023, Cieslik et al. [25] published the results of their controlled trial on using virtual reality to support the mental health of senior women. Beyond this study, there have been few others, therefore exposing the gap in this area.
Traditionally, VR experiences are generated via computer graphics. Cinematic virtual reality experiences (CVREs) are one sub-type of VR that focuses on using moving visuals captured with an omnidirectional VR360 camera. CVREs typically consist of elements such as 360-degree visuals, spatial audio, actors, graphics, and lighting to create an experience where users can look around in a 360-degree space akin to watching a film [26]. In CVREs, users can look at and interact with the virtual environment by moving their head via a VR head-mounted display (HMD). This mode of delivery allows for a true immersive experience. This is the result of the two VR affordances: immersion and presence.
Immersion is made possible by being ‘immersed’ in the virtual environment. This controlled and dedicated environment facilitates connecting the users to the VR experience through the realistic reproduction of the real environment using audio and video. This immersive experience enables users to believe that they are present in the actual physical space. This immersion also motivates the user to begin to respond to any stimuli within and interact with the VR environment [27].
Presence is the ideal sweet spot of VR experiences that is achieved when a user begins to think and exist within the VR world, forgetting for that moment that they are using VR. Presence is defined as “the subjective experience of being in one place or environment, even when one is physically situated in another” [28]. VR users are given agency and control and are enabled to move around and explore the whole VR experience, which is the key to allowing users to gradually forget that they are using VR. VR can bring users to places and space they could never go to and never experience in real life.
Previous research has shown VR to be a tool to connect socially with others [29]. As homebound seniors lose their ability to ambulate beyond their home, conversation topics gradually become limited. VR recreation therapy has been designed to address this by the utilisation of VR technology to transport these seniors from the limitations of their mobility to the unlimited virtual spaces and places offered in the virtual world. These VR recreation experiences are selected to stimulate seniors’ cognitive, emotional, and social domains, motivating them to be able to have meaningful conversations with their facilitators and caregivers.
The topic of integrating VR technologies in healthcare has received significant interest in Singapore. However, many existing interventions remain largely focused on managing real-life scenarios targeting care providers. Some examples include the National University of Singapore’s VR Agitation Management [30], Dementia Singapore’s [31] EDIE (Educational Dementia Immersive Experience), and Singapore General Hospital’s IV NIMBLE [32]. Nevertheless, a small number of use cases have examined VR as a non-pharmacological intervention, for example, Dancing Mind’s [33] VR Digital Therapy and Mind Palace’s VR Reminiscence Therapy [34].
Although Mind Palace’s VR Reminiscence therapy content is more generic (e.g., ‘Gardens by the Bay’ and ‘Haw Par Villa’), it is delivered only on an ad hoc basis in selected nursing homes. While their three- to four-minute VR experiences have proven to keep participants engaged and reduce their stress [34], several questions regarding the intensity and frequency of interventions remain to be addressed. In addition, there is limited research on the effective ways of using VR as part of a curriculum in improving the health and well-being of homebound seniors in Singapore. Furthermore, a closer look at past studies on psychological interventions found that a minimum frequency of four weeks is necessary for any intervention to be effective [35].
3.1. VR Recreation Therapy
The VR recreation therapy programme was developed by Vue Reality Labs with the purpose of stimulating the senior’s cognitive, emotional, and social domains. In the review ‘Positive technology for elderly well-being’, Grossi et al. [36] affirmed that the literature identified cognitive reasoning, emotional quality, and social connectedness as the “three main characteristics of human personal experience largely influencing the overall well-being”. Cognitive reason is defined as the ability to complete activities using one’s own strength and talents. Emotional quality is described as an individual’s mood state, and social connectedness is the integration and connections between individuals, groups, and organisations.
The therapy follows a structured curriculum comprising the VR experience and a facilitation guide, which includes background information on the place featured, conversational cues, and a set of inquiry-based questions. Its application has been observed in various pilot use cases, including active ageing centres (Loving Heart MSC), nursing homes (Singapore Christian Home), and in this study, with individual homebound senior participants.
3.1.1. VR Recreation Therapy Kit
VR recreation therapy is delivered via the Vue Uno Kit comprising a Pico G2 VR head-mounted device (HMD), and an Android tablet. The Pico G2 is a lightweight 3-degrees of freedom (3DoF) device, which is optimal for users that are limited in mobility and will be experiencing the VR in a seated position. The 3 degrees of freedom enable the user to look left and right, up and down, and pivot vertically up and down in the safety of a chair or bed. The devices are linked wirelessly via Bluetooth, with the Android tablet acting as the controller of the HMD. The controller can start and stop the VR experience inside the HMD. It also displays the point of view of the HMD and the position within the 360-degree frame that the user is looking at, thereby enabling the facilitator to know what the user is seeing and to be able the facilitate the experience. Additional control functions are volume and annotations within the VR environment to direct the viewing experience. The Vue Uno Kit is powered by rechargeable batteries and does not require any internet connection to operate, making it entirely mobile and easy to deploy in a mobile home-care environment.
3.1.2. VR Recreation Therapy Content
Vue Reality’s VR for well-being programme offers a curriculum of VR content designed for cognitive, social, and emotional stimulation for seniors who are limited in mobility and/or homebound. The content is designed in themes and offered to participants on a once-weekly basis. The desired outcomes of the programme are social mobility and improvement in health and quality of life.
Each VR recreation therapy session is designed to be 1 h, consisting of a series of activities such as a quick health check, the VR experience, and a facilitated conversation. During each VR session, the participant will be exposed to one 6 min immersive virtual reality experience with a full 360-degree viewing experience while stationary. The proposed intervention regimen of one 6 min VR exposure takes into consideration the short attention span of the residents (seniors) and ensuring that they avoid fatigue and eye strain.
The 3-degrees of freedom (3DoF) experience provides participants the agency to choose where to look and to change their point of view constantly. Throughout the VR experience, participants are fully immersed in surround sound and 360-degree vision of a virtual environment that is designed to stimulate them to respond and react. Figure 2 shows a sample of the VR recreation therapy content used in this study.
The VR experiences are divided into various content themes with the aim of stimulating different domains, such as cognitive and social interactions by stimulating the long-term memory using familiar places, food, and festivals for reminiscence therapy. Traditional reminiscence therapy (e.g., personal photographs) is well acknowledged to improve the well-being of seniors [20,37].
There are also experiences with nature themes like parks, gardens, and beaches. This set of videos aims to soothe the confused, agitated, and restless participant. The last series of videos features new places and adventures. These experiences might be suitable for the participant who is looking for something new and exciting to try. Each weekly VR experience is accompanied by an associated facilitation guide that contains the recommended facilitation protocol, a summary of the specific VR experience, including specific details of each VR scene, and a series of suggested conversational cues and inquiry-based questions. The questions are designed to stimulate the cognitive, social, and emotional domains, and are designed within the Life Course Framework [38].
3.1.3. VR Recreation Therapy Protocol
All participants took part in one weekly VR recreation therapy session each during the study period. Each would eventually complete 52 sessions over 52 weeks. Each weekly session was approximately one hour long and followed the protocol in Table 1.
4. Objectives of the Research
The overall purpose of this study was to examine how VR recreation therapy, a structured curriculum comprising weekly VR experiences and facilitation guides including background information, conversational cues, and a set of inquiry-based questions, can be used to improve the well-being of homebound seniors in Singapore.
The data collected aimed to address the following research questions:
RQ1: How effective is virtual reality (VR) as an agent in recreation therapy to stimulate social interaction between homebound seniors and their facilitators?
RQ2: In what ways does VR recreation therapy improve the health and well-being of homebound seniors?
Based on these research questions, the hypotheses were as follows:
H1.
VR Recreation Therapy increases the frequency and depth of social interactions between homebound seniors and their caregivers or facilitators, as observed over an 8-month period.
H2.
Homebound seniors participating in weekly VR recreation therapy sessions show statistically significant improvements in emotional well-being and cognitive function after six months of intervention.
5. Research Methods
This study adopted a mixed-methods approach, incorporating both quantitative data of participants’ emotional, social, and cognitive conditions throughout the 52-week study period as well as qualitative data from facilitator and caregiver interviews. Given its nature as an exploratory pilot study, it did not include a control group or adopt a randomised controlled trial structure. The findings of this study will serve to identify trends and gather insights that will inform the development of a more rigorous experimental design in the subsequent research.
5.1. Project Stakeholders
The project stakeholders facilitated the various roles and responsibilities, as described in Figure 3. This structure illustrates the roles and collaborative relationships among stakeholders, emphasising the multi-faceted support system that enabled the study’s success.
Singapore University of Social Sciences (SUSS) was the lead research institution overseeing the study. They were responsible for designing the research, analysing the results, and publishing the findings. Vue Reality Labs are XR technology experts who provided the VR technology and content. They also trained the care associates (facilitators) in facilitating the VR recreation therapy sessions and collaborated with SUSS in program design and implementation. The NTUC Health Home Care—Care Associates were trained to be the facilitators to conduct the VR recreation therapy sessions with the senior participants. They assisted in collecting observational data and reporting findings to the university researchers. The homebound seniors, the participants of the study, experienced the VR recreation therapy and provided behavioural and emotional data through their responses. NTUC Health Home Care, the home-care provider, supported the recruitment of senior participants, coordinated with families and caregivers, and provided logistical support for the VR recreation therapy sessions. Families/caregivers supported participants during and after the VR recreation therapy sessions and provided feedback on observed changes in the participants’ well-being.
5.2. Participants
This exploratory pilot study employed convenience sampling in its recruitment of participants, as its primary goal was to gather preliminary insights. The participants were recruited from the home-care provider partner NTUC Health Home Care’s readily accessible clients. NTUC Health Home Care included VR recreation therapy as part of their ‘mental stimulation’ home-care offerings and marketed the service to their existing and new clients.
The recruitment process applied the following exclusion criteria. Individuals with motion sickness were excluded, as VR experiences can exacerbate this, leading to feelings of nausea and dizziness. Others excluded were those with a history of stroke or seizures and any individuals with transmissible diseases. Finally, those with severe facial eczema or other dermatological conditions were also advised not to participate. These exclusions were to ensure the safety of all individuals involved and helped maintain the integrity of the data by minimising any external factors that could complicate or compromise the VR experience.
NTUC Health Home Care recruited 71 homebound seniors between the ages of 50 and 102 years to participate in the study. Figure 4 shows an NTUC care associate facilitating a participant. Overall, 62% (n = 44) of participants were diagnosed with varying levels of dementia.
5.3. Key Variables and Relationships
Independent variable: exposure to VR recreation therapy sessions (frequency and duration of sessions).
Dependent variables: social interaction levels, emotional well-being (mood, cheerfulness), cognitive function (memory recall, cognitive engagement), and physical relaxation (calmness and reduced agitation).
Relationships among variables: VR recreation therapy is hypothesised to positively influence the dependent variables by offering a platform for reminiscence, mental stimulation, and emotional expression. Increased social interaction, emotional well-being, and cognitive function are expected as outcomes of regular immersive VR recreation therapy experiences.
5.4. Data Collection
As this study was an exploratory pilot, the main objective was to evaluate the feasibility and initial impact of VR recreation therapy on homebound seniors. No formal reliability measures or standardised assessment tools were included in the initial design. The choice to forego formal reliability and standardised assessments was a pragmatic one, aiming to maximize the feasibility of this new intervention for senior participants. There were several key reasons for simplifying the data collection. First, this study focused on testing a novel intervention in real-world settings. The researchers did not have any external grants or funding required for the additional training, specialised equipment, or more extensive data protocols required of reliability measures and standardised tools. Second, at this pilot stage, the priority was to observe initial trends, gather qualitative insights, and identify areas for improvement, rather than generating generalizable results that demand high reliability and validity. Third, because we were deploying the VR recreation therapy with homebound seniors in their home environment, this itself posed logistical challenges. Participants possessed different levels of cognitive impairment, making it challenging to implement standardised cognitive or emotional assessment tests consistently. Therefore, simple observational surveys were chosen instead to reduce participant burden and allow caregivers to focus on the experience rather than standardised scoring. And finally, this pilot study was conducted with the view of following it up with larger extended research. As such, the insights and observations gathered from this study will serve as a foundation for designing a more robust future study. Based on the findings, future studies can integrate validated instruments and reliability checks to strengthen the reliability and generalizability of the results, especially once the feasibility of the intervention has been confirmed.
In this study, data were collected at three key time points—baseline (0 months), 3 months, and 8 months—to assess the changes over time in the variables of interest. The baseline (0 months) served as the initial reference point, providing a snapshot of the participant’s condition or behaviour before any intervention was introduced. This allows for a clear understanding of the starting state of the variables being measured. At 3 months, an early follow-up measurement was taken to evaluate any immediate or short-term effects of the intervention. This time point provides insight into whether the intervention or treatment has had an early impact. Finally, at 8 months, a longer-term follow-up measurement was conducted to determine whether any changes observed at the 3-month mark were sustained, further developed, or diminished over time. Collecting data at these three time points enabled the research team to track both short-term and long-term trends and assess the lasting impact of the intervention, providing a comprehensive view of the progression of the studied variables.
5.4.1. Quantitative Data
As the sample of this pilot was small, which is typical of such studies, it was designed to explore the general impact and feasibility of VR recreation therapy rather than to provide statistically conclusive evidence. The quantitative data collected were compiled from observation surveys of the homebound seniors who underwent the VR recreation therapy that were conducted between June 2022 to February 2023. Facilitators filled out a quantitative observation survey form with three sections during and after each weekly session with a client. This survey form was based on Tcha-Tokey et al.’s [39] ‘Questionnaire to Measure the User Experience in Immersive Virtual Environments’. Section A featured questions on observations of participants’ reactions and responses during the therapy, including emotions, behaviour, and social, physical, and cognitive domains. Section B focused on caregiver observations of participant behaviour post-therapy, including mood, eating, engagement, communication, sleep, and agitation. Section C covered the participants’ reactions to the VR experience, including presence, immersion, emotions, and side effects. Sections A and C were answered based on observations by the facilitators after each VR recreation therapy session and Section B was based on caregiver (family/maid) feedback, also gathered each week by the facilitator after each session.
5.4.2. Qualitative Data
Qualitative data was derived from post-session interviews with the facilitators. A semi-structured in-depth interview guided by an aide-mémoire was individually conducted with the five care associates (facilitators) who were deployed by NTUC Health Home Care for the VR recreation therapy. The interviews consisted of 5 main questions, which covered (1) degree of acceptance of virtual reality recreation therapy, (2) perceived goal of virtual reality recreation therapy, (3) perceived quality of virtual reality recreation therapy, (4) opportunities that arose from virtual reality recreation therapy, and (5) advantages and disadvantages presented in virtual reality recreation therapy.
A thematic analysis was conducted to analyse the interview responses and field notes [40]. The interviews were transcribed, and the responses were first grouped by the question. Subsequently, each line of responses was coded for its literal meaning to identify similarities and differences. Finally, the researchers explored the relationship between codes and potential themes relevant to the research question. Field notes were condensed into concise summaries. Given the preliminary scope, thematic analysis was kept broad to provide initial insights. More detailed organisation of themes will be possible in future studies, where the qualitative analysis can be better structured and expanded.
6. Results
This section presents the empirical findings from the data in relation to the research questions.
6.1. RQ1
In order to answer RQ1, ‘How is virtual reality an effective agent within recreation therapy to stimulate social interaction between homebound seniors and their facilitator?’, we unravelled the relationship between VR recreation therapy, the homebound seniors and their facilitators, as well as examined the interaction of the homebound seniors with their family members. The existing literature has demonstrated the need for social connection and its impact on social well-being [6,41]. The facilitators observed the following changes in the social domain of their participants between the 3- and 8-month points of the 12-month trial, as reported in Figure 5 and summarised in Table 2.
Based on the summary in Table 2, the participants were observed to be more sociable after going through VR recreation therapy for a period of 8 months: 25% of the participants showed an increase in interaction with family members and facilitators from originally 15.4% of the participants initially reporting “almost always and often” to 40.4% recording “almost always and often” following 5 additional months of VR recreation therapy.
In further answering RQ1, the facilitator interviews revealed the following themes and associated perspectives.
6.1.1. Facilitates Conversation and Storytelling
VR helps break the ice between the facilitator and the seniors by serving as a conversation starter. As participants view scenes in VR, they are prompted to share memories related to the content, such as past experiences in familiar locations like Chinatown or the market. This often leads to deeper personal storytelling, which might not have occurred without the VR experience. The shared virtual experiences allow the facilitators to relate to the seniors on a personal level, discussing both the past and present. The emotional connection formed during these exchanges helps build rapport, trust, and openness.
Facilitator 1 said, “This uncle, he will share with us, telling us stories about places he used to go with his family.”
Facilitator 3 shared that “I try to ask them about the olden days. Then they’re able to say, ‘Oh, I was very poor before. I got a lot of family’. So they will share the olden stories because of the video they just saw.”
Facilitator 2 added that “They start to open up more and they start to build better trust with me” and “I win their trust more. They start to believe that there are still good people out there because we are going to their homes.”
6.1.2. Encourages Reminiscence Therapy
Through VR, participants are taken to familiar places that evoke memories from their past, which they might share with the caregiver. For example, seniors recalled their youth, their time spent in places like markets or parks, and even compared their past experiences with the current virtual experience. This reminiscence fosters a sense of shared history, allowing the seniors to feel more comfortable and inclined to engage with their facilitators.
Facilitator 2 suggested that “With the VR … they may recollect something that I may not be able to catch. So at least the VR can reminisce, reminisce that past.”
Facilitator 3 added that “Sometimes it triggers them. They recall the olden times. Then after the session, they will ask the family member, ‘I need to go out’” and “Some clients who have early-stage dementia are triggered by the VR to recall old times, and they become more engaged after the session.”
6.1.3. Promotes Non-Verbal Communication
Even for non-verbal participants, VR helps stimulate interactions by encouraging physical responses. The facilitator can observe how a client reacts physically (e.g., smiling, hand gestures, body movements) and use these cues to engage with the client. VR provides a shared experience that allows both verbal and non-verbal communication to flow more naturally between participants and caregivers, deepening their connection.
Facilitator 3 said, “I got a few clients that are literally non-communicative, but once they have this VR session, just help them move their head right, they got some response”.
Facilitator 4 added that “there are some that are non-verbal. It’s hard to see if they are responding to the VR. Can only see from body gestures. So if they tilt a bit or their hands move a bit, then we know he is reacting.”
Facilitator 1 shared that “I can see from their smiling. Even though they don’t talk, their facial expressions show they are enjoying it.”
6.1.4. Increases Frequency and Depth of Interaction
Many facilitators observed that participants who used VR became more engaged in conversations, even initiating discussions about their VR experiences, compared to their other clients who did not use VR. The VR experience provided a new subject of conversation that was enjoyable and engaging, thus fostering repeated and deeper social interactions over time.
Facilitator 2 described how “They always ask me, ‘Where are we going today?’ They look forward to the VR session every week”.
Facilitator 3 agreed, saying, “Most of my clients will say, ‘What will be our content next week?’ So, they are looking forward to the VR session. It’s making them kind of interested”.
Facilitator 1 explained that “Because they enjoy it, it allows me to have more conversations with them, and they also thank me for bringing them out in a way”.
Facilitator 3 felt that “It has given me something new to talk to them about … we have different conversations now.”
Facilitator 2 added that “With the VR, they start to share more. Even stories that the family didn’t know they had”.
The VR experience acts as a catalyst for social interaction between homebound seniors and their facilitators by offering shared experiences that spark conversation, build emotional connections, and foster a sense of trust and familiarity.
6.2. RQ2
Regarding RQ2, ‘In what ways does VR recreation therapy improve the health and well-being of homebound seniors?’, prior research has shown that individuals with diverse relationships tend to have better health outcomes compared to isolated individuals [41,42]. Overall, the results of the observation surveys highlighted that there were major significant differences in the participants’ characteristics in three categories (emotional, social, and cognitive) after undergoing 6 months of VR recreation therapy.
6.2.1. Emotional
In terms of emotional aspects, the participants of the VR recreation therapy were observed to be more cheerful and happy, with 64.9% of participants reporting being cheerful/happy compared to 38.6% 5 months prior, as presented in Figure 6 and summarised in Table 3.
This growth reflects a change in their emotional states, indicating participants may have become more at ease and comfortable with the facilitators.
6.2.2. Behavioural
In terms of behavioural changes, 5.3% of the participants that underwent VR recreation therapy were observed to become calmer and 3.5% of participants were less agitated during the VR recreation therapy sessions, as shown in Figure 7 and summarised in Table 4.
While these increases were small, given the high ‘calm’ baseline of 68.4% and the low ‘agitated’ baseline of 10.5%, the improvements are significant. The increment of 5.3% of participants feeling calmer acknowledges that VR recreation therapy and facilitation can create a safe environment for participants to engage in relaxation activities that can induce a state of calm, which can in turn have a profound effect on well-being. The ability to achieve calmness often involves letting go of tension and being in the moment [43].
6.2.3. Cognitive
Besides changes in emotional and behavioural well-being, positive cognitive changes were also observed. VR recreation therapy comprises the VR experience integrated with facilitation tools such as background information, conversational cues, and inquiry-based questions. This information and the follow-up questions are delivered during each weekly session and include regular informal check-ins and recollections. Recollection plays a crucial role in cognitive processing, as it helps homebound seniors draw upon past experiences to inform present actions and decisions. In terms of cognitive changes, the participants that underwent VR recreation therapy were observed to have improved in several ways, as presented in Figure 8.
This was evident by the 50.9% of participants who recorded that they were able to (sometimes and often) remember where they put their things after 8 months of VR therapy, which was an increase of 19.3% in the same participants 5 months prior.
Figure 9 shows that 93% of the same group were also reported to behave rationally and logically after receiving the VR recreation therapy compared to 73.7% of the same group prior to the therapy, and Figure 10 shows that 80.7% of them were reported to be receptive to new ideas, which was a 12.3% increase.
These collective positive results, summarised in Table 5, can be attributed to the participants having attended the weekly VR recreation therapy where their memories and ‘recollections’ were constantly stimulated. The consistency of such stimulation can potentially slow a participant’s cognitive decline, and slower cognitive decline suggests advantages such as higher levels of life satisfaction and well-being [44,45].
The findings are consistent and provide further support to the limited number of studies that have previously evaluated VR as a form of therapy for seniors in Singapore [33,34].
In further answering RQ2, the facilitator interviews further revealed the following themes and associated perspectives.
6.2.4. Improves Mental and Emotional Well-Being
Stress Relief and Emotional Expression: VR helps reduce anxiety and emotional stress by offering a therapeutic escape. Many participants reported feeling a sense of calm and happiness after ‘visiting’ places they could no longer physically go to, such as the seaside, shopping malls, or parks. The ability to reconnect with these environments in a virtual space provides emotional comfort and satisfaction. In some cases, participants who were previously withdrawn or anxious began to open up emotionally after VR sessions.
Facilitator 1 explained that “Some they like it because they cannot go. They say we want to go there, we cannot go there, because they will use their wheelchair. Seaside also not easy for them.”
Facilitator 2 added that “When they experience the VR, especially places that are familiar to them, it helps them overcome their fear and feel more at ease” and “VR allows them to experience places they used to visit, which brings out emotions. They talk about their past and relieve emotional stress.”
Enhanced Cognitive Stimulation: VR supports cognitive health by encouraging memory recall and mental engagement. Senior individuals who used VR were observed recalling past experiences and comparing them with the virtual experience, stimulating their cognitive functions. This regular mental stimulation can help delay cognitive decline, especially in individuals who are homebound and lack other forms of intellectual engagement.
Facilitator 1 recalled, “So they remember last time when they go, and then now they look at it. Very nice and their views are, last time they were good and different … and it helps them to remember last time they passed, so they compare from their time and now.”
Facilitator 2 agreed that “They remember last time when they went to these places, and they compare how it looks now. This helps them reminisce about the past.”
6.2.5. Promotes Physical Relaxation and Better Sleep
Induces Fatigue and Better Sleep: For some participants, VR experiences provided a level of mental engagement that translated into physical exhaustion, leading to improved sleep quality. Many facilitators noted that participants who struggled with sleeplessness experienced better sleep after VR sessions, likely due to the immersive nature of the experience, which mimicked the fatigue they would feel after a real-world outing.
Facilitator 2 described that “because they feel the ‘jalan jalan’ (going out), they feel that they are very exhausted after six minutes because they feel that we are going out to the beach, going out to the shopping centre, so they feel very exhausted … they are able to sleep because some are not having some are having sleepless nights … that means they don’t sleep, then after the VR, they feel tired suddenly … they can sleep better”.
6.2.6. Facilitates Social and Emotional Well-Being
Increases Sociability: Participants using VR became more sociable, engaging in more frequent conversations with facilitators, family members, and even among themselves. VR provided a shared activity that invited discussion and interaction, breaking the social isolation often experienced by homebound seniors.
Facilitator 1 said, “They will share with us, happy one, emotional one. But they are willing to talk about even sad things.”
Facilitator 3 felt, “For me, it was an enjoyable experience because I was able to know more about my client. They shared those old stories.”
Facilitator 2 added, “Actually it’s a way for them to escape their boring, their boredom. A way to allow them to communicate to me about their past, about their spouse who passed on earlier than them or to also communicate more about their personal story with their children or their moms and dads.”
Empowerment and Independence: Some participants felt empowered by the VR experience, as it allowed them to ‘travel’ independently, fulfilling desires that they otherwise could not achieve due to physical limitations. This sense of agency improved their emotional well-being, as they felt they were still able to explore the world, even from their homes.
Facilitator 2 said, “I feel happy that they managed to overcome their fears. They managed to hold hands with me and go out. They managed to have the trust.”
Facilitator 1 described how “She will enjoy her own self, but he doesn’t talk one. He will enjoy up and down, turn around” and “They say thanks to you, we will … go to the seaside or shopping mall, the other country. Because they are homebound, even bed bound.”
6.2.7. Combats Depression and Loneliness
Alleviates Loneliness: VR provides a way for senior individuals to escape their daily routine and experience a world outside of their home, which is especially beneficial for those who have been confined for long periods. The change in environment, even virtually, reduces feelings of loneliness and isolation, which are common contributors to depression in the seniors.
Facilitator 1 described that “For them, because some they cannot go out to the seaside or park, we bring them there through VR. They are happy, we are happy” and “They enjoy it because they say they cannot go to these places anymore, and they thank me for bringing them out.”
Triggers Emotional Release: By revisiting meaningful places and experiences through VR, participants often release pent-up emotions and engage in cathartic emotional expression. This is particularly significant for participants who have difficulty expressing their emotions in traditional therapy settings.
Facilitator 2 explained that “I allow them to cry, I allow them to be angry, I allow them to … feel the bad trigger that means I allow them to cry, I allow them to pour out, I allow them to so-called understand what is the thing that makes them angry … I tell them that is my perspective, and they say ‘No girl, you don’t understand’ … I accept it because I don’t understand, but at least we get to talk it out—that’s more important.”
VR recreation therapy significantly improves the mental, emotional, and social well-being of homebound seniors by providing cognitive stimulation, emotional relief, social engagement, and opportunities for relaxation. This holistic benefit to their well-being helps counter the negative effects of isolation and physical limitations, fostering a healthier and more contented life.
7. Discussion
The integration of VR into senior care shows significant promise. The Singapore government has recently allocated SGD 800 million to the Age Well SG programme [46], aimed at promoting active ageing through preventive care with the objective of keeping seniors active and socially engaged [4]. Active ageing centres can potentially leverage VR recreation therapy to achieve common goals like building strong social connections and combating social isolation. This study highlights the effectiveness of VR recreation therapy and can serve as a foundation for further development of similar programmes, contributing to overall improvements in homebound senior care.
7.1. Limitations
The study acknowledges several limitations in two key areas: study design and participants.
Regarding study design, the research relied mostly on facilitators’ observations and perceptions of the homebound seniors’ experiences, which introduces potential biases. Future studies should consider directly interviewing the homebound seniors to obtain more accurate insights, which on the flipside also means having to add an inclusion criterion to recruit only participants with lower cognitive decline. As the VR recreation therapy requires training and experienced facilitation, another limitation is the need for proper staff training. If the facilitator is not adequately trained, it could lead to ineffective implementation and a lack of engagement from the participants, leading to ineffective outcomes. Also, due to the pilot nature of this study, there was an absence of any longitudinal view of the efficacy of the VR recreation therapy. As such, it is recommended that there should be further post-intervention studies to determine if the positive effects of VR recreation therapy on social interaction and well-being persist beyond the therapy period. This will provide a more comprehensive understanding of the therapy’s long-term impact, which may be influenced by the regularity of interactions, rather than the therapy itself.
For participants, engagement can be affected by their level of interest or willingness to engage with the VR technology. Factors such as a prior negative experience with technology can play a role. Beyond the technology, the appropriateness and relatability of the content to the participant and their backgrounds, interests, and cognitive levels can influence its effectiveness. Culturally relevant content was also found to be a key consideration. As many of the seniors are bound by their own cultural beliefs, practices, and norms, to offer them a safe and comfortable VR experience, it is important to present environments and content that are localised and familiar to maximise the engagement.
7.2. Recommendations
The results of this study suggest several concrete recommendations for future research.
7.2.1. Control Group Studies
For future studies, a control group should be incorporated to enhance the robustness of the findings. These studies should incorporate more comprehensive statistical analysiss and could include advanced techniques such as multivariate analysis, regression modelling, or meta-analysis to better understand the relationships between variables.
7.2.2. Long-Term Effects of VR Therapy
It is recommended that future studies investigate the long-term effects of VR recreation therapy on the physical and mental well-being of seniors. This could involve longitudinal studies that assess cognitive function, emotional health, and social engagement over an extended period.
7.2.3. Comparative Studies
Future studies could compare the efficacy of VR recreation therapy with other established forms of therapy such as occupational therapy or cognitive behavioural therapy. This would help identify the unique benefits of VR and inform best practices for its integration into senior care.
7.2.4. Assessment of VR Content Types
Future studies should analyse the different types of VR content used in VR recreation therapy such as documentaries, guided meditation, and animated content. This can provide insights into which genres are more effective for specific populations or conditions.
7.2.5. Co-Design
Future studies should involve senior participants in the design process of the VR content. This co-design methodology ensures that the content and related tools are accessible and appealing to the targeted user group. Focus groups and usability testing with seniors can be employed to gather feedback that will inform the future design of the VR content.
8. Conclusions
This study was designed as an exploratory pilot in anticipation of being followed up with a larger study on the utilisation of VR recreation therapy for seniors. Overall, this study endorses the use of evidence-based VR recreation therapy as a viable option for homebound seniors in Singapore. The findings from this pilot program provide valuable insights into the growing body of research on VR applications in therapeutic settings for seniors. Empirical evidence demonstrates that regular VR recreation therapy sessions significantly enhance participants’ happiness, calmness, and cognitive engagement. These improvements are particularly critical for promoting well-being among homebound seniors, who often have limited access to engaging activities. The data underscores the potential of VR sessions to deliver meaningful stimulation, positively influencing both emotional and cognitive health. Consequently, the study concludes that implementing weekly VR recreation therapy can be an effective strategy for improving the overall health, well-being and quality of life of homebound seniors.
Author Contributions
Conceptualisation, J.J.F., K.H.C., J.T. and C.H.K.M.; methodology, J.J.F., K.H.C. and C.H.K.M.; validation, J.J.F. and K.H.C.; formal analysis, J.J.F. and K.H.C.; investigation, J.J.F., K.H.C., P.L. and C.H.K.M.; writing—original draft preparation, J.J.F. and K.H.C.; writing—review and editing, J.J.F., K.H.C. and P.L.; supervision, J.J.F., J.T. and C.H.K.M. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the Singapore University of Social Sciences under the protocol code APL-0180-2022-EXP-01 for studies involving humans.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
Restrictions apply to the availability of these data. Data were obtained from NTUC Health Home Care and are available from the authors with the permission of NTUC Health Home Care.
Acknowledgments
The authors would like to thank NTUC Health Home Care for providing the manpower and logistics and Vue Reality Labs for providing the VR recreation therapy content & curriculum for this study. Special thanks also to the South West CDC for the South West Innovation Fund (SWIF+) grant that supported the purchase of the VR hardware for this study.
Conflicts of Interest
The authors declare no conflicts of interest.
References
- World Health Organization. Ageing and Health. Available online: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health (accessed on 1 October 2024).
- Visaria, A.; Malhotra, R. Live Long and Prosper? A Super-aged Singapore Society Does Not Have to Be a Sad One. The Straits Times, 29 August 2023. Available online: https://www.straitstimes.com/opinion/live-long-and-prosper-a-super-aged-singapore-society-does-not-have-to-be-a-sad-one (accessed on 1 October 2023).
- Ministry of Health. Action Plan for Successful Ageing 2023. Available online: https://www.moh.gov.sg/others/resources-and-statistics/action-plan-for-successful-ageing (accessed on 1 October 2024).
- Shafeeq, S. More Active Ageing Centres, Boost to Retirement Schemes for Seniors: Forward SG Report. The Straits Times, 28 October 2023. Available online: https://www.straitstimes.com/singapore/more-active-ageing-centres-boost-to-retirement-schemes-for-seniors-forward-sg-report (accessed on 16 November 2023).
- Jung, J.B. Demographic Characteristics of Homebound Older Adults in Central Part of Singapore. Tsao Foundation. Available online: https://tsaofoundation.org/doc/Abstract_Papers/Oral_Presentation/1-Home_Care_Nursing/Demographic-Characteristics-of-Homebound-Older-Adults-in-Central-Part-of-Singapore.pdf (accessed on 1 October 2023).
- Prince, M.J.; Harwood, R.H.; Blizard, R.A.; Thomas, A.; Mann, A.H. Social Support Deficits, Loneliness and Life Events as Risk Factors for Depression in Old Age. The Gospel Oak Project VI. Psychol. Med. 1997, 27, 323–332. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Health. Ageing in the Community Stay Active in Your Golden Years with Age Well SG. Available online: https://www.moh.gov.sg/ageing-well/ageing-in-the-community (accessed on 1 October 2024).
- Legislative Council. Residential Care Services for the Elderly in Hong Kong. Available online: https://app7.legco.gov.hk/rpdb/en/uploads/2024/ISSH/ISSH08_2024_20240517_en.pdf (accessed on 1 October 2024).
- Lau, D. How Singapore is Preparing for a Super Aged Society Come 2026. ChannelNewsAsia, 5 October 2024. Available online: https://www.channelnewsasia.com/today/big-read/super-aged-2026-singapore-ready-4656756 (accessed on 10 October 2024).
- National Development Council. Population by Broad Age Group, 2014 to 2024. Available online: https://pop-proj.ndc.gov.tw/main_en/Custom_Detail_Statistics_Search.aspx?n=175&_Query=e00749e7-86fe-4494-9a09-5a33014cffb7 (accessed on 1 October 2024).
- Gee, C. Commentary: From Pioneer and Merdeka to ‘Young Seniors’, Singapore Shifts away from Generational Support Packages. ChannelNewsAsia, 23 August 2023. Available online: https://www.channelnewsasia.com/commentary/singapore-majulah-package-pioneer-merdeka-generation-support-shift-ndr-2023-3715821 (accessed on 1 October 2023).
- Chia, H.X.; Lee, D.N.G. Reimagining ageing in place for the ‘missing middle’. The Straits Times, 2 March 2022. Available online: https://www.straitstimes.com/opinion/reimagining-ageing-in-place-for-the-missing-middle (accessed on 1 October 2023).
- Ministry of Health. Elderly with Mobility Issues. Available online: https://www.moh.gov.sg/newsroom/elderly-with-mobility-issues (accessed on 1 October 2024).
- Byers, A.L.; Sheeran, T.; Mlodzianowski, A.E.; Meyers, B.S.; Nassisi, P.; Bruce, M.L. Depression and risk for adverse falls in older home health care patients. Res. Gerontol. Nurs. 2008, 1, 245–251. [Google Scholar] [CrossRef] [PubMed]
- Qiu, W.Q.; Dean, M.; Liu, T.; George, L.; Gann, M.; Cohen, J.; Bruce, M.L. Physical and Mental Health of Homebound Older Adults: An Overlooked Population. J. Am. Geriatr. Soc. 2010, 58, 2423–2428. [Google Scholar] [CrossRef] [PubMed]
- Tan, S.K. Finding the ‘Silver Economy’: Singapore Firms Build New Products, Services for Greying Population. ChannelNewsAsia, 1 November 2021. Available online: https://www.channelnewsasia.com/business/silver-economy-singapore-businesses-build-products-services-ageing-population-2267176 (accessed on 1 October 2024).
- Steuer, J. Defining Virtual Reality: Dimensions Determining Telepresence. J. Commun. 1992, 42, 73–93. [Google Scholar] [CrossRef]
- Kaur, A. Virtual reality a rising force in the global healthcare industry. The Straits Times, 6 September 2020. Available online: https://www.straitstimes.com/lifestyle/virtual-reality-a-rising-force-in-the-global-healthcare-industry (accessed on 1 October 2023).
- Anthes, C.; Garcia-Hernandez, R.J.; Wiedemann, M.; Kranzlmuller, D. State of the art of virtual reality technology. In Proceedings of the 2016 IEEE Aerospace Conference, Big Sky, MT, USA, 5–12 March 2016; IEEE: Piscataway, NJ, USA, 2016. [Google Scholar] [CrossRef]
- Fuchs, M.V.R. ‘Reminiscence Therapy’ Lets Seniors Relive the Past. The New York Times, 6 May 2022. Available online: https://www.nytimes.com/2022/05/06/well/mind/virtual-reality-therapy-seniors.html (accessed on 1 June 2024).
- Appel, L.; Appel, E.; Bogler, O.; Wiseman, M.; Cohen, L.; Ein, N.; Abrams, H.B.; Campos, J.L. Older Adults With Cognitive and/or Physical Impairments Can Benefit From Immersive Virtual Reality Experiences: A Feasibility Study. Front. Med. 2020, 6, 329. [Google Scholar] [CrossRef] [PubMed]
- Chaze, F.; Hayden, L.; Azevedo, A.; Kamath, A.; Bucko, D.; Kashlan, Y.; Dube, M.; De Paula, J.; Jackson, A.; Reyna, C.; et al. Virtual reality and well-being in older adults: Results from a pilot implementation of virtual reality in long-term care. J. Rehabil. Assist. Technol. Eng. 2022, 9, 20556683211072384. [Google Scholar] [CrossRef] [PubMed]
- Lin, C.X.; Lee, C.; Lally, D.; Coughlin, J.F. Impact of virtual reality (VR) experience on older adults’ well-being. In Human Aspects of IT for the Aged Population. Applications in Health, Assistance, and Entertainment: 4th International Conference, ITAP 2018, Held as Part of HCI International 2018, Las Vegas, NV, USA, 15–20 July 2018, Proceedings, Part II 4; Springer International Publishing: New York, NY, USA, 2018; pp. 89–100. [Google Scholar]
- De Amorim, J.S.C.; Leite, R.C.; Brizola, R.; Yonamine, C.Y. Virtual reality therapy for rehabilitation of balance in the elderly: A systematic review and META-analysis. Adv. Rheumatol. 2018, 58, 18. [Google Scholar] [CrossRef] [PubMed]
- Cieślik, B.; Juszko, K.; Kiper, P.; Szczepańska-Gieracha, J. Immersive virtual reality as support for the mental health of elderly women: A randomized controlled trial. Virtual Real. 2023, 27, 2227–2235. [Google Scholar] [CrossRef] [PubMed]
- Mateer, J. Directing for Cinematic Virtual Reality: How the Traditional Film Director’s Craft Applies to Immersive Environments and Notions of Presence. J. Media Pract. 2017, 18, 14–25. [Google Scholar] [CrossRef]
- Dede, C.; Richards, J. Glossary of realities’ terms. In Virtual, Augmented, and Mixed Realities in Education; Liu, D., Dede, C., Richards, J., Eds.; Springer: Berlin/Heidelberg, Germany, 2017; pp. 5–11. [Google Scholar]
- Witmer, B.G.; Singer, M.J. Measuring Presence in Virtual Environments: A Presence Questionnaire. Presence Teleoperators Virtual Environ. 1998, 7, 225–240. [Google Scholar] [CrossRef]
- Kalantari, S.; Xu, T.B.; Mostafavi, A.; Kim, B.; Dilanchian, A.; Lee, A.; Boot, R.W.; Czaja, J.C. Using Immersive Virtual Reality to Enhance Social Interaction Among Older Adults: A Cross-Site Investigation. Innov. Aging 2023, 7, igad031. [Google Scholar] [CrossRef] [PubMed]
- Bharade, A. New VR programme teaches medical, nursing students how to manage agitated patients. The Straits Times, 26 May 2022. Available online: https://www.straitstimes.com/singapore/health/new-vr-programme-teaches-medical-nursing-students-how-to-manage-agitated-patients (accessed on 1 October 2023).
- Dementia Singapore. In March 2019, Dementia Singapore Introduced the First Virtual Reality Application in Asia that Offers Users First-Hand Experience on Dementia. Available online: https://dementia.org.sg/academy/edie/ (accessed on 1 October 2023).
- Ang, A. Singapore General Hospital shifts to gamified VR nurse training. Healthcare IT News, 8 February 2023. Available online: https://www.healthcareitnews.com/news/asia/singapore-general-hospital-shifts-gamified-vr-nurse-training (accessed on 1 October 2023).
- Dancing Mind. Dancingmind’s Digital Therapy Platform. Available online: https://www.dancingmind.com/ (accessed on 1 October 2023).
- Ghosh, M. Virtual Reality in Combating Dementia. Jumpstart Mag, 16 April 2021. Available online: https://www.jumpstartmag.com/virtual-reality-in-combating-dementia/ (accessed on 1 October 2023).
- Bolier, L.; Haverman, M.; Westerhof, G.J.; Riper, H.; Smit, F.; Bohlmeijer, E. Positive psychology interventions: A meta-analysis of randomized controlled studies. BMC Public Health 2013, 13, 119. [Google Scholar] [CrossRef] [PubMed]
- Grossi, G.; Lanzarotti, R.; Napoletano, P.; Noceti, N.; Odone, F. Positive technology for elderly well-being: A review. Pattern Recognit. Lett. 2020, 137, 61–70. [Google Scholar] [CrossRef]
- Xu, L.J.; Li, S.S.; Yan, R.F.; Ni, Y.Y.; Wang, Y.C.; Li, Y. Effects of Reminiscence Therapy on Psychological Outcome Among Older Adults Without Obvious Cognitive Impairment: A Systematic Review and Meta-analysis. Front. Psychiatry 2023, 14, 1139700. [Google Scholar] [CrossRef] [PubMed]
- Barrett, A.E.; Barbee, H. The subjective life course framework: Integrating life course sociology with gerontological perspectives on subjective aging. Adv. Life Course Res. 2022, 51, 100448. [Google Scholar] [CrossRef] [PubMed]
- Tcha-Tokey, K.; Christmann, O.; Loup-Escande, E.; Richir, S. Proposition and Validation of a Questionnaire to Measure the User Experience in Immersive Virtual Environments. Int. J. Virtual Real. 2016, 16, 33–48. [Google Scholar] [CrossRef]
- Neuman, W.L. Social Research Methods: Qualitative and Quantitative Approaches; Allyn and Bacon: Boston, MA, USA, 2014. [Google Scholar]
- NIH. Do Social Ties Affect Our Health? News in Health. 2017. Available online: https://newsinhealth.nih.gov/2017/02/do-social-ties-affect-our-health (accessed on 16 November 2023).
- Umberson, D.; Karas Montez, J. Social Relationships and Health: A Flashpoint for Health Policy. J. Health Soc. Behav. 2010, 51 (Suppl. 1), S54–S66. [Google Scholar] [CrossRef] [PubMed]
- Bradberry, T. How Successful People Stay Calm. Forbes, 10 December 2021. Available online: https://www.forbes.com/sites/travisbradberry/2014/02/06/how-successful-people-stay-calm/?sh=5cb756da2f79 (accessed on 16 November 2023).
- Comijs, H.C.; Dik, M.G.; Aartsen, M.J.; Deeg, D.J.; Jonker, C. The impact of change in cognitive functioning and cognitive decline on disability, well-being, and the use of healthcare services in older persons. Dement. Geriatr. Cogn. Disord. 2005, 19, 316–323. [Google Scholar] [CrossRef] [PubMed]
- St John, P.D.; Montgomery, P.R. Cognitive Impairment and Life Satisfaction in Older Adults. Int. J. Geriatr. Psychiatry 2010, 25, 814–821. [Google Scholar] [CrossRef] [PubMed]
- Teo, J. Singapore Sets Aside $800m to Help Seniors Age Well at Home, in Their Communities. The Straits Times, 16 November 2023. Available online: https://www.straitstimes.com/singapore/singapore-sets-aside-800m-to-help-seniors-age-well-at-home-in-their-communities (accessed on 16 November 2023).
Figure 1.
Tripartite research partnership.
Figure 2.
Sample VR recreation therapy content.
Figure 3.
Stakeholders relationship.
Figure 4.
Participant experiencing VR recreation therapy.
Figure 5.
Social—Interaction with family/VR facilitator.
Figure 6.
Emotions—cheerful.
Figure 7.
Behaviour—Calm/Agitated.
Figure 8.
Cognitive—Remembering - where client put their things.
Figure 9.
Cognitive—Is the client rational—logical?
Figure 10.
Cognitive—Is the client more receptive to new activities?
Table 1.
VR recreation therapy session protocol.
| Item | Process |
|---|---|
| 1. | Equipment set-up |
| 2. | Introduction to session |
| 3. | Safety checklist |
| 4. | Gear up |
| 5. | VR experience |
| 6. | Safety checklist 2 |
| 7. | Facilitation discussion |
| 8. | Replay VR experience (optional) |
| 9. | Safety checklist 3 |
| 10. | Conclusion and complete survey |
Table 2.
Social domain data.
| Domain | Characteristics | At 3 Months | At 8 Months | Difference | |
|---|---|---|---|---|---|
| Never and seldom | 58.8 | 29.4% | −29.4% | ||
| Social | Interaction with family/VR facilitator | Sometimes and often | 9.8% | 52.9% | +43.1% |
| Almost always and often | 15.4% | 40.4% | +25% |
Table 3.
Emotion domain data.
| Domain | Characteristics | At 3 Months | At 8 Months | Difference |
|---|---|---|---|---|
| Emotions | Cheerful/happy | 38.6% | 64.9% | +26.3% |
Table 4.
Behavioural domain data.
| Domain | Characteristics | At 3 Months | At 8 Months | Difference |
|---|---|---|---|---|
| Behavioural | Calm (positive): felt calm during the VR | 68.4% | 73.7% | +5.3 |
| Agitated (negative): felt confused and agitated | 10.5% | 7% | −3.5% |
Table 5.
Cognitive domain data.
| Domain | Characteristics | At 3 Months | At 8 Months | Difference |
|---|---|---|---|---|
| Cognitive | Remembering—where client put their things (sometimes and often) | 29.8% | 50.9% | +21.1% |
| Rational and logical (yes) | 73.7% | 93% | +19.3% | |
| Receptive to new activities (yes) | 68.4% | 80.7% | +12.3% |
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MDPI and ACS Style
Foo, J.J.; Chew, K.H.; Lim, P.; Tay, J.; Ma, C.H.K. Using Virtual Reality Recreation Therapy to Enhance Social Interaction and Well-Being in Homebound Seniors. J. Ageing Longev. 2024, 4, 373-393. https://doi.org/10.3390/jal4040027
AMA Style
Foo JJ, Chew KH, Lim P, Tay J, Ma CHK. Using Virtual Reality Recreation Therapy to Enhance Social Interaction and Well-Being in Homebound Seniors. Journal of Ageing and Longevity. 2024; 4(4):373-393. https://doi.org/10.3390/jal4040027
Chicago/Turabian StyleFoo, Jonathan J., Keng Hao Chew, Peggy Lim, June Tay, and Carol Hok Ka Ma. 2024. "Using Virtual Reality Recreation Therapy to Enhance Social Interaction and Well-Being in Homebound Seniors" Journal of Ageing and Longevity 4, no. 4: 373-393. https://doi.org/10.3390/jal4040027
APA StyleFoo, J. J., Chew, K. H., Lim, P., Tay, J., & Ma, C. H. K. (2024). Using Virtual Reality Recreation Therapy to Enhance Social Interaction and Well-Being in Homebound Seniors. Journal of Ageing and Longevity, 4(4), 373-393. https://doi.org/10.3390/jal4040027
