THE APPLICATION OF VIRTUAL REALITY IN GERIATRIC MENTAL HEALTH: THE STATE OF THE EVIDENCE

Introduction In recent years, there has been a rise in the prevalence of cognitive and affective disorders in the ageing population. This has led to an impetus on innovative, scalable and engaging interventions for these disorders, and technology has proved to be a promising frontier. In the past decade, virtual reality (VR) technology has seen a shift from two-dimensional non-immersive projections to three-dimensional fully immersive experiences, allowing for the development of more sophisticated simulations. There have been successful applications of VR in clinical settings with children and teens, including social cognition training for autism, sustained attention in attention-deficit hyperactivity disorder (ADHD), exposure-based therapies for anxiety disorders, and depression pathology. However, VR has been less studied in the geriatric population. The purpose of this study is to determine the existing levels of evidence for use of VR in clinical settings and identify areas where more evidence may guide translation of existing VR interventions for older adults. Methods This study is a systematic review. We conducted a search on PubMed in December 2018 for peer-reviewed journal articles published in English within the last 10 years. We narrowed the search to VR technology and its applications in older adults, as well as studies of VR in normal aged adults for comparative value. We rejected articles if the title and abstract did not meet inclusion criteria and authors LM, AR and MS agreed by consensus on which articles were relevant. We also used the bibliographies of selected articles to find additional articles that we may have missed in the initial search. We then reviewed article content to classify the articles into appropriate domains of geriatric mental health (content domains) and research objectives (research domains). Results Based on our review, a total number of 426 articles were found, and 49 met our inclusion criteria related to older adults. We conducted a yearly count for the number of search results to identify if there has been an increase in research in the field. The number of search results by year are positively correlated (see Figure 1). We also identified 5 additional articles which focused on younger adults which we opted to include in the review based on internal consensus amongst all authors that they reflected VR application in domains of mental health that are known to apply to older adults as well. We found that the articles fell across several content domains: Cognition, conditions along the mood spectrum, anxiety, post-traumatic stress disorder (PTSD), and caregiver burden. The research domain with the highest number of articles was VR validity testing (26), followed by cognitive training (18), indicating that these are the VR applications for which the best evidence exists currently. Conclusions Currently, existing evidence offers clear support for the use of VR as a screening tool for cognitive impairment in older adults, and as a training tool to improve cognitive skills. VR-based tasks demonstrated validity comparable to some traditional paper-based assessments of cognition. Furthermore, there are indications that VR can play a role in delaying the onset of Alzheimer's Disease (AD), mild cognitive impairment (MCI), and other forms of dementia. More work is needed to refine VR screening capabilities for more specific diagnoses, but the potential for innovation in VR environments and tasks makes VR a promising medium to achieve this specificity. Additionally, there were many different VR environments used across studies, which may show a need for standardization of environments before comparisons can be made between VR simulations. Given the robust evidence of VR as a treatment in affective disorders in younger adults, we see potential for the same intervention in older adult mood spectrum disorders and other psychiatric conditions. Finally, future studies should address key issues surrounding VR use in clinical settings, such as usability, data privacy, and confidentiality. This research was funded by Anonymous philanthropic donation to McLean Hospital.