Virtual Reality (VR) is a technology that can be defined as “a three-dimensional computer-generated simulated environment, which attempts to replicate real world or imaginary environments and interactions, thereby supporting work, education, recreation and health” (Abbas et al., 2023, p. 7). This relatively broad definition emerged in a healthcare focused systematic review (Abbas et al., 2023), which is the domain of this research article, yet other definitions have been used throughout the literature (see for example, Burdea and Coiffet, 2003; Furht, 2008; Heim, 1993; Steuer, 2000). VR can be non-immersive or immersive (Hamad and Jia, 2022; Wohlgenannt et al., 2020), the former in the form of screens surrounding the user (Rahouti et al., 2021) and the latter through the use of head-mounted displays (HMDs), which allows the virtual information to be presented to the user in a fully three-dimensional manner and always from his standpoint (Hamad and Jia, 2022; Slater and Sanchez-Vives, 2014). This multitude of sensory inputs from VR (through visual, sound, and haptic feedback through controllers or gloves (Wohlgenannt et al., 2020)), plus the user’s ability to interact with the environment, create a feeling of immersion, presence and embodiment in the virtual environment, which can trigger behavioral responses similar to the ones in real life (Seinfeld et al., 2022; Slater and Sanchez-Vives, 2014). Medicine and healthcare have recognized the benefits of VR, incorporating the technology in medical and surgical education and training (Chheang et al., 2024; Haque and Srinivasan, 2006; Jiang et al., 2022; Shaun et al., 1999), in diagnostics (G. Burdea et al., 1999; Ma et al., 2022; Randell et al., 2013; Shaun et al., 1999) and in therapy (Chheang et al., 2023; Freeman et al., 2017; Liu et al., 2019; Lohse et al., 2014; Shaun et al., 1999). In a meta-analysis of current literature on therapy opportunities of VR, Riva and colleagues summarize the potential of VR as a technology that “offer [s] an important source of personal efficacy” (Riva et al., 2016, p.8). This is why scholars consider VR as a (moral) education tool that is potentially able to reduce racial bias and improve empathy (Francis et al., 2017; Kiafar et al., 2024; Maister et al., 2015).

Gerontological research indicates that older adults can greatly benefit from the use of VR technology. Older adults often suffer from gait, balance or mobility disorders, which can increase their risk of falls (Campbell and Buchner, 1997; Verghese et al., 2006). A systematic review comparing (both immersive and non-immersive) VR-interventions with conventional balance training and physical exercise programs, concluded that older adults receiving VR-therapy had better outcomes regarding muscle strength, static and dynamic balance, and postural control (Rodríguez-Almagro et al., 2024). An explanation for this may be the precision and continuity with which VR can measure movement and offer corrections (Clark et al., 2012; Rodríguez-Almagro et al., 2024; van Diest et al., 2014). Another issue that older adults are likely to experience is cognitive decline (Jaul and Barron, 2017). In a study with a fully immersive VR-application, involving both cognitively fit older adults and older adults with mild cognitive impairment, both groups showed improvement in cognitive abilities, such as new information retention and frontal lobe activity (Maeng et al., 2021). VR-based cognitive exercises, such as simulation of shopping at a virtual supermarket or a virtual closet where pairs of shoes had to be organized, improved execution of daily activities, verbal memory and global cognitive function in older adults who suffer from cognitive impairment (Liao et al., 2020; Oliveira et al., 2021; Son and Park, 2022). Veterans suffering from cognitive decline and post-traumatic stress disorder exhibited less psychological symptoms of dementia and needed less medication after an intervention with VR (Appel et al., 2022). Older adults are more prone to experience social isolation, an issue that was highly present during the COVID-19 pandemic (B. Wu, 2020). VR’s ability to gather users in a virtual space, thus overcoming physical distances, can foster social engagement in older adults. A study connecting older adults in a VR environment in pairs and assigning them problem-solving tasks increased their social engagement (Kalantari et al., 2023). Another study investigating VR as a group activity in a nursing home found that older adults with low engagement with others before the intervention became more proactive and socially engaged with others after (Li et al., 2024). VR has had promising results regarding the mental health of older adults. A scoping review found that function-oriented VR interventions tended to improve the mental health of older adults, more so than merely entertainment-oriented VR interventions (Li and Muschalla, 2024). Immersive VR experiences enhanced the quality of life of older adults and decreased signs of apathy (Appel et al., 2020; Kang et al., 2021; Lin et al., 2018; Roberts et al., 2019). Lastly, palliative patients can cope better with their symptoms through the immersive nature of VR that invites relaxation and focused attention (Woo et al., 2024).

Even before the appearance of VR, interactive computer games relayed promising results for older adults, indicating that digital environments are beneficial for them. For example, digital games improved performance in everyday life for closely related tasks for older adults (Simons et al., 2016) or incentivized exercise due to requiring physical movement (Bleakley et al., 2015). Lastly, gaming simply proved beneficial for older adults because they perceived it as a pleasurable activity or because it improved their social connectedness (De Schutter and Brown, 2016; Osmanovic and Pecchioni, 2016; Pearce, 2008; Schell et al., 2016).

VR can trace its beginnings back to the 1960s, with technologies such as the Sensorama developed by Morton Heilig (Bown et al., 2017) and the Ultimate Display by Ivan Sutherland (Sutherland, 1965). The commercial success of VR started approximately a decade ago, when the social media company Meta acquired the VR-company Oculus (Hamad and Jia, 2022). VR currently remains a technology mostly used by younger persons (Di Natale et al., 2020; Korn et al., 2024). Given that the older population worldwide is growing (United Nations Department of Economic and Social Affairs, 2022), which means an increasing user base, some companies are recognizing the market potential and trying to create VR-products specifically for older adults (Kalantari et al., 2023; Rendever Inc, 2023; Sonida Senior Living, 2023). The fact that users can tap into experiences without physically leaving their homes means that VR can offer activities to older persons that are not accessible to them in the real world anymore (Kalantari et al., 2023). Nevertheless, acceptance among older persons regarding VR and new technologies in general is currently relatively low (Fowe and Boot, 2022; Shah et al., 2022b; Xu et al., 2022). The main reasons for VR include the unfamiliarity with the technology (Han and Oh, 2021; Wang and Wu, 2021), skepticism regarding its usefulness or even fear of potential downsides such as accidents and the lack of social connectedness (Shah et al., 2022a; Shah et al., 2022b). Conversely, a factor enhancing acceptance for older adults is social relativeness, meaning that, if technology can enhance the feeling of belonging to a group, it is more easily accepted (K. Chen, 2020). Interestingly, these factors of hindering or fostering the uptake of VR for older adults seem similar to factors researched for digital interactive technologies in general, where older adults reported either a lack of familiarity, a perceived difficulty in actually playing the video games, or a lack of interest or value in the activity (Brown, 2017). Likewise, many healthcare providers lack familiarity with VR as a professional technology and therefore are not equipped to include it in their practice (Ong et al., 2024; Seifert and Schlomann, 2021).

In short, while research on VR and older adults indicates a beneficial impact for their health and wellbeing and should therefore receive a chance as a caregiving technology, adoption of VR among older adults and their caregivers is still scarce. Successful incentives to integrate VR into caregiving for older adults will however depend on the actual needs and wishes of the involved stakeholders to tailor them accordingly, as well as understanding their fears and concerns regarding VR, to avoid realizing them (Wei et al., 2023; Xu et al., 2022). As current research is sparce (Sadowski and Khoury, 2022),we conducted a qualitative study to explore the opinions of older adults, as well as their caregivers (formal and informal) on VR, to fill in the gaps of how VR technology adoption could be improved. Our research question can be summarized as follows: What purposes do older adults and their caregivers foresee for VR technology in caregiving and what concerns do they have regarding VR in such a context?

Our findings contribute to understanding the potentials and the risks older persons and their caregivers perceive when using VR in a caregiving context. The results thus expose conditions that facilitate or hinder acceptance by these groups. Knowing what older persons and their caregivers want and expect from VR can pave ways for a successful introduction of the technology into the care process and an easier adoption among these populations of future evolvements of VR.

This paper is part of a mixed-method study (Creswell and Clark, 2010), called “RESOURCE” where the goal was to explore the existing knowledge, attitudes and barriers to acceptance and emerging ethical issues regarding the use of different technologies in aged care in Switzerland. The qualitative part of the study followed exploratory theoretical framework that used thematic analysis (Konstantinos, 2024). The data for this paper stem from interviews carried out in the German-speaking part of the country involving 3 stakeholder groups and investigated other technologies next to VR (Felber et al., 2024; Wangmo et al., 2024). Below we report our method and analysis using the COREQ-32 checklist (Tong et al., 2007).

The research project was approved by the Ethics Commission of Northwest and Central Switzerland (EKNZ) under ID: AO_2020-00027. A document containing all relevant information regarding the purpose of the study, the content of the interviews, the measures taken to ensure data privacy and a contact person in case of doubts were distributed before the interview to each participant. Participants provided written consent before the start of their interview and were told that they could retract their participation anytime up until the transcription of their interview started. No participant chose that option.

The goal of our qualitative study was to investigate the perceived benefits and risks of VR by older adults and their caregivers to determine VR’s utility in the context of aged care and to understand why the technology has difficulty to be adopted these populations. VR’s utility was envisioned in a variety of ways: firstly, in traveling to places that an older person cannot access anymore due to physical limitations, secondly, in a therapeutic manner, where VR experiences were described as enriching and beneficial to cognition. And thirdly, as a means to reduce loneliness, albeit for already very lonely people. However, the hesitancy to adopt VR as a caregiving technology was expressed as worries that VR may cause negative feelings, such as regret or sadness, or that VR could be too difficult or even dangerous for older adults to use alone, therefore requiring constant supervision of care recipients by caregivers.

As mentioned in the introduction, a general hesitancy to use VR could at least partially be explained as a generational difference, as younger persons adopt technologies more quickly and the current older generations had less exposure to technology during their lifetime, making late adoption more difficult (Di Natale et al., 2020; Han and Oh, 2021; Korn et al., 2024; Wu et al., 2015). Nevertheless, the replies of the study participants shed light on two important issues. Firstly, our research clarifies the applications of VR as a caregiving technology, providing a direction for researchers and developers of VR to ensure that they offer to older adults and their caregivers what they envision. And secondly, the study uncovers fears and worries of older adults and caregivers regarding VR. Comparing them to current research highlights which fears are warranted and which seem harmful stereotypes, therefore offering strategies to stakeholders in healthcare and industry to improve adoption of VR as a caregiving technology, to promote the health and wellbeing of older adults.

Our study has highlighted a few conditions which may facilitate the acceptance of VR as a caregiving technology, both by older adults and caregivers. As discussed in section 5.1, personalization and improving “realness” of VR experiences could be a first priority, not only because these features seem to increase the benefit of VR interventions (Restout et al., 2023), but also because generating personalized experiences may become easier due to the increased digitalization of people’s lives, including pictures and videos (Oeldorf-Hirsch and Sundar, 2016). Next to personalization, it will be valuable to adapt interactive VR experiences that are aimed towards persons suffering from cognitive decline to their cognitive level, as this improves the experience of the participants on the one hand and fosters acceptability of the technology by caregivers on the other hand (Tziraki et al., 2017). Lastly, given that both older adults and their caregivers expressed reluctance to use VR as a caregiving technology, mentioning the fear of increasing loneliness as a potential factor, efforts should be undertaken to develop VR-intervention that foster intergenerational engagement in families (Wei et al., 2023) and greater engagement with social networks. Not only could this enhance social engagement for older adults who are prone to loneliness, it may more easily dismantle the fears of the involved stakeholders around VR.

Despite our relatively large sample size of over 60 participants, our findings are not generalizable due to its qualitative nature. Furthermore, study participants were unable to test VR themselves and only watched a video of other older adults using VR for entertaining purposes, which means our participants only had first-hand experience of the technology if they had the opportunity to test it before the interview, which was the case for some participants. This may have biased the results, as many VR-studies where participants were able to experience the technology for themselves, reported no hesitancy of participants pre-intervention and enjoyment or satisfaction with the technology post-intervention (Hughes et al., 2014; Man et al., 2012; Roberts et al., 2019). Furthermore, the video presented to the participants was not personalized, nor did we investigate prior to the study if the shown underwater world was of special interest to the participants. A more personalized VR-application or at least the possibility to choose between different scenarios may have influenced the results. Specifically, familiar environments may trigger reminiscence strongly and increase older adults’ motivation so share memories (Appel et al., 2022; Restout et al., 2023). It would therefore be useful to do a future study where participants have the opportunity to test VR themselves first, ideally with a personalized application and are then asked similar questions to those that we asked older persons and their caregivers. Lastly, given that the study was conducted in Switzerland, the socioeconomic background of older adults may be higher than that of the average older person worldwide (Baeriswyl and Oris, 2023; Ghani et al., 2020) and issues such as costs of the technology or internet access were not discussed in this study, even though high costs are a common barrier to the uptake of caregiving technology (Felber et al., 2024).

Overall, our study findings suggest that older adults and caregivers see utility in VR as a caregiving technology, however they also foresee many issues with the technology that prevents them from enthusiastically embracing it. Travelling, cognitive training and a means to ease loneliness were envisioned as benefits of VR, but at the same time, fears of further isolating or discarding the older person prevailed, as well as worries about having to constantly supervise users and about overwhelming those suffering from cognitive decline. Furthermore, the virtual aspect of the experience was seldom perceived positively or enriching on its own, but rather “good enough” to provide some benefit. Comparing these results with intervention studies around VR and videogaming show which applications are already tested, what benefits they provide, and, even more importantly, which fears and worries seem unfounded by our study participants, as study results do not confirm them. The positive effect of VR on older adults’ cognitive abilities, their social connectedness and general wellbeing, as well as the lack of evidence of further social isolation, cybersickness and an inability of older adults with cognitive decline to learn how to use the technology point towards strategies that would improve the adoption of VR as a caregiving technology, namely,: increasing awareness regarding the benefits of VR and increased exposure, so that both caregivers and older adults can experience the technology and its benefits for themselves, and correct their misconceptions about it. In short, the barriers we found in stakeholders need to be dismantled before VR will be accepted as caregiving technologies.