Virtual Reality Experience Intervention May Reduce Responsive Behaviors in Nursing Home Residents with Dementia: A Case Series

Article type: Research Article

Authors: Sultana, Munira^{a; e; *} | Campbell, Karen^{b; c; d} | Jennings, Morgan^a | Montero-Odasso, Manuel^{e; f; g; h} | Orange, J.B.^h | Knowlton, Jill^c | St. George, Arminⁱ | Bryant, Dianne^{h; j; k}

Affiliations: [a] Health and Rehabilitation Sciences, Western University, London, ON, Canada | [b] International Skin Tear Advisory Panel, Ottawa, ON, Canada | [c] Primacare Living Solutions Inc.^TM, Toronto, ON, Canada | [d] Master of Clinical Science - Advanced Health Care Practice, Western University, London, ON, Canada | [e] Gait & Brain Lab, Parkwood Institute, London, ON, Canada | [f] Department of Medicine and Department of Epidemiology & Biostatistics, Western University, London, ON, Canada | [g] Geriatric Medicine, St. Joseph’s Health Care, London, ON, Canada | [h] Lawson Health Research Institute, London, ON, Canada | [h] School of Communication Science and Disorders and Canadian Centre for Activity and Aging, Western University, London, ON, Canada | [i] Crosswater Digital Media, LLC, Buffalo, NY, USA | [j] School of Physical Therapy and Schulich School of Medicine & Dentistry (Orthopaedic Surgery), Western University, London, ON, Canada | [k] Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

Correspondence: [*] Correspondence to: Munira Sultana, PhD, MPH, MBBS, Health and Rehabilitation Sciences, Western University, Rm. 1014, Elborn College, 1201 Western Rd., London, ON N6G 1H1, Canada. E-mail: [email protected].

Abstract: Background:People with advanced dementia often exhibit responsive behaviors such as apathy, depression, agitation, aggression, and psychosis. Non-pharmacological approaches (e.g., listening to music, watching television, doing arts and crafts) are now considered as a first-line strategy to manage responsive behaviors in clinical practice due to the potential risks associated with the antipsychotic medications. To date, no evaluations of immersive non-head mounted virtual reality (VR) experience as a non-pharmacologic approach for people with advanced dementia living in nursing homes have been reported. Objective:To evaluate the feasibility (acceptance and safety) of VR experience. Methods:A single site case series (nonrandomized and unblinded) with a convenience sample (N = 24; age = 85.8±8.6 years; Cognitive Performance Scale score = 3.4±0.6) measuring depression and agitation before and after the intervention. The intervention was a 30-min long research coordinator– facilitated VR experience for two weeks (10 sessions). Results:The intervention was feasible (attrition rate = 0% ; adverse events = 0). A reduction in depression and in agitation was observed after the intervention. However, we suggest extreme caution in interpreting this result considering the study design and small sample size. Conclusion:This study provides the basis for conducting a randomized controlled trial to evaluate the effect of VR experience on responsive behaviors in nursing homes. Since our intervention uses a smart remote-controlled projector without a headset, infectious exposure can be avoided following the COVID-19 pandemic-induced physical distancing policy in care homes.

Keywords: Dementia, nursing home, responsive behaviors, virtual reality experience intervention

DOI: 10.3233/JAD-210010

Journal: Journal of Alzheimer's Disease, vol. 84, no. 2, pp. 883-893, 2021