How Virtual Reality Is Changing the Reality of Aging

Worldwide, one million people turn 60 every month, ¹ and the numbers are continuing to rise. In the United States alone, according to the U.S. Department of Health and Human Services, the number of people older than 65 in the United States grew by 37.2 million from 2006 to 2016. ² Worldwide, the United Nations estimates that the number of older persons (aged 60+) will double from the current 600 million in 2020 to 1.2 billion by 2025, and then to a staggering 2 billion by 2050. ¹ Complicating this situation, the ratio of younger to older family members is declining, creating a looming shortage of family caregivers. This, coupled with the increasing scarcity of professional home health workers ³ and the fact that most older adults live in homes and communities that are not designed to support their unique needs and capabilities, ¹ foreshadows an impending crisis in our ability to care for the aging world population.

Many nonprofit and government organizations have created initiatives to address this predicament. For example, The European Innovation Partnership in Active and Healthy Ageing was launched several years ago by the European Commission to foster innovation and digital transformation in the field of active and healthy aging. ⁴ In addition, The World Health Organization recently introduced a movement to establish age-friendly communities. ¹

Studies show that the vast majority of those aged 50 or older would like to “age in place,” remaining in their homes and communities as they grow older.^5,6 One way that many propose to solve the issue of an aging population and limited access to professional caregivers is through the increased use of advanced technologies. Scientists argue that with the right technology in place (e.g., sensors that monitor vital signs or pharmaceutical regimens, telehealth access points, etc.), older people can remain in their own homes longer and spend less money on hired health aides.^2,7

While the idea of older adults interacting seamlessly (and willingly) with advanced technologies may seem unlikely to some, and there is the persistent stereotype of seniors as out of touch or struggling with new technology, statistics don't actually support this. A June 2019 Pew Research Center survey found that people aged 60 and older now spend more than half of their daily leisure time in front of screens. ⁸ This rise in screen time also coincides with significant growth in the use of digital technology by older Americans. While in the year 2000 only 14% of those aged 65 and older used the Internet, nearly 20 years later, 73% do. And while smartphone ownership in all age groups was very low two decades ago, today just over half (53%) of people aged 65 and older have and use these devices. ⁹ Research shows that this group is willing to spend money on advanced technologies too. A recent American Association of Retired Persons survey projects that in 10 years, Americans aged 50 and older will be spending more than $84 billion a year on technology products. ¹⁰

It is clear that older generations will continue to make up a large percentage of the worldwide population as time goes on. Unfortunately, the systems in place to care for these seniors are still mainly based on 20th century models that are high in both expense and hands-on personnel time. In order for us to reduce the burden of care and at the same time meet the needs of this growing segment of the population, health care needs to allow people to take a more active positive role in their own health care and well-being. ¹¹ The use of technology can allow for this through the expansion of health care beyond the traditional doctor's office or hospital. These tools can include things such as advanced simulation technologies (e.g., virtual reality [VR] or augmented reality) and spontaneous peer networks (e.g., blogs, online communities, etc.). In other words, things that are now main fixtures in 21st century life.^12,13

These innovative solutions are what sparked the call for papers in this special issue—Virtual Reality Interventions for Health and Well-Being in the Elderly—and it yielded a number of interesting and original research papers.

Kicking off the issue, Huang investigates the role of presence in the effectiveness of exergames to aid cognitive improvement in people older than 50. Participants were divided into two groups: one that used non-immersive technology to play a game over 4 weeks, and the other that used an immersive virtual environment to play the same game for the same amount of time. Results indicated that the sense of presence created by the immersive virtual environment contributed to more improvement in cognitive tasks than the non-immersive condition, situating immersive VR as a promising technology for preventing cognitive decline in older adults.

Next, Gamito et al. describe a controlled study comparing the use of a VR ecological environment to a traditional paper and pencil task for cognitive stimulation in the elderly population. Overall results suggested that the VR environment had a positive impact on general cognition, executive functioning, attention, and visual memory. Further study may be done to see whether these effects extend to well-being and functionality in cognitively impaired older adults.

In their paper, Liu et al. explore how different video viewing conditions affect the emotions of both elderly and college student populations. All participants viewed an uplifting 360° video, though some viewed them on a VR headset (immersive condition) and the rest on a smartphone (non-immersive condition). Results show that while both viewing conditions had a positive effect on the self-reported emotions of college students, only the smartphone condition had the same impact on elderly participants. Review of the post-viewing interviews with elderly participants revealed that this may be due to a resistance in older adults to the VR technology itself, highlighting the importance of considering technological preferences during the development of advanced technologies for use by the elderly population.

Dissanayaka et al. explored a similar theme in their research on the feasibility of using VR to reduce apathy and improve mood for residents of varying cognitive capacities in a residential aged care environment (i.e., nursing homes or long-term care). After one session of VR delivered by mobile phone, results indicated that the VR significantly reduced apathy in residents, and no significant increase in fear or anxiety was observed. This suggests that VR may indeed be beneficial for residents in these types of facilities.

Capping off the issue is a cluster of papers focused on vision problems in the elderly population. As people grow older, they face increasing risk for many eye diseases and conditions. ¹⁴ Though VR is often thought of as a tool for those with unimpaired vision, these three papers explore its use in preventing, assessing, and treating age-related vision problems. First, Gopalakrishnan et al. use VR to understand and evaluate patients' functional vision while executing activities of daily living. Using a bank virtual environment, the authors observed both participants with normal vision and those with low vision complete a list of tasks. A significant difference was detected between normal and low vision subjects in the VR environment, suggesting that VR could be useful for both assessing and rehabilitating those with vision issues.

Next, Li et al. explore whether at-home individualized visual training with a VR helmet can improve vision in those with glaucoma. Results of the training showed significant improvement in visual acuity after 3 months of training, indicating that VR training may indeed be a useful method for treating those with glaucoma.

Finally, Powell et al. examine the accessibility of commercially available (and therefore lower cost) VR technology for a patient with age-related macular degeneration. The authors found notable improvements in object, face, and color recognition by increasing display brightness. The participant was able to engage fully with several unmodified VR applications, indicating that low vision may not preclude patients from using off-the-shelf VR applications without costly modifications.

All of these papers support the idea that advanced technologies such as VR can play an important role in maintaining and improving quality of life in older adults. With our world population aging rapidly and our pool of caregivers dwindling, technology may be just what is needed to fill this important gap in health care.