Using Virtual Reality for Reminiscence to Improve Apathy in Residential Aged Care: Results from a Multi-site Non-Randomised Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Dimitrios Saredakis ◽  
Hannah AD Keage ◽  
Megan Corlis ◽  
Erica S Ghezzi ◽  
Helen Loffler ◽  
...  
Keyword(s):  
Older Adults ◽  
Virtual Reality ◽  
Side Effects ◽  
Passive Control ◽  
Aged Care ◽  
Residential Aged Care ◽  
Control Group ◽  
Reminiscence Therapy ◽  
Secondary Outcomes ◽  
Therapy Intervention

BACKGROUND Apathy is a frequent and under-recognized symptom of neurological disorders. Reduced goal directed behaviour caused by apathy is associated with poor outcomes for older adults in residential aged care. Recommended nonpharmacological treatments include person-centred therapy using information and communication technology. Virtual reality (VR) is a fully immersive technology providing access to wide range of freely available content. The use of VR as a tool for therapy has demonstrated promise in areas including treatment for posttraumatic stress disorder and anxiety. Research using VR for symptoms of older adults in residential aged care facilities is limited. OBJECTIVE This study examined changes in apathy after three sessions of a reminiscence therapy intervention including VR. METHODS In this multi-site trial, 43 participants were allocated to one of three groups: reminiscence therapy intervention using VR, reminiscence therapy using a laptop computer and physical items (active control), and a usual care (passive control) group. The primary outcome was apathy, secondary outcomes included cognition and depression. Side effects from using head-mounted displays were also measured in the VR group. RESULTS Mixed model analyses revealed no significant time by group interaction in outcomes between the VR and laptop groups, estimate=-2.24, SE=1.89, t(40)=-1.18, P=.24. Pooled apathy scores in the two intervention groups compared to the passive control group also revealed no significant time by group interaction, estimate=-0.26, SE=1.66, t(40)=-0.16, P .88. There were also no significant results in the secondary outcomes. Most participants in the VR group did state they would prefer to watch content in VR than on a flat screen, Chi-square (2)=11.2, P=.004, and with careful selection of content, it was found that side effects were negligible to minimal according to Simulator Sickness Questionnaire cutoff scores. CONCLUSIONS Although there were no significant results in outcome measures, this study found that participants engaged with the research and enjoyed the process of reminiscing using both forms of technology. It was found that VR can be implemented in an aged care setting with the correct protocols in place. Providing residents in aged care with a choice of technology may assist with increasing participation in activities. We cannot dismiss the importance of immediate effects while the therapy was in progress, this is an avenue for further research that will be reported from this study. CLINICALTRIAL Australian and New Zealand Clinical Trials Registry ACTRN12619001510134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378564 INTERNATIONAL REGISTERED REPORT RR2-DOI: 10.1136/bmjopen-2020-046030

scholarly journals Virtual reality intervention to improve apathy in residential aged care: protocol for a multisite non-randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e046030
Author(s):  
Dimitrios Saredakis ◽  
Hannah A D Keage ◽  
Megan Corlis ◽  
Tobias Loetscher
Keyword(s):  
Older Adults ◽  
Virtual Reality ◽  
Passive Control ◽  
Aged Care ◽  
Residential Aged Care ◽  
Laptop Computer ◽  
Reminiscence Therapy ◽  
Increased Risk ◽  
Secondary Outcomes

IntroductionApathy is a prevalent neuropsychiatric symptom for older adults residing in aged care. Left untreated, apathy has been associated with accelerated cognitive decline and increased risk of mortality. Reminiscence therapy is commonly used in aged care and has demonstrated to reduce apathy. Traditional methods of reminiscence use physical objects and more recently technology including tablets and laptop computers have demonstrated potential. Virtual reality (VR) has successfully been used to treat psychological disorders; however, there is little evidence on using VR for behavioural symptoms such as apathy in older adults. Using VR to deliver reminiscence therapy provides an immersive experience, and readily available applications provide access to a large range of content allowing easier delivery of therapy over traditional forms of therapy. This study aims to identify changes in apathy after a reminiscence therapy intervention using head-mounted displays (HMDs).Methods and analysisParticipants will be allocated to one of three groups; reminiscence therapy using VR; an active control using a laptop computer or physical items and a passive control. A total of 45 participants will be recruited from residential aged care (15 in each group). The three groups will be compared at baseline and follow-up. The primary outcome is apathy, and secondary outcomes include cognition and depression. Side effects from using HMDs will also be examined in the VR group. Primary and secondary outcomes at baseline and follow-up will be analysed using linear mixed modelling.Ethics and disseminationEthics approval was obtained from the University of South Australia Human Research Ethics Committee. The results from this study will be disseminated through manuscript publications and national/international conferences.Trial registration numberACTRN12619001510134.

scholarly journals Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Dimitrios Saredakis ◽  
Hannah AD Keage ◽  
Megan Corlis ◽  
Tobias Loetscher
Keyword(s):  
Older Adults ◽  
Virtual Reality ◽  
Mixed Methods ◽  
Side Effects ◽  
Neurological Disorders ◽  
Verbal Fluency ◽  
Aged Care ◽  
Mixed Methods Study ◽  
Residential Aged Care ◽  
Reminiscence Therapy

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 (<i>t</i><sub>14</sub>=−3.27; <i>P</i>=.006) but not phonemic fluency scores (<i>t</i><sub>14</sub>=0.55; <i>P</i>=.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 (<i>r</i>=0.719; 95% CI 0.327 to 0.900; <i>P</i>=.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.

scholarly journals Virtual reality intervention to improve apathy in residential aged care: protocol for a multi-site trial

2020 ◽  
Author(s):  
Dimitrios Saredakis ◽  
Hannah AD Keage ◽  
Megan Corlis ◽  
Tobias Loetscher
Keyword(s):  
Older Adults ◽  
Virtual Reality ◽  
Side Effects ◽  
Usual Care ◽  
Aged Care ◽  
Residential Aged Care ◽  
Laptop Computer ◽  
Pharmacological Interventions ◽  
Reminiscence Therapy ◽  
Increased Risk

Background: Apathy is a prevalent neuropsychiatric symptom for older adults residing in aged care. Left untreated, apathy has been associated with accelerated cognitive decline and increased risk of mortality. Pharmacological interventions have not been established and can have side effects, placing a priority on the evaluation of non-pharmacological interventions. Reminiscence therapy, a psychosocial, person-centred intervention is commonly used in aged care and has demonstrated to reduce apathy. Traditional methods of reminiscence utilise physical objects and more recently technology including tablets and laptop computers have demonstrated potential. Virtual reality (VR) has successfully been used to treat psychological disorders, however there is little evidence on using VR for behavioural symptoms such as apathy in older adults. Using VR to deliver reminiscence therapy provides an immersive experience, and readily available applications provide access to a large range of content allowing easier delivery of therapy over traditional forms of therapy. This study aims to examine the effect of tailored reminiscence therapy using VR on apathy.Methods: In this multi-site trial, participants will be allocated to one of three groups; a reminiscence therapy intervention using VR; an active control using a laptop computer or physical items; and a passive control usual care group. A total of 45 participants will be recruited from residential aged care (15 in each group). The three groups will be compared at baseline and follow-up. The primary outcome is apathy, secondary outcomes include cognition and depression. Side effects from using head-mounted displays will also be examined in the VR group.Discussion: This study intends to establish if using VR reminiscence therapy improves levels of apathy compared to traditional reminiscence therapy or usual care. Results from this study will inform the therapeutic use of VR for older adults residing in aged care and provide knowledge for implementing VR into existing lifestyle activities in this context.Trial registration: This trial was registered in the Australian and New Zealand Clinical Trials Registry (ACTRN12619001510134). Registered 31 October 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378564&amp;isReview=true

scholarly journals Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study

10.2196/17632 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e17632 ◽  
Author(s):  
Dimitrios Saredakis ◽  
Hannah AD Keage ◽  
Megan Corlis ◽  
Tobias Loetscher
Keyword(s):  
Older Adults ◽  
Virtual Reality ◽  
Mixed Methods ◽  
Side Effects ◽  
Neurological Disorders ◽  
Verbal Fluency ◽  
Aged Care ◽  
Mixed Methods Study ◽  
Residential Aged Care ◽  
Reminiscence Therapy

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.

scholarly journals Using virtual reality to improve apathy in residential aged care

2019 ◽  
Author(s):  
Dimitrios Saredakis ◽  
Hannah AD Keage ◽  
Megan Corlis ◽  
Tobias Loetscher
Keyword(s):  
Older Adults ◽  
Virtual Reality ◽  
Side Effects ◽  
Neurological Disorders ◽  
Aged Care ◽  
Residential Aged Care ◽  
Common Symptom ◽  
Willingness To Participate ◽  
Technical Problems ◽  
Proxy Measure

Background and Objectives: 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 carer burden. A lack of effective pharmacological treatments for apathy has placed an emphasis on non-pharmacological interventions. Virtual reality (VR) using head-mounted displays (HMD) has been successfully used in exposure and distraction-based therapies, however, there is limited research in using HMDs for symptoms of neurological disorders. This feasibility study assessed if VR using HMDs could be used to deliver tailored reminiscence therapy. Willingness to participate; response rates to measures; time taken to create tailored content; and technical problems were examined.Methods: A mixed methods study was conducted in a sample of older adults residing in aged care, 17 participants were recruited. Apathy was measured using the Apathy Evaluation Scale, verbal fluency was used as a proxy measure of improvements in apathy and debriefing interviews assessed feedback from participants. Side effects that can occur from using HMDs were also measured. Results: Those with higher levels of apathy demonstrated the greatest cognitive improvements after a VR reminiscence experience. All participants enjoyed the experience despite 35% of participants experiencing temporary side effects.Implications: There is a need to closely monitor side effects from HMD use in older adults. 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.

Evaluating the use of interactive virtual reality technology with older adults living in residential aged care

2020 ◽  
Vol 57 (3) ◽  
pp. 102105 ◽  
Author(s):  
Steven Baker ◽  
Jenny Waycott ◽  
Elena Robertson ◽  
Romina Carrasco ◽  
Barbara Barbosa Neves ◽  
...  
Keyword(s):  
Older Adults ◽  
Virtual Reality ◽  
Aged Care ◽  
Residential Aged Care ◽  
Virtual Reality Technology

scholarly journals Identifying the Association Between Older Adults' Characteristics and Their Health-Related Outcomes in a Transition Care Setting: A Retrospective Audit

2021 ◽  
Vol 9 ◽  
Author(s):  
Jo-Aine Hang ◽  
Jacqueline Francis-Coad ◽  
Chiara Naseri ◽  
Angela Jacques ◽  
Nicholas Waldron ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Care Service ◽  
Aged Care ◽  
Functional Improvement ◽  
Residential Aged Care ◽  
Discharge Destination ◽  
Transition Care ◽  
Retrospective Audit ◽  
Health Related

Introduction: Continued evaluation of Transition Care Programs (TCP) is essential to improving older adults' outcomes and can guide which older adults may benefit from undertaking TCP. The aim of this study was to audit a transition care service to identify the association between the characteristics of older adults undertaking a facility-based TCP and (i) discharge destination and (ii) functional improvement.Materials and methods: An audit (n = 169) of older adults aged 60 years and above who completed a facility-based TCP in Australia was conducted. Outcomes audited were performance of activities of daily living (ADL) measured using the Modified Barthel Index (MBI) and discharge destination. Data were analyzed using logistic regression and linear mixed modeling.Results: Older adults [mean age 84.2 (±8.3) years] had a median TCP stay of 38 days. Fifty-four older adults (32.0%) were discharged home, 20 (11.8%) were readmitted to hospital and 93 (55%) were admitted to permanent residential aged care. Having no cognitive impairment [OR = 0.41 (95% CI 0.18-0.93)], being independent with ADL at admission [OR = 0.41 (95% CI 0.16-1.00)] and a pre-planned team goal of home discharge [OR = 24.98 (95% CI 5.47-114.15)] was significantly associated with discharge home. Cases discharged home showed greater improvement in functional ability [MBI 21.3 points (95% CI 17.0-25.6)] compared to cases discharged to other destinations [MBI 9.6 points (95% CI 6.5-12.7)].Conclusion: Auditing a facility-based TCP identified that older adults who were independent in ADL and had good cognitive levels were more likely to be discharged home. Older adults with cognitive impairment also made clinically significant functional improvements.

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