Immersive Virtual Reality for Older Adults in Long-Term Care Settings

Use of Immersive Virtual Reality in Long-Term Care Facilities and Seniors' Homes in Quebec

The goal of this clinical trial is to learn if an immersive virtual reality mindfulness meditation program is feasible and acceptable for older adults living in long-term care settings in Quebec who have mild to moderate neurocognitive disorder. It will also learn about the safety and potential effects of the program on well-being.

The main questions it aims to answer are:

• Is the virtual reality mindfulness meditation program feasible and acceptable for residents and staff in long-term care settings?
• Does the adapted version of the program show potential benefits for well-being, including depression, anxiety, quality of life, mindfulness, pain, and loneliness?
• What practical challenges, user experiences, and side effects, such as cybersickness, occur during the program?

Researchers will compare the original Toujours Dimanche virtual reality mindfulness meditation program, an adapted version of Toujours Dimanche designed for older adults with mild to moderate neurocognitive disorder, and standard care alone to see if the adapted program is feasible, acceptable, and potentially helpful.

Participants will:

• Take part in up to 8 virtual reality mindfulness meditation sessions over 4 weeks, if assigned to a virtual reality group
• Complete questionnaires before and after the 4-week study period
• Share feedback about their experience, when possible
• Be observed by staff or research team members to document feasibility, acceptability, user experience, and safety

This pilot feasibility trial will evaluate the use of a mindfulness meditation intervention delivered with or without the Toujours Dimanche immersive virtual reality application in long-term care settings in Quebec. The study will be conducted with older adults living in long-term care facilities, seniors' homes, and alternative seniors' homes in the Chaudière-Appalaches and Capitale-Nationale regions who have mild to moderate cognitive impairment or neurocognitive disorder.

The pilot phase will use a randomized experimental design. The purpose of this phase is to evaluate the feasibility, acceptability, safety, user experience, and preliminary effects of the intervention in real-world long-term care settings. This phase will also help identify practical issues related to time management, human resources, data collection, and intervention delivery before a future larger-scale effectiveness trial.

A total of 36 residents will be recruited. This sample size is based on recommendations for feasibility studies, with 12 participants per group. Staff members who regularly work with participating residents and who have completed virtual reality training through Super Splendide and/or Martine Bordeleau will also be recruited. These staff members will deliver the intervention and provide feedback on its feasibility and acceptability.

Residents who meet the inclusion and exclusion criteria will be assigned to one of three groups. Group A will receive standard care and guided mindfulness meditation sessions designed for people with cognitive impairment. Group B will receive standard care and the adapted version of the Toujours Dimanche program, which includes guided mindfulness meditation sessions designed for people with cognitive impairment. Group C will receive standard care for four weeks.

Allocation to the groups will be performed using minimization, a method recognized as an acceptable alternative to randomization when the sample size is small. The allocation procedure will consider sex, gender, and age group. The study coordinator will have access to participants' group allocation. The long-term care team will plan the intervention sessions and inform the study coordinator of the selected dates and times.

Participants in Groups A and B will be invited to complete 8 mindfulness meditation sessions over 4 consecutive weeks, with approximately 2 sessions per week. Each session will last about 5 to 15 minutes, depending on the participant's preferences, comfort, and tolerance. The sessions will be delivered by trained staff members who know the participating residents well. Sessions will take place in the resident's room. Participants may stop a session at any time.

Data will be collected from residents and staff members when possible. If a resident has difficulty communicating verbally or through gestures, the staff member who knows the resident best may provide responses using observer-rated versions of the questionnaires. Sociodemographic information will be collected at baseline. Feedback on the program will be collected after the 4-week study period from residents, when possible, and from staff members.

Feasibility outcomes will include recruitment, adherence, attrition, intervention completion, and practical challenges encountered during implementation. Acceptability will be assessed from the perspectives of residents and staff using researcher-developed questions, including visual analogue scales and open-ended questions. User experience, perceived presence, potential risks, side effects, and other practical issues will also be documented.

Preliminary clinical outcomes will be assessed before the beginning of the intervention and after the end of the 4-week period. The primary clinical outcomes are depression and anxiety. Quality of life will be assessed as a secondary outcome. Mindfulness, pain, and loneliness will be assessed as tertiary or exploratory outcomes. Measures will be administered in a predefined order, beginning with depression and anxiety, followed by quality of life, and then the exploratory outcomes. If a participant shows signs of excessive fatigue or reduced motivation, data collection may be paused or stopped.

Because the study includes residents with cognitive impairment, consent and assent procedures will be adapted to protect residents' rights, comfort, and dignity. When residents are able to provide informed consent, consent will be obtained directly from them. When needed, consent will be obtained from a legal representative or from a person authorized to consent on behalf of the resident. Resident assent will also be sought verbally or behaviorally before participation. Before each visit, residents will be asked whether they are still interested in participating. If a resident refuses, shows distress, or no longer wishes to participate, study activities will stop.

The purpose of this pilot trial is not to determine definitive effectiveness. Rather, it will assess whether the intervention and study procedures are feasible, acceptable, and safe for older adults with mild to moderate cognitive impairment or neurocognitive disorder living in long-term care settings.

Inclusion Criteria:

For resident participants:

• Resident of a participating long-term care facility, seniors' home, or alternative seniors' home in the Chaudière-Appalaches or Capitale-Nationale regions of Quebec
• Aged 60 years or older
• Able to understand French or English
• Able to provide informed consent or assent, or have consent provided by a legally authorized representative or person authorized to consent
• Mild to moderate cognitive impairment or neurocognitive disorder
• Normal or corrected vision and hearing

For staff participants:

• Regularly works with at least one resident participating in Phase 3
• Has completed the revised virtual reality training provided by Super Splendide and/or Martine Bordeleau

Exclusion Criteria:

For resident participants:

• Recurrent migraines
• Epilepsy
• Traumatic brain injury during the past year
• Glaucoma or recovery from eye surgery
• Diagnosed uncontrolled epilepsy
• Diagnosed severe vertigo
• Severe hearing impairment without a corrective hearing device
• Significant visual impairment that would prevent use of a virtual reality headset
• Motion sickness that would prevent use of a virtual reality headset
• Any health condition that restricts movement or prevents safe participation, such as a significant reduction in neck or upper-limb range of motion