The Careful Project: Evaluating the acceptability of local virtual reality experiences as a leisure activity for residents in aged care

Abstract

Objectives

The aim of this project was to evaluate the feasibility and acceptability of virtual reality (VR) as a leisure activity for people living in residential aged care. Virtual reality experiences may offer alternatives for residents with limited mobility, or during times when older people are unable to leave residential care.

Methods

The intervention used VR videos delivered via a head‐mounted device. Video content was created by a local artist specifically for use with older Western Australian adults and used local content. VR sessions were videotaped for analysis. The evaluation included structured observation of video content to assess mood and engagement and post‐intervention interviews with participants.

Results

Mood and engagement scores indicated overall favourable mood and considerable positive engagement with the VR experience. Interview content analysis reflected the enjoyment participants took in visiting places they had once been and the surprising ways that the experience made them feel and act as though they were actually there. Videos featuring coastal visits were the most popular and videos featuring music were the most engaging. Some participants found the head‐mounted device uncomfortable. VR was considered potentially beneficial for residents with limited mobility or living with cognitive impairment.

Conclusions

Overall VR is a feasible and acceptable leisure activity for older people in residential care. The use of local content has the potential to prompt memories and generate new conversations. Future use of VR may consider different modes of video delivery and advancements in evaluation.

Practice impact.

Virtual reality (VR) technology is a viable option for enriching the quality of life for older adults in residential care by reducing boredom and improving mood. Connection with familiar places, sounds and activities can facilitate conversation and reminiscence for value‐added person‐centred care. These experiences may have a particular therapeutic benefit for people with mobility impairment.

1. INTRODUCTION

Residential aged care (RAC) provides high‐level support for older Australians, particularly in the areas of activities of daily living and complex health care. ¹ To meet the psychosocial needs of residents, a range of social and other activities are typically offered to enhance well‐being, quality of life and sense of connectedness. ² Activities can include outings, games, pet therapy, music events, art therapy and craft activities. ² , ³ , ⁴ Engagement in leisure activities has been shown to have a positive impact on life satisfaction, quality of life and social relationships for older adults in RAC. ⁵ , ⁶ However, limited opportunity to engage in activities, reduced mobility and limited transportation are significant barriers to participation. ⁷ Recently COVID‐19 restrictions placed additional limits on social access and reduced many of the leisure and recreational activities offered in RAC. ⁸

One contemporary leisure activity with potential to positively impact the quality of life is virtual reality (VR). Facilitated by an interactive device such as a head‐mounted display, VR technology provides the ability to transcend geographic and physical limitations by substituting the physical environment with a digital one. Virtual reality can enable residents to experience places and activities that they enjoy, provide a calming experience and foster reminiscence ⁹ without the need to engage in group activities or leave the facility. ² Content used for VR technologies for older adults generally features nature‐based scenes including forests, ¹⁰ fields, ¹¹ beaches, snowscapes, farmyard animals, ¹² underwater scenes and parks. ¹³ , ¹⁴ Some videos have depicted travel destinations, ¹² , ¹³ music and concerts, truck driving, ¹³ , ¹⁴ and virtual environments ³ along with Google street views (accessing past environments). ⁹ , ¹⁵

Research on the use of VR technology in RAC is emerging, and early indications show that VR is generally well tolerated and enjoyed by residents, ⁹ , ¹⁰ including residents living with dementia. ³ , ¹¹ , ¹² , ¹⁴ Studies have reported increased social engagement, increased quality of life, decreased anxiety and fatigue ¹³ ; increased positive and decreased negative emotion ¹¹ ; and increased pleasure and alertness. ¹⁰ However, there have been some reports of negative experiences including dizziness, eye strain, discomfort and unwanted memories, as well as higher fear, anxiety, tiredness and loneliness. ¹⁰ , ¹¹ , ¹² , ¹⁵

A range of methods have evaluated the acceptance and impact of VR, with most studies using multiple data collection methods. The most common have been semi‐structured interviews with participants ¹⁰ , ¹¹ , ¹² , ¹³ , ¹⁴ , ¹⁵ and established measures of mood states such as depression, ⁹ , ¹³ anxiety and apathy. ⁹ , ¹⁰ , ¹² In situ emotional responses have been observed using both standardised ¹⁰ , ¹¹ , ¹² , ¹³ , ¹⁴ , ¹⁵ and non‐standardised approaches. ³ , ¹⁶ Additionally, some studies have measured simulator sickness. ⁹ , ¹² , ¹⁵ Due to the mixed findings from VR studies, further research is needed to identify the benefits and risks of VR as an activity for older people in RAC. Additionally, identifying the preferred types of VR experiences will be beneficial for both future research and implementation. The aim of this study was to assess resident responses to a VR experience to establish the feasibility and acceptability of bespoke VR for older people living in RAC.

2. METHODS

2.1. Participants

Residents from a 100‐bed RAC facility in the southwest of Western Australia were invited to participate. A promotional flyer detailing the aim and requirements of the study was displayed in the facility. The study was introduced to residents by the facility's Lifestyle Coordinator as an opportunity to engage in a new leisure activity. Residents with cognitive impairment (Cognitive Impairment Scale ≥4 in the last 3 months), ¹⁷ vision or hearing impairment (without aids); or currently unwell, including experiencing bouts of dizziness, were excluded. Interested residents were screened for eligibility by the Lifestyle Coordinator acting in the role of research assistant. All participants were provided with detailed information on what the project entailed, including that VR sessions would be video recorded and interviews would be audio recorded. Residents had an opportunity to discuss the project before providing informed consent. Participants were assured the confidentiality of the data and anonymity in reporting of results. The study was approved by the Edith Cowan University Human Research Ethics Committee (2022‐03279‐POROCK).

2.2. Intervention

For this study, two of the authors (CY), a visual artist/photographer based in the southwest of Western Australia, and (MB) Lifestyle Coordinator, had initial conversations with residents to determine suitable video content; the focus was on where residents grew up and lived, where they would like to go on outings, favourite activities and musical interests. Local musicians and artists were engaged and a set of immersive VR experiences featuring visits to familiar places (within 70 km of the aged care facility), including beaches and nature experiences, as well as music performances held for the purpose of filming, was created. Landscape videos took approximately 6 h to create while musical performance videos took up to 3 days to create. The style of filming features slow transitions between scenes to minimise the perception of movement often associated with the experience of motion sickness when viewing VR videos. ¹⁸

Residents watched VR videos wearing a Meta Quest head‐mounted device ¹⁹ with full auditory and visual immersion. A selection of 29 videos that ranged from three to 9 min in length were available to watch. ²⁰ Video content included visits to local beaches and coastal areas (12 videos) music, concerts, and dancing (14 videos) and scenic visits to local farms (3 videos).

2.3. Procedure

Each participant chose three VR experiences over a 2‐week period between May and December 2022. Multiple sessions were offered so that participants could experience a range of content if they chose. Sessions took place in a quiet room without distractions. Before the first session, the Lifestyle Coordinator demonstrated how the equipment was used and assisted in the selection of VR videos. She ensured the head‐mounted device was fitted comfortably and stayed with the resident during their experience. To facilitate analysis of participant mood and engagement, all sessions were video recorded using a mounted Samsung tablet. On completion of the session, the Lifestyle Coordinator helped participants remove the device, made sure they were not experiencing any negative effects and asked whether they would like to take part in another session in a few days. All VR equipment was cleaned and sanitised between each use.

2.4. Measures

Consent was obtained to collect demographic data (age and gender) from resident records. As in previous research, ¹¹ , ¹² , ¹³ , ¹⁴ , ¹⁵ , ¹⁶ qualitative and quantitative data were collected for evaluation. The mood and engagement section of a Dementia Care Mapping tool (DCM) ²¹ was used to assess mood and engagement. Mood was assessed by six items ranging from ‘Very happy, cheerful, very high positive mood’ (+5) to ‘Very distressed, very great signs of negative mood’ (−5). Engagement was assessed by four items ranging from ‘Very absorbed, deeply engrossed/engaged’ (+5) to ‘Withdrawn and out of contact’ (−1). Mood and engagement scores were considered separately. To augment the mood and engagement data, the Lifestyle Coordinator observed and noted participant behaviours. ²² Following completion of all sessions, participants took part in a brief one‐on‐one semi‐structured interview with the Lifestyle Coordinator. Interviews included questions relating to what participants liked and did not like about the VR experience and whether they had any recommendations for future use. Interviews were audio recorded and transcribed verbatim by an experienced research assistant who was independent of the interviews.

2.5. Data analysis

Video recordings of the participant engaging in each session were combined with actual VR content viewed and presented side by side in one video enabling viewing of the participant's response and the VR image simultaneously. There were eight individual videos for analysis. Two researchers independently watched the videos, pausing at 2‐min intervals to rate the resident's mood and engagement; scores were combined and averaged. Behavioural observations were categorised according to salient actions including facial expressions, body movements and vocalisations.

Conventional qualitative content analysis was used to analyse interview transcripts. ²³ Primary codes were developed and grouped according to the question responses and conceptual similarities. Codes were reviewed and categorised for reporting by PC, MB, and MG, and confirmed by all authors. Dependability was determined by triangulating video analysis, along with interviews, observation, fieldnotes and pre‐existing data collected by the aged care facility.

3. RESULTS

Eight residents with an average age of 87 years (range: 72–96) participated in this study. The participants were selected by the Lifestyle Coordinator as she knew the residents very well and could screen not only for the inclusion and exclusion criteria but also personal preference. Three participants were women, and none had any previous experience with VR. Seven participants engaged in three VR sessions, and one engaged in two sessions. Overall, videos of scenic coastal images were watched most frequently (see Table 1).

TABLE 1.

Virtual reality video type and mood and engagement mean scores.

Participant	VR type	Mean mood score	Mean engagement score
1	Coastal	1.00	4.00
	Coastal	1.13	3.13
	Music	1.00	4.00
2	Coastal	2.00	4.00
	Coastal	1.57	4.57
	Coastal	1.78	4.89
3	Coastal	2.75	5.00
	Rural	2.42	5.00
	Coastal	3.17	5.00
4	Rural	3.5	5.00
	Music	4.14	5.00
	Music	5.00	5.00
5	Coastal	2.00	4.17
	Coastal	3.50	4.67
	Coastal	1.29	4.29
6	Music	2.00	3.60
	Rural	1.00	4.00
7	Music	2.00	3.00
	Coastal	2.00	3.00
	Music	2.25	4.00
8	Rural	1.00	2.00
	Coastal	2.16	4.50
	Music	3.00	5.00

3.1. Mood and engagement

Mean mood scores on the DCM ranged from +1 to +5, meaning no indicators of negative mood or distress were observed. Participants' faces were mostly relaxed and/or neutral. Content featuring music elicited generally higher mood scores. Mean engagement scores also ranged from +2 to +5, indicating participants were considerably or very engaged with content. All video types scored high on engagement (see Table 1).

When engaging in the VR sessions, some participants turned their heads and upper body to view the full spectrum of scenes. One participant in a wheelchair could not turn their upper body far, yet while viewing a trip along a jetty they exclaimed ‘I am going for a ride’. Participants were often observed smiling and some made comments such as ‘lovely’, ‘beautiful’ and ‘nice’. Some participants reacted by nodding their heads and some started humming or singing along with the music; one participant applauded at the end with the audience. At times, participants appeared to respond as though the scene really was happening around them. While viewing a windy coastal scene one participant shivered, another participant giggled, first during a rural visit as they felt a sheep come close to them, and again during a coastal visit as they felt water ‘touching’ their feet. Some participants also recognised familiar places.

3.2. Content analysis

Analysis of the interview transcripts reflected the structure of the interviews and resulted in the following two content categories: (i) enjoyment and connection and (ii) shortcomings and recommendations.

3.2.1. Enjoyment and connection

Overall, participants responded positively to the VR sessions; as one participant voiced, they enjoyed the opportunity to engage in ‘a pure new experience… something totally out of my wavelength’ (Participant 2). Participants enjoyed the realistic nature of VR content. They found themselves immersed and felt a part of the different surrounding environments. As the following extracts indicate, whether coastal, rural or musical, all content engaged the senses:

I've never felt so much wind at Castle Rock before. Well, I got to a place … that I haven't done physically myself before … that was amazing how I was looking down. (Participant 1)

… the part on the ground it felt as though you could scruff your feet around in the leaves, that was lovely. (Participant 4)

… that engine you could hear it and … you sort of felt you were chugging along with it. (Participant 2)

I got a bit close to the conductor a few times. Thought he might hit me on the head … It was nice, the singing with an orchestra again. (Participant 4)

A sense of being there was evoked by the sights, the sounds, the atmosphere, and in some cases the familiarity of the content. Participants also enjoyed being able to gain access to spaces they had not been able to physically visit: ‘Being able to see people and do things that I can't do on my own’ (Participant 1), the experience provoked an interest ‘in seeing different places again’ (Participant 6). Most participants wanted to watch additional content, such as more music videos or wanted to visit new places ‘like a tourist’ (Participant 7).

Some experiences aroused nostalgia for places and experiences. Through the bespoke content, participants enjoyed the opportunity to connect to their personal histories in meaningful ways as the next extracts show. The extracts also indicate the participant could see places they had enjoyed visiting as children, and as adults, and could take pleasure in activities and associations no longer available to them:

I saw that 10 years ago and it was good … because it's a really interesting place to go … it's beautiful … even more special than before… now [in a] wheelchair I can't go to many rocks, can't go on to the edge. (Participant 1)

… makes me remember the spots we used to go fishing. I really loved I it … used to go fishing there four or five times a year even … catching salmon. (Participant 8)

I remember that piece of music … It reminds me of the good times I had. I had a lot of experience with music, and I don't get it here. (Participant 4)

When asked how the VR experiences made them feel, while one participant admitted ‘I wasn't very enthused doing it’, most responded positively, indicating feelings of calm and happiness:

I've always found that water and rivers, peaceful to watch … with water, there's always movement, but there's not a lot of noise about it. It's just peaceful. (Participant 8)

Well, it was just lovely… a calming influence. (Participant 5)

I felt quite happy … it's been such a new experience … I just hope that it makes other people happy too. (Participant 4)

3.2.2. Shortcomings and recommendations

None of the participants reported feeling unwell after the VR sessions. However, one participant reported feeling ‘woozy’ and commented that they ‘might have fallen asleep’ (Participant 7) while watching a farm scene. Wearing the Meta Quest head‐mounted device was a new experience for all participants, and some commented that the headset was ‘heavy’ (Participant 6) and ‘did not feel comfortable’ (Participant 6), and one resident reported that they were left feeling ‘headachy’ (Participant 8). While most participants enjoyed the bespoke video content, some expected more varied and different content options and others found content lacking:

I expected something different. I've seen everything from Australia. I've seen it all so there wouldn't be much to see. (Participant 7)

I was disappointed. I couldn't see the wind instrument section… It took me a while to realise there was actually a wind section, cause all I could see was strings. I was disappointed in the pitch. Yeah, it was very flat. (Participant 6)

While one participant expressed appreciation for the novel experience, they admitted that they did not have ‘a burning desire to use’ (Participant 7) the technology again. Of the two aspects identified as challenging, first is hardware, something which is currently limited by the available technology, and second is the video content, something which is more within the remit of future research and application.

In terms of recommendations, participants appreciated that VR experiences would be particularly beneficial for people who were ‘disabled …confined to the bed …can't get around or see much or do much’ (Participant 2). Residents also saw the benefit of VR for people living with dementia. As one resident expressed, bespoke VR might play an important role in connecting people to lost memories and places:

… for those with, especially with dementia, they sort of remember something when they were a bit younger and now, they can't see it. And if they could … be able to see back in the sort of scenery that they used to see all the time … I think it would give those that extra delight in seeing things … (Participant 3)

Most participants enjoyed the local content, conveying that the offerings and experience was ‘perfectly nice as it was’ (Participant 4). When asked about the additional types of content they would like to see, suggestions included more music content, more animals, more tourist‐type content such as hotels and resorts, and visits to other Australian locations such as the Northern Territory to see ‘things that we don't get to see down here’ (Participant 2).

4. DISCUSSION

The study aimed to evaluate the feasibility and acceptability of using bespoke VR experiences in RAC. Overall, VR was a successful activity with few challenges, demonstrating the viability of the intervention and providing insight into the novel use of local bespoke content. As in previous research a mixed methods approach to evaluation was taken. The assessment of mood and engagement was somewhat difficult due to the facial expressions typically observed for DCM ratings being obscured by the headset. However, the facility's Lifestyle Coordinator also performed the role of research assistant, both collecting and analysing data, and this provided additional insight into the participants' usual response to activities. Such familiarity may mean that despite faces being partially concealed a small gesture of pleasure or surprise could be captured. To minimise bias, DCM was conducted independently by author PC. This study also took the unique approach of matching the video of the participant engaging in the VR session with the specific VR content viewed providing additional insights and observations. The combination of data sources enabled a multifaceted in‐depth analysis.

The use of local content was a unique feature of this intervention. The RAC was situated in a coastal town, and coastal VR visits were popular. Participants responded in ways consistent with ‘being there’ and fond memories and conversations were elicited as familiar places were recognised. Future studies may build on this to specifically explore how locally produced VR can be integrated into reminiscence therapy, an accepted approach for enhancing the mood of older adults. ²⁴ Interestingly, the most outward expression of enjoyment was to the music videos, with participants singing along and applauding. Our findings confirm the long‐established knowledge that music enables pleasure, movement and distraction as demonstrated in a recent systematic review. ²⁵ Whether VR enhances experiences where live music is not available could be explored in future research. The video content used in this pilot study was developed as part of a funded project and made available by the creator free of charge. We acknowledge that there may be time technological, and/or financial barriers for other RAC providers to create their own bespoke content.

Due to the specific West Australian restrictions on non‐medical researchers interacting with people living with dementia, ²⁶ this study did not include participants with cognitive impairment. Consistent with the literature, ³ , ¹¹ , ¹² , ¹⁴ participants considered VR to be a valuable option for people living with dementia. Indeed, the inclusion of local content could potentially provide connection to early memories, enhance communication and reduce a sense of social isolation for people with cognitive impairment. A sense of connectedness and belonging is important to well‐being and prevents loneliness. ²⁷ Connectedness can be to place not just people. For people who have grown up in the local area, viewing familiar content potentially gives them that sense of connectedness to place. The difference between connectedness to place, land or country could vary across people living in the city, metropolitan or regional areas: This warrants further investigation. Furthermore, not all people age in the place where they spent the majority of their life and local content may be difficult to access for them. As VR use becomes more readily accessible it may become easier to cost‐effectively tailor experiences to individual interests and places and shared with couples and families who are unable to share experiences in the real world. ¹⁴

This study used VR as a leisure activity. It is evident that VR has more wide‐ranging applications for people in RAC. In addition to aiding reminiscence therapy, VR, using general content, has been effectively used for pain management and as a distraction from procedural pain. ²⁸ Pilot studies show VR use in physical rehabilitation programs and exercise routines. ²⁹ Future technological advancements and options may reduce the costs of producing local content and impact the ways VR can be delivered and evaluated in RAC. While not as immersive, handheld VR tablets with gyroscopic capabilities can provide a viewing alternative for people who find the headsets uncomfortable. Such options would also allow easier monitoring for signs of distress as resident's faces would be visible. ³⁰ Technological improvements may enable alternatives to the facial observation evaluation used here. For example, wearable devices used in conjunction with VR can measure electrophysiological responses of emotional engagement allowing for a deeper understanding of participant response. ³¹

5. CONCLUSIONS

In conclusion, this small study set out to evaluate the work of an artist who created VR experiences of local scenery and activities for older adults in RAC in Western Australia's southwest. Unique to this study was the use of local content which, as anticipated, created significant enjoyment and connection for participants. Mood and engagement, which can have positive impact on well‐being, were enhanced in all experiences. ³² As VR becomes more widely used in aged care, where feasible, local content should be considered as part of the variety of offerings. In sum, from a therapeutic perspective, VR offers an opportunity for conversations, enabling people to remain connected to the broader world not least when mobility and other restrictions such as lockdowns inhibit many activities.

FUNDING INFORMATION

The artist and creatives performing in the Virtual Reality videos were funded by a grant from the Australian Government Regional Arts Fund. In‐kind support was provided by the Edith Cowan University, Centre for Research in Aged Care.

CONFLICT OF INTEREST STATEMENT

There was no commercial interest involved in this project. Christopher Young developed the VR content used for testing purposes, which has been made freely available on a public webpage. Christopher Young was not involved in data collection or data analysis. All video content and a comprehensive guidebook for carers are freely available at www.zebra‐factory.com/careful/index.html.

Porock D, Cain P, Young C, et al. The Careful Project: Evaluating the acceptability of local virtual reality experiences as a leisure activity for residents in aged care. Australas J Ageing. 2025;44:e13379. doi: 10.1111/ajag.13379

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.