- How did older people with mild to moderate cognitive or memory impairment experience the VR nature environments intervention?
- What did carers and volunteer staff facilitating the memory café sessions think about VR for people with dementia and care home residents?
2. Materials and Methods
2.1. Study Design and Participants
2.2. Virtual Reality Nature Intervention
2.3. Data Collection and Analysis
I’m on the beach. Haven’t been on the beach in ages! Ooh, it’s lovely. Which beach is it, maid*?…Oh now I’m under the sea! Look at all these fishes. It’s good innit? Wow!…and now there’s someone comin’ in on a boat. Hello! Ahhh. The waves are lovely (10-ML) [*a Cornish dialect word for girl].
It’s sort of a forest thing, and it’s got a path…like mountains an’ that as well. It’s very nice…Oh wow I can see a beach now. Oh yeah, it’s a bit like Polzeath it is, with people on it. Oh yeah, people playing games an’ that on the beach. It’s hot ‘cause they got their shorts and t-shirts on. It’s very nice. Oh I can see a pink bucket as well. A…a very busy beach…very busy…oh yeah, very nice. [inaudible] they’re going out in the boat now. Oh yeah, there’s a chap going out on the beach—on the boat now. Ooh, very nice. I’ve had enough now (05-ML).
Oh that’s under the sea, oh that’s looking, oh that’s beautiful! Absolutely! Oh we like these sort of things. [husband’s name], you’ll enjoy this one. The coral, yeah, it’s lovely [husband’s name]. You’ll enjoy that (16-C).
3.1. “It Makes You Feel That You Are There”: VR as an Immersive Experience
Oh, now I’m in the sea with the fish!…Back on the beach. Who’s that over there? (13-ML)
It makes you feel as if you’re at the sea, right at the sea, doesn’t it?…it makes you feel that you are there [emphasis] on the sand, with the sea rolling in (15-V).
and I’ve got a beautiful view where I live, so I can look out, but I’m looking through a window whereas that [the VR], you’re there, which is the difference, yeah (18-V).
Some of these beaches I can’t access. So it’s actually quite nice to…see. This actually makes you, it does actually make you feel better ‘cause you can sort of, like it feels like you can feel the sand [laughs] (19-ML).
I mean it makes you feel, good in a way, you know, just as you can see it, and um, you don’t see anything else, just all those fishes, the massive fish. (17-ML)
I liked seeing the people on the beach and I liked to, playing the Frisbee thing, you know the one on the beach and he was standing there and I thought, ‘well is he gonna talk to me?!’ you know [laughs] and I saw the chap in the water catching it and it was just nice to be ‘in’ there, especially when the surfer came down by your side and went down, it was just like being there (18-V).
3.2. “Oh Beautiful, It Was Lovely”: The Soothing Effect of Nature Scenes
The beach and the water coming in and the fish, was lovely [laughs] (08-ML).
Oh that sea, yeah. This is why we came back to Cornwall I think. Well it was, definitely. Incredible sand, isn’t it (02-C).
Oh the fishes were beautiful they were. I never been er…what d’ya call it?…Diving, I’ve never done it. But I love the water (10-ML).
the sea, the one in the sea was beautiful. Well I like water, for a start. It was just, um, the colours were very beautiful and erm, soothing and um…I like watching fish (12-ML).
3.3. “It Was Really Nice, Nice to See Places I Recognised”: Using Nature to Reminisce
it was really nice, nice to see places I recognised. I mean it’s always nice, when you can identify things—you do it don’t you, even when you’re watching the telly and that sort of stuff (14-V).
Oh on the beach, you know, because I love the coast, I do. I grew up here in C…well not here, bit further down, place called Crantock, near Newquay… spent many a summer holiday in Crantock. My Mother was still there, see. And we took the kids, and then the grandkids when they come along… It’s [the coast] part of me, you know, growin’ up with it. I do miss it terribly (13-ML).
16-ML: I took her a lot of places, didn’t I maid*? [*a Cornish dialect word for girl]
16-C: Yeah, but I mean, it was interesting to see the different places, an’ that
16-C: Which we won’t be seein’ anymore, anyhow will we?
3.4. “It’s…Like Goin on Holiday”: VR as a Different Experience
but it was lovely ‘cause it gives you, I don’t know, a sense of freedom, yes. Anyone who’s had to be indoors, they just get that feeling of being there. And certainly when it was just the sea, the empty sea, I’d just like to go and have a nice swim (18-V).
the going under the sea. And just being able to look around like you’re walking somewhere—like you’re going somewhere. It looks, it’s really good, yeah (19-ML).
we like that coral one. Where you’re under the sea. Because we watch those programmes anyhow…and we love doing that, don’t we (16-C).
It’s very, very good…[inaudible] like goin’ on holiday, kinda thing, an’ it’s a bit like Polzeath, ‘cause, you got the sea, the sea there [gestures], you got the boat there [gestures] and the houses there, and the sand, and there’s people around you (05-ML).
Oh wow I can see a beach now. Oh yeah, it’s a bit like Polzeath it is, with people on it. Oh yeah, people playing games an’ that on the beach. It’s hot ‘cause they got their shorts and t-shirts on. It’s very nice. Oh I can see a pink bucket as well. A…a very busy beach…very busy…oh yeah, very nice. [inaudible] they’re going out in the boat now. Oh yeah, there’s a chap going out on the beach—on the boat now. Ooh, very nice (05-ML).
3.5. Strange and Scary: The VR Nature Experience Is Not Always Positive
Well from what I saw of the little bits, when she [her Mother] was at the beach, she obviously quite liked that. I think under the water was a bit confusing for her.” (07-C)
12-ML: Back to the beach. Ooh, clouds. Oh the little group in the corner there… Ooh yeah.
It’s a lot better down here than when we were there and I was up the top, terrified… Ooh, I don’t like this.
Researcher: What is it?
12-ML: It’s all steep and falling away into the sea below me. I’m sitting on a rock.
Researcher: Are you OK, do you want to take it off?
3.6. Responses to VR Equipment
Now it’s gone right behind me. My neck won’t swivel that far. How on earth do they do this? Oh gosh it makes it look so good that I want to go in the sea. Extraordinary marks in the sand. Absolutely amazing [inaudible] (02-C).
Oh wow yeah. It’s quite an amazing sort of thing. It’s almost like an experience without the smells [laughs] (04-V).
I could see that it could make you feel a bit queasy if you stayed in it for a long time. I think if it, it’s made smaller and more comfortable, then it would be beneficial (12-ML).
the only problem was I wanted to be able to go round 180 degrees and I couldn’t. I think a wheelie chair would be a terrific advantage because I think a lot of people aren’t as mobile as I am, you know (02-C).
That looked round a bit too hard for my neck (19-ML).
I found the first bit on the beach was quite blurred. I don’t…was that my eyes or was it?… I was having quite a job focussing on a lot of that… It just kind of spoilt, spoilt it for me a bit, because I couldn’t see some of the detail in anything (14-V).
I mean you put it on and took it off. Will you always be there to put it on and take it off? (03-ML)
You used to use all these things but you don’t get along with it any more. I’m the one with the computer now. And mobile phone. You don’t telephone out. You barely turn on the telly unless I do it and find the channel [both laugh] (03-C).
I’ve got my phone and my ipad, that sort of thing. And I get ‘round it alright. But I’m not expert in it. But you know, if I want to find out something, I usually can do it some way or another. Or phone up me brother in Australia and ask him [laughs] (11-C).
Maybe, maybe they would need someone with them all the time, if they didn’t, to set it up for them. ‘Cause I’m just thinking of how my husband was, and he wouldn’t have been able to do that. Because unfortunately, I mean, he would always put music on for us for Saturday night while we had a nice meal. And then one night he said, well, he said ‘I can’t get the CD to play’ and I said ‘well you just press that button’. You see, it had just gone out of his mind. He, well, he lost his sort of, spatial awareness, thing. (18-V)
3.7. Volunteer Staff and Carers’ Perceptions of VR for People with Dementia in Long Term Care
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|People with Memory Loss |
(ML; n = 10)
|Carers (C; n = 8)||Volunteer Staff |
(V; n = 6)
|Relationship to person with memory loss|
|Perceptions of VR||Illustrative Quote from Volunteer (V) or Carer (C)|
|1. Alternative means of accessing nature and the outdoors +||“I think it’s a great idea, especially, like you say, for people who can’t get out.” (17-C)|
“I think maybe for the person that’s being cared for, then yeah. Sort of make them feel like they’ve got out of the four walls … even if it’s ten minutes.” (07-C)
“sometime in the future, I’ll not be able to drive, and I think, if I couldn’t get out, that would be great, that sort of thing… ‘Cause it brings the outside back right into you, yeah.” (09-V)
|2. Relieving boredom +||“It gives them a chance to go and see something…she gets quite bored, and so I think going out to look at something like that, would be quite nice. Whether she’d sit there for long with it on…but you don’t have to do you” (17-C)|
|3. Trigger memories +||“Oh, I think that could be marvellous. If you can make it personal, …trigger the memories, you know, it would be lovely.” (10-C)|
“I think it depends on what sort of dementia they’ve got, really…I think it’d be lovely for a lot of people. Especially, as you say, the ones that are in homes. You know, especially if it was a horrible afternoon and you could say ‘alright we’ll go down to the beach, this is what it was like’. And bringing back memories.” (18-V)
“…if they’re able to watch it, I think it’d be brilliant for them. Just like, the way I say, to be able to bring back memories for them. Especially if it was all, sort of, local to that person’s… well, you know, we live in Cornwall, so they’re places in Cornwall that we would recognise.” (14-V)
|4. Improve mood and calming +||“I suppose it could help put people in a better mood, especially if they’re havin’ a bad day, and they can’t get out.” (10-C)|
“I do think that if someone’s having a really bad day, that it would help to calm them. It’s like music, ‘cause seeing that visually—the sun and people having fun on the beach…” (06-V)
|5. Potentially confusing −||“I don’t think it would help him [husband LwD]. He’d go through it. He wouldn’t remember what had happened two minutes afterwards. I think he might be a bit confused.” (02-C)|
“I mean for some people they would find it a bit confusing, you know, and think: ‘what on earth’s going on here…this is a bit weird’. Um and especially those who, you know, their memory loss is so great that they don’t remember one minute to the next minute…that contradict themselves all the time you know, so you ask them if they enjoy it one minute and they’d go ‘yes’, and then you ask them again and they’d go ‘what?’… they can’t even remember what they look…saw” (04-V)
|6. Unable to cope with the VR equipment −||“I think one thing about the technology is definitely that [husband] wouldn’t be able to cope with it. He would definitely need somebody there to switch it on, switch it off, do whatever is necessary.” (03-C)|
“…it’s quite heavy on your face, and I think…it’s all going to vary depending on what sort of dementia it is, but I wonder how they would cope moving around, physically and that sort of thing, to see, or whether they would just sort of think they’ve just gotta look forward. And even, even if they realise they can move around, would they physically be able to do it easily, I don’t know?” (14-V)
|7. Time-consuming for use in long term care −||“I think the sad thing is though…whether it would actually get used…in a care setting, I don’t know. Because it’s time, it’s gonna be time consuming isn’t it, and it’s one-to-one, and everything, and maybe in care settings that’s quite a difficult task isn’t it, time-wise.” (14-V)|
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