Non-pharmacological interventions are of growing interest in the management of dementia symptoms. Not only because of the side effect profiles of some of the drug therapies, but also because they’re super effective and can have significant impacts on the quality of life of people living with dementia, and their caregivers too. There are a huge variety of non-pharmacological interventions available such as music, singing and dancing therapies, art based projects, cooking, talking and listening, and as highlighted in a previous blog of mine – animal interactions. However, the focus of the today’s blog is different, perhaps even futuristic, it’s on virtual reality.
Virtual reality, or VR is a computer-generated and simulated artificial three dimensional environment with scenes and objects that appear to be real, making the user feel as if they are immersed in their surroundings. Oh, and I really mean that. I’ve personally engaged with VR gaming lots of times and can vouch for the reality aspect. Walking the plank in a VR simulation will have your heart racing and give your stomach butterflies just like the real thing! The environment is typically perceived through a VR headset or helmet. VR is being increasingly used in clinical settings, for example for managing stress and anxiety during painful procedures and has been proven effective in the treatment of specific phobias and traumas. It may also have benefits for people living with dementia, particularly people in care homes. It is a self-paced, flexible and safe strategy that may possibly combat loneliness, enhance sense of identity and engage exercise all from the comfort and safety of home. It may be particularly beneficial to people with mobility problems too, where getting outdoors is no longer achievable and familiar environments or open outdoor spaces can be simulated for them.
But how would it work in dementia? What would it look like? And is it a promising possibility?
A care series published last year may help to provide some answers! A Canadian based research team conduced a feasibility study using a convenience sample of 24 participants from a single nursing home site. The outcomes of interest were depression and agitation before and after exposure to the VR intervention. The intervention was a 30-min long researcher facilitated VR experience of 10 sessions over a 2 week period (Monday to Friday).
The VR intervention involved a 360 projector, as opposed to a head mounted helmet or headset to maximise comfort for the user, but still provided an interactive and immersive 3D visual and auditory experience. Depending on the users mobility, the projector could be taken to their room. The virtual environments delivered to the nursing home residents were tailored – pretty cool right. The researchers asked family members and nursing home staff about the residents preferred leisure activities, favourite genres of music and general preference to nature or urban scenery at the start of the study. This resulted in a custom library of 360 video scenes with music, for example – there was a cherry blossom scene which simulated an afternoon stroll in the park with blooming cherry flowers set to soft classical music, and a farm scene which simulated a morning walk in a farmyard with cows and chickens set to animal and bird sounds. Each scene contained its own little hidden details – the cherry blossom scene for instance included a bride and groom posing for pictures, people walking their dogs and children climbing.
So what did they find? 75% of the participants were able to complete 80% of the planned sessions – and the mean length of the VR session was 22.2 minutes. Sessions had to be shortened for various reasons, including residents falling asleep or being distracted, but also in some cases as a result of distress. However, there were no adverse events observed during the intervention period. Although EQ-5D was administered, there were (not surprisingly) no detectable changes to participants health. There were however statistically insignificant changes in CSDD and CMAI – which measure depression and agitation. Depression outcomes improved, however agitation appeared to worsen. It is not suprising that these changes are non-significant, the intervention period was short, and the sample was small – the study was not powered to detect significance, but rather to explore feasibility. However, overall, the findings ARE super promising! The VR intervention was found to be both feasible and acceptable for use in dementia nursing home residents and indicated preliminary findings in terms of depression. A full trial to evaluate the effectiveness of VR in dementia populations would be needed to draw any solid conclusions, but the future of non-pharmacological interventions in dementia management, and the integration of technological advancements is exciting and promising, and it looks like there will be way more to come!
Thanks for listening, Hannah!
Hannah Hussain is a PhD Student in Health Economics at The University of Sheffield. As a proud third generation migrant and British-Asian, her career path has been linear and ever evolving, originally qualifying as a Pharmacist in Nottingham, then Health Economics in Birmingham. Her studies have opened a world into Psychology, Mental Health and other areas of health, and with that and personal influences she found her passion for dementia.