Aisling Flynn

Virtual reality (VR) is increasingly being adopted in dementia research. However, much of the research to date has focused on single-user VR applications with limited attention paid to how multi-user VR (MUVR) applications may be designed to promote or maintain social connectedness. This paper explores the design preferences of seven people living with dementia and their seven support persons to inform a MUVR application for social connectedness. The qualitative data obtained from four focus groups were analysed thematically and resulted in two main themes. The first theme, promoting social connectedness through familiarity, described people living with dementias’ need to experience MUVR with someone familiar, including familiar avatars, activities, and multisensory content. The second theme related to the need for an easy-to-use MUVR application to enrich social experiences and improve the quality of the shared MUVR experience. These findings provided design guidelines which supported the development of a MUVR application to promote or maintain the social connectedness of this population. The paper also provides information to support future MUVR design research in this area.

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Background: Pet robots are a type of social robots that have been used to benefit the psychosocial health of people living with dementia, particularly in nursing home settings. Despite the body of literature that have been conducted to evaluate their impacts, research to understand how pet robots can be translated from research into real‐world practice have been largely overlooked. This study seeks to address this knowledge gap by exploring the multilevel barriers and facilitators to implementing two pet robots for dementia care in nursing homes.Methods: We conducted a descriptive qualitative study, conceptualised and guided using the Consolidated Framework of Implementation Research (CFIR), which consists of 39 constructs within five domains salient to implementation. Maximum variation sampling was used to identify and recruit healthcare professionals and organisational leaders from nursing homes. Individual, semi‐structured interviews were conducted with each participants face‐to‐face or over Zoom. Data was transcribed and analysed using Framework Analysis, supported by the NVivo12 qualitative data management software.Results: A total of 22 participants from eight nursing homes were included in this study, of which 9 had seen or used a pet robot with residents with dementia. Barriers and facilitators were mapped to constructs from all five CFIR domains: 1) intervention characteristics, 2) outer setting, 3) inner setting, 4) characteristics of individuals and 5) process. Facilitators include the realisticness and familiarity of pet robots, identification of residents’ needs that can be met (or were met) using a pet robot, compatibility with prevailing regulatory guidelines and organisational care process, intrinsic desires to improve residents’ quality of life, and buy‐in from stakeholders. Barriers include a lack of customisability of pet robots to suit residents’ abilities and preferences, doubts about long‐term use, prohibitive costs, lack of external funding, lack of resources and knowledge, infection prevention mandates, and conflicting views on the anthropomorphisation of pet robots.Discussion: Overall, this study highlights an incongruence between the characteristics of pet robots, organisational considerations (such as available resources), and external contextual factors. These findings have practical utility in informing the development of implementation strategies to guide the translation of pet robots from research into real‐world practice.

Background: Older adults living with dementia often experience reduced social connectedness and must be supported to enhance or maintain their social connections. Digital technology is increasingly being used to address this area. In particular, virtual reality (VR) has shown promising benefits for sociability despite not being designed for this purpose. Research has highlighted the need to design social VR spaces which can enable multi‐user experiences to foster social connectedness. Such a design process needs to meaningfully involve older adults living with dementia and their support persons from the outset.Methods: Action research was used to co‐design a VR social connecting space for older adults living with dementia. The research aimed to explore one’s experience and perception of social connectedness and how VR may be used to help older adults living with dementia stay socially connected. Using participatory methods of data collection, older adults living with dementia and their support person had the opportunity to use a VR technology probe and participate in a series of semi‐structured interviews, group meetings and design workshops. Reflexive thematic analysis was used to analyze transcripts alongside observational field notes taken by the researcher. The findings from each phase of data collection were used to inform subsequent research activities.Results: The meaning and importance of social connectedness is dynamic and transient. Older adults living with dementia experience several barriers and facilitators to social connectedness and their support person often plays an important role in maintaining existing connections. VR was considered a novel and enticing technology to enhance and maintain one’s connections. Older adults living with dementia and their support person expressed preferences for shared experiences and these were translated into the virtual environment (VE). Design preferences to facilitate co‐location and co‐presence in the VE were also integrated into the social connecting space.Conclusion: VR was considered an enticing technology to enhance or maintain the social connectedness of older adults living with dementia. Older adults living with dementia and their support person contributed to the design decisions which shaped the development of the social connecting space.

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

Virtual Reality (VR) is increasingly being applied in dementia care across a range of applications and domains including health and wellbeing. Despite the commercial availability of VR, informants of design are not always aware of its functionality and capabilities, to meaningfully contribute to VR design. In designing VR applications for people living with dementia, it is recommended that older adults living with dementia and their support persons be involved in the design process using participatory approaches, thereby giving them a voice on the design of technology from the outset. A VR technology probe is a useful means of familiarising older adults living with dementia and their informal caregivers with the knowledge and understanding of interactive VR to employ technology that supports them to maintain their social health. This paper charts the implementation and evaluation of a VR technology probe, VR FOUNDations. To explore their experiences, nine older adults living with dementia and their nine informal caregivers trialled VR FOUNDations and completed semi-structured interviews after its use. Overall, older adults living with dementia and their informal caregivers perceived VR FOUNDations to achieve its aim of increasing understanding and inspiring future design decisions. The findings also identified promising positive experiences using a VR technology probe which may be indicative of its applicability to social health and wellbeing domains. This paper advocates for the structured design and implementation of VR technology probes as a pre-requisite to the participatory design of VR applications for the health and wellbeing of people living with dementia. The use of such technology probes may afford older adults living with dementia and their informal caregivers the best opportunity to contribute to design decisions and participate in technology design to support their health and wellbeing.

Background: Immersive virtual reality (IVR) can be defined as a fully computer-generated environment shown on a head-mounted display. Existing research suggests that key features of IVR can assist older adults in their everyday lives, providing opportunities for health promotion and tackling social isolation and loneliness. There has been a surge in qualitative studies exploring older adults’ experiences and perceptions of IVR. However, there has been no systematic synthesis of these studies to inform the design of new, more accessible IVR technologies. Objective: This study aimed to systematically review and synthesize qualitative studies exploring older adults’ experiences and perceptions of IVR. Methods: A systematic review and thematic synthesis were conducted following the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. In total, 2 reviewers completed title and abstract screening, full-text screening, data extraction, and quality appraisal. Thematic synthesis is derived from the qualitative method, thematic analysis. It involves 3 key steps: initial coding and grouping of these codes, the formation of descriptive themes from these codes, and going beyond these data to form analytical themes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research approach. Results: Overall, 13 studies were included in the final synthesis, including 224 participants across 9 countries and 5 continents. Confidence in the evidence ranged from high to moderate. Three descriptive themes were generated: practical aspects of IVR use, experiencing unique features of IVR, and perceptions of IVR. The findings from the descriptive themes suggested that there are several improvements that need to be made to existing IVR devices to facilitate older adults’ use of this technology. However, older adults’ responses to IVR were generally positive. Three analytical themes were generated: tolerating the bad to experience the good, buying in to IVR (don’t judge a book by its cover), and “it proves to me I can do it.” The analytical themes illustrated that older adults were willing to tolerate discomforts that accompany existing IVR technologies to experience features such as immersive social networking. There was a discrepancy between older adults’ perceptions of IVR before use—which were generally negative—and after use—which were generally positive—and IVR provided a platform for older adults to access certain activities and environments more easily than in the real world because of limitations caused by aging. Conclusions: This review offers insights into older adults’ experiences and perceptions of IVR and suggests how a few improvements to its existing hardware and software as well as how it is first presented could offer new opportunities for older adults to take part in meaningful activities tailored to their needs and preferences. Trial Registration: PROSPERO CRD42020200774; https://tinyurl.com/8f48w2vt International Registered Report Identifier (IRRID): RR2-10.1177/16094069211009682

Dementia is a global health challenge, and people living with dementia (PLWD) are especially susceptible to reduced engagement in meaningful occupations, including social participation. In the past few decades, socially assistive technologies continue to be developed amidst a rapidly evolving technological landscape to support the social health of PLWD and their caregivers. Examples include social robots, virtual reality, smart home technology, and various digital technologies, such as mobile applications for tablets and smartphones. Despite an increasing body of research and interest in this field, several gaps relating to the design and implementation process of socially assistive technologies continue to undermine their relevance for PLWD in daily life. In this paper, some of these gaps are highlighted and the role of occupational therapy in the design and implementation of socially assistive technology is presented. In the design process, occupational therapists are uniquely skilled to advise and advocate for the tailoring and personalisation of technology to address the occupational needs of PLWD. In the implementation of socially assistive technologies, occupational therapists are skilled to educate, train, and conduct ongoing evaluations with PLWD and their caregivers, to incorporate socially assistive technologies into their routine and daily lives. We recommend that occupational therapists should continue to be acquainted with such technologies through continuous professional development and educational curricula. Moreover, we highlight the necessary collaboration between occupational therapists, technology developers, and researchers to enhance the process of designing and implementing socially assistive technology, so that their relevance for PLWD and their caregivers can be maximised.