Key Stakeholders' Experiences and Perceptions of Virtual Reality for Older Adults Living With Dementia: Systematic Review and Thematic Synthesis

3R Nursing Combined with Dietary and Nutritional Interventions Enhances Self-care Ability in Elderly Patients with Vascular Dementia

BACKGROUND

Vascular dementia (VD) is an extremely common neurological dysfunction in the elderly population, and greatly affects the patient's ability to take care of themselves. Recent research suggests that VD patients need more targeted and individualized nursing during treatment, so as to enhance cognitive function and therapeutic efficacy. The objective of this study is to observe the effect of reminiscence, reality, and remotivation (3R) nursing combined with dietary and nutritional interventions on elderly patients with VD, so as to provide clinical evidence for the management of VD in older adults.

METHODS

120 elderly VD patients admitted between December 2022 and December 2023 were selected, including 64 cases receiving 3R nursing combined with dietary and nutritional interventions (the research group) and 56 cases receiving routine nursing (the control group). The two groups were compared in terms of neurological function, self-care ability, and nutritional status before and after nursing, as well as nursing compliance. After the completion of the care, patients' quality of life and family satisfaction were investigated.

RESULTS

In comparison with the control group, the research group displayed higher scores on the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), greater self-care ability, and higher levels of nutritional proteins and grip strength (p < 0.05). In addition, patients in the research group displayed greater nursing compliance and quality of life of patients, as well as higher family satisfaction (p < 0.05).

CONCLUSIONS

3R nursing combined with dietary and nutritional interventions can effectively improve the neurological function of VD patients and enhance their self-care ability.

The use of virtual reality as a perspective-taking manipulation to improve self-awareness in Alzheimer's disease

Lack of awareness of symptoms or having a condition referred to as anosognosia is a common feature of individuals with Alzheimer's Disease (AD). Previous literature on AD reported difficulties in evaluating self-abilities, often showing underestimation of limitations. There is increasing evidence that the perspective through which information is presented may moderate the performance appraisal and that anosognosia in AD might be a consequence of a deficit in assuming a third-person perspective. In this context, some studies showed that subjects may better recognize self-and other-difficulties when exposed to a third-person perspective. Considering the variety of approaches aiming to investigate the lack of awareness, there is still a scarcity of methods that provide great ecological validity and consider more than one facet of awareness, thus failing to offer more accurate evaluations of daily experiences. The present paper primarily addresses the theme of the multidimensional character of awareness of abilities in AD and the effect of perspective-taking on its trajectories. The focus turns to virtual reality as a promising tool for a greater evaluation of perspective-taking and self-awareness. Particularly, these systems offer the possibility to involve users in cognitive and sensorimotor tasks that simulate daily life conditions within immersive and realistic environments, and a great sense of embodiment. We propose that virtual reality might allow a great level of complexity, veracity, and safety that is needed for individuals with AD to behave according to their actual abilities and enable to explore the liaison between the subject's viewpoint, performance, and self-evaluation. In addition, we suggest promising clinical implications of virtual reality-based methods for individualized assessments, investigating specific impacts on subjects' life and possible improvements in their awareness.

Social connectedness and the role of virtual reality: experiences and perceptions of people living with dementia and their caregivers

PURPOSE

People living with dementia are often at increased risk of becoming socially disconnected due to dementia-related challenges. In recent years, digital technology has been designed to help address the social health of people living with dementia and provide opportunities to promote or maintain their social connectedness. This paper presents the findings from phase two of a participatory action research project, which explored people living with dementia and their caregiver's experiences and perceptions of social connectedness and the potential role of Virtual Reality (VR) in promoting or maintaining same.

MATERIALS AND METHODS

People living with dementia (n = 8) and their informal caregivers (n = 8) participated in an individual, 1:1 online interview. Data analysis was guided by reflexive thematic analysis.

RESULTS

The findings presented four themes: social connectedness: lived experiences and insights, facilitating social connectedness, barriers to social connectedness and the potential of multi-user VR for social connectedness. People living with dementia experienced a range of personal, community and societal connectedness. Facilitators of social connectedness included supportive, non-judgemental, and reciprocal relationships, technology adoption, and personal and contextual facilitators. Dementia-related difficulties and periods of disruption or change were considered barriers to social connectedness. Multi-user VR was perceived as useful for promoting and maintaining social connectedness.

CONCLUSIONS

The perceived usefulness of multi-user VR for social connectedness indicates its potential for use with this population. Understanding the lived experiences, barriers, and facilitators of social connectedness will assist researchers and the human-computer interaction community to inform the design of future multi-user VR for social connectedness outcomes with people living with dementia and their caregivers.

Impact of digital assistive technologies on the quality of life for people with dementia: a scoping review

BACKGROUND

Digital assistive technologies (DATs) have emerged as promising tools to support the daily life of people with dementia (PWD). Current research tends to concentrate either on specific categories of DATs or provide a generic view. Therefore, it is of essence to provide a review of different kinds of DATs and how they contribute to improving quality of life (QOL) for PWD.

DESIGN

Scoping review using the framework proposed by Arksey and O'Malley and recommendations from Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

DATA SOURCES

Cochrane, Embase, PubMed, Scopus and Web of Science (January 2013 to May 2023).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Completed scientific literature with a primary focus on DATs for PWD, perspectives of caregivers, family members or healthcare workers in relation to a PWD, people living in diverse settings and all severities of dementia.

DATA EXTRACTION AND SYNTHESIS

Screening and data extraction were conducted, followed by quantitative and qualitative analyses using thematic analysis principles and Digital Therapeutics Alliance categories for DAT grouping.

RESULTS

The literature search identified 6083 records, with 1056 duplicates. After screening, 4560 full texts were excluded, yielding 122 studies of different designs. The DATs were categorised into digital therapeutics (n=109), patient monitoring (n=30), digital diagnostics (n=2), care support (n=2) and health system clinical software (n=1). These categories were identified to impact various aspects of QOL: preserving autonomy, engagement, and social interaction, health monitoring and promotion, improving activities of daily living, improving cognition, maintaining dignity, managing behavioural and psychological symptoms of dementia and safety/surveillance.

CONCLUSIONS

Various DATs offer extensive support, elevating the QOL of PWD. Digital therapeutics are predominantly used for ageing-in-place and independent living through assistance with daily tasks. Future research should focus on less-represented digital health technology categories, such as care support, health & wellness or software solutions. Observing ongoing DAT developments and their long-term effects on QOL remains essential.

Digital Health Technology Use Among Older Adults: Exploring the Impact of Frailty on Utilization, Purpose, and Satisfaction in Korea

BACKGROUND

The importance of digital technology is increasing among older adults. In this study, the digital health technology utilization status, purpose, and satisfaction of older adults were investigated according to frailty.

METHODS

A face-to-face survey was conducted among adults aged 65 years or older. Frailty was defined using the Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight scale.

RESULTS

A total of 505 participants completed the survey, with 153 (30.3%) identified as pre-frail or frail and 352 (69.7%) as healthy. All respondents used smartphones; 440 (87.1%) were application users, and 290 (57.4%) were healthcare application users. Wearable devices were used by only 36 patients (7.1%). Pre-frail or frail respondents used social media more frequently than healthy respondents (19.4% vs. 7.4%, P < 0.001). Among the respondents, 319 (63.2%) were not able to install or delete the application themselves, and 277 (54.9%) stated that the application was recommended by their children (or partner). Pre-frail and frail respondents used more healthcare applications to obtain health information (P = 0.002) and were less satisfied with wearable devices (P = 0.02).

CONCLUSION

The usage rate of digital devices, including mobile phones among older adults in Korea is high, whereas that of wearable devices is low. There was a notable difference in the services used by pre-frail and frail respondents compared to healthy respondents. Therefore, when developing digital devices for pre-frail and frail older adults, it is crucial to incorporate customized services that meet their unique needs, particularly those services that they frequently use.

Introducing and Familiarising Older Adults Living with Dementia and Their Caregivers to Virtual Reality

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.