Reducing behavioural and psychological symptoms of dementia in older adult long term care home residents with virtual reality therapy
Abstract
Individuals with dementia often exhibit Behavioural and Psychological Symptoms of Dementia (BPSD). BPSD worsens as dementia progresses and intensifies caregiver distress. The Registered Nurses’ Association of Ontario recommends non-pharmacologic methods such as group activities, music therapy, cognitive behavioral therapy, and cognitive stimulation therapy (CST) to manage BPSD. I wanted to explore the potential of virtual reality (VR) as a possible CST for Ontario long-term care home (LTC) residents with moderate to severe dementia. I analyzed data of a single site case series (n=24), piloted to explore the feasibility of VR therapy, residents’ tolerance for the therapy, facilitators and barriers to implementing the therapy, sensitivity to change, and longitudinal construct validity of the selected BPSD measuring tools. The VR therapy was provided with Broomx© (http://www.broomx.com/broomxvr.php) for 30 minutes, five days a week for two weeks. The analysis revealed that older adults with moderate to severe dementia could tolerate VR therapy. Strategies such as use of Broomx© projector instead of headset, tailored VR library items, and a soundproof room with no visual distractions facilitated, whereas residents’ conflicting schedule challenged, VR implementation. The selected measuring tools were sensitive to change and were valid. The logistics of collecting these measures were of concern since they were additional to mandated outcomes and had to be completed by Personal Support Workers. I also performed an interpretive description using semi-structured interviews (n=15) with individuals positioned to observe the residents during the pilot. In my interpretation, residents’ mood, demeanor, and daily activities improved noticeably during VR therapy. Several issues (e.g. VR library items, therapy schedule, staff commitment) were important in implementing the therapy. Based on the findings from both studies, I designed a matched-pair cluster randomized control trial (CRT) using mandated outcome measures in 659 participants or 28 LTC homes or 14 matched-pairs to evaluate if usual care and VR therapy can reduce BPSD in older adults with moderate to severe dementia living in Ontario LTC compared to usual care alone, useful in clinical decision making. The CRT also will compare the cost between the intervention and control.