Introduction：
Looking back on the entire project, my project can be divided into three phases. After three self-questioning sessions, I eventually turned my question into ‘ How can ‘Extended Reality’ experiences contribute and compete with immersive entertainment activities, for the time and attention of elderly residents in care homes?’
In the beginning, there were several reasons why I focused my attention on the elderly and new technologies. First, I experienced the successive death of Grandparents, in the final stages of their lives, because they can not go out, every day trapped in a room, even with the company of family, can not eliminate the pain and psychological suffering. During the COVID-19 pandemic, when the number of visits by older people to their families and others was limited, whether they could connect with the outside world using virtual technology? Second, my previous job was game design, I was interested in new technology, and I watched “San Junipero”, the fourth episode of the third season of Black Mirror, a fictional seaside city where real-life nursing home elderly people can take advantage of a new “hospice” Technology comes into the city, where they are rejuvenated young, not old and dead, with zero pain. They are free to choose the time entrance and experience a different life. And at the end of life, people can choose to die peacefully or live forever in this city. Finally, the whole world is aging, and the problem of old age must be an area of concern in the future. So I set the initial question as to whether Extended reality could reduce negative emotions in older people.
Primary research：
First, I learned about what Extended reality is. I took ‘the Intro to AR/VR/MR/XR: Technologies, Applications and Issues course‘ on the Coursera website. Extended reality (XR) is a term referring to all real-and-virtual combined environments and human-machine interactions generated by computer technology and wearables, where the ‘X’ represents a variable for any current or future spatial computing technologies. It includes Virtual Reality(VR) ， Augmented Reality (AR)，Mixed Reality (MR) and the areas interpolated among them. The levels of virtuality range from partially sensory inputs to immersive virtuality also called VR.
In addition, I searched online for some research and videos on the combination of virtual technology and the elderly. Let me know that there are many projects are already being developed for the elderly, for example, the multi-sensory interactive window，a system that allows experiencing distant places and communicating with distant people through a tangible installation that exploits the window metaphor and multi-sensory feedback; The seal robot Paro, Its appearance is designed using a baby harp seal as a model, and its surface is covered with pure white fur. Ubiquitous surface tactile sensors are inserted between the hard inner skeleton and the fur to create a soft, natural feel and to permit the measurement of human contact with Paro. It is equipped with the four primary senses; sight (light sensor), audition (determination of sound source direction and speech recognition), balance and tactile sense; Google’s Project Starline, a technology project that combines advances in hardware and software utilizing hologram technology to enable friends, families, and coworkers to feel together, even when they’re cities (or countries) apart，and so on. At the same time, I learned that Potential ethical implications of VR include physiological and cognitive impacts and behavioral and social dynamics. Identifying and managing procedures to address emerging ethical issues will happen not only through regulations and laws (e.g., government and institutional approval), but also through ethics-in-practice (respect, care, morals, and education).
Secondary Research in China：
To understand the real situation，I first interviewed staff of China’s pension institutions and a VR project manager and president of a VR association. From the information I have,
China’s national policy is to encourage the elderly to care at home if it is widowed elderly, or the elderly who have to move into nursing homes, basically in a poorer state, from china’s elderly happiness index analysis, 80% of the elderly are depressed in poverty, and China’s elderly institutions are more concerned about the basic quality of life, the support for the mental health of the elderly in human and economic investment is not enough. When did I ask if it was possible to use VR technology to opportunity the psychological comfort of the elderly? Pension agency officials say it’s a good idea, but it’s not good in China right now. VR project manager and president of an XR association for this problem, all said that China’s VR market is not yet mature, technology also has a lot to explore, users are mainly targeted at young people, and enterprises. The main research and development direction for individuals is the game. There are few products developed for the elderly in nursing homes. The project may not be suitable for China’s pension situation at the moment.
The first psychological change：
Based on this feedback, I had my first questions about the project, and I began to worry about whether XR was a new technology, whether my research direction could be combined with reality, or whether it was my interest and imagination. I started to get a little confused, and with the encouragement of my mentor, I thought I should keep exploring, so I started to understand the situation in the UK.
Secondary Research in the UK：
First I attended an online seminar online organized by UCL, the theme was ‘Aging playfully. This symposium congregates interested parties to discuss the place of play and games in old age from diverse disciplinary perspectives to share ideas and build collaborations about aging playfully well. Through this activity I know about the VR project ROVR Relieve，it delivers relaxing and ultimately distracting virtual reality scenes and sounds through a wireless VR headset and tablet for use by carers. The immersive experience helps relax the mind and has a positive impact on carers and those cared for who are anxious, lonely, or perhaps feel a sense of isolation, loss, or pain. Fortunately, I got in touch with the project producer and had a zoom meeting, and his view of VR for older people was that Initially VR is best used with people who are capable of using a tablet or phone to talk to a relative or friend using a video chat. If they can interact with a video chat then they can normally easily accommodate the next step of seated VR. Training is important, but just because people are in their 80s, does not always mean they are technophobes. Acceptance of technology, in general, has a lot to do with how it is presented. So the Carer, if that is the person introducing VR, needs to be confident and positive in presenting the technology.
To test if older people can accept XR technology, I began to understand the situation of older people in the UK. From the data of the emotional needs of the elderly, loneliness is the strongest emotion, followed by loss of value, powerlessness. Then, I looked for elderly groups online, but also applied to participate in elderly care volunteers, but because of this special period, temporarily unable to join volunteers, and I have difficulty contacting the elderly living alone, so finally I put my focus on the elderly who are living in nursing homes. I contacted London nursing homes on the Carehome website and luckily Muriel Street Resource Centre was very willing to take part in my project.
The first time I spoke face-to-face with Fiona, the administrator of Muriel Street Resource Centre, she told me about the basics of nursing homes and said that they had three VR headsets for 2 years, and every Saturday afternoon was their time to experience VR for residents, and I had a brief experience of some simple VR stand-alone games, such as one in which a game was handled with a stone bottle so that crows could drink water from the bottle. In the experience process, I found that this game can exercise human control, perhaps because the technology is not perfect, feel but not good operation, the game is not enough, will soon lose the desire to play. I want the administrator to know the old people with VR feedback, whether they like to play these games. She told me the status of the residents is unstable, depending on how they feel that day, to decide whether to experience, experience for how long. She also said When they first tried VR technology for the elderly, some old people would be afraid, some old people would refuse, but some old people would find it amazing and exciting. It has been two years since this care home introduced VR technology. The elderly people who live here have adapted to VR, But they can only experience VR on Saturday afternoon with the help of a carer. According to the manager, every old person experiences a few minutes and then doesn’t want to continue. So, I don’t think their existing games can meet the needs of the elderly
The use of VR in care homes is limited, and the elderly are unable to integrate VR technology into their lives. First of all, at this stage VR equipment purchase and maintenance costs are high, nursing homes can not provide every elderly person with VR equipment； Secondly, the elderly can not control the device by themselves, in their side must have a carer to help them use VR, and observe their physical and mental state.
When I asked if VR socializing could be achieved for older people, such as using apps such as Alcove, VRchat, and VTimeXR, older people could socialize with family, friends or strangers, staff and the elderly are excited, but there are many constraints, economics, two-way practical problems and so on.
Survey：
I did a questionnaire about loneliness on several old people. They think that everyone feels lonely when it comes to emotional needs, and they’ve found ways to ease it. When it comes to what they want to do but can’t do now, there’s dancing, rock climbing, football, dessert, and so on, everyone is different. They are also eager to continue to do what they love in the VR world. But it’s worth noting that during my survey, nursing home staff were accompanied throughout the process, and when I asked if they felt lonely, older people might take into account the emotions of nursing home staff, or we were around them at the moment, so they didn’t feel lonely.
The second inner doubt：
This feedback once again got me into question about the project, if the elderly in the nursing home did not feel lonely, then my project is set up? Whether there is still a need to continue the study. I couldn’t get an answer, and I decided to keep exploring. I share this feedback with the previously mentioned ROVR Release project manager, whose feedback is that it needs to be of interest to the person, just like for TV, books, holidays, etc. Older people have likes and dislike just like anyone else and so having a variety is important, but there are common themes that the majority will find distracting and enjoyable.
The first intervention plan：
I think I needed to know what virtual apps were available to the elderly, so I bought an Oculus Quest2 headset. and learned about downloading the Alcove app. Aimed at removing barriers caused by social isolation or physical limitations, and opening new doors to those affected … and we’re doing it with fun and engaging VR. Alcove bridges the physical distance between family members and empowers people to experience new places and things they wouldn’t otherwise be able to do because of cost, time, or mobility constraints. I think this social app is great for older people living in nursing homes, who can shorten their relationships with others. They can invite friends into their room, where you can watch videos, play games, upload family photos to the living room photo wall, and travel together, exercise, chat, and so on.
To compare different user experience feedback, I invited 4 young people to experience alcove and other applications. The first attempt at their reaction is to present a very shocked, not very familiar with the operation, some people choose to sit experience, some people are walking around the experience, frequent turn of the head and change the perspective so that not half an hour to feel dizzy. So I went online to find out about it. I learned that VR makes people feel sick because it triggers motion sickness. When your brain thinks you are moving, but your body is static, it creates a disconnect between the two that causes enough confusion to make you feel ill. I don’t know if this will happen in older people’s experiences, so I think the first attempt could shorten the experience time.
Then, I planned to connect two seniors through the VR app so that they can communicate with each other. I contacted the Alcove team and came up with my idea, and the feedback I got was if I want to realize VR socialization for the elderly in nursing homes, there are no two conditions： high-speed wi-fi and all users must have a Facebook account. I think these two conditions are easy to meet, and I can connect my VR headset to the facility in the nursing home mentioned earlier. Then I looked online for another nursing home, but unfortunately, the nursing home that responded was euphemistically rejected by the thought of the outbreak. So I changed direction, whether it was possible to link the elderly and the young through VR. But when it did, I found that the VR headsets in the nursing home couldn’t connect to the Internet. The VR social experience can only be transformed into VR travel. I chose the Wander app，Wander is a VR application in which users can explore the world via Google StreetView locations. Users can move around as if they were driving or walking in many locations, as well as visit specific Wander curated collections of locations. Wander is also better for navigating interior spaces (i.e. The Louvre and other museums) ，allows you to travel back in time and see how locations looked years ago (data permitting), and has the aforementioned multiplayer support. I think maybe with this app, older people can evoke their memories or go where they want to go.
The process of first intervention：
So I took my VR headset to the nursing home for the second time and first experienced the app for nursing home staff to familiarize themselves with the operation to help residents. In action, we found that due to a wifi problem in the nursing home, we couldn’t cast on the phone to see what the user was looking at when they experienced VR. This problem has troubled us for a long time, looking for many ways that can not be solved.
In the end, we decided to let the residents experience first, even if we couldn’t see what they saw. So we held a group event, six elderly people gathered around a table, each experience 5-10 minutes, but the whole experience is not ideal. First of all, the experience is a personalized experience, when one person experiences, because it can not be cast, resulting in a state of isolation from the surrounding environment, others felt bored. And everyone is just a short experience, but we need a lot of time to get along with them, ask if they want to go anywhere, set coordinates in the VR, and then give the old people the experience. Time is short, the effect is not ideal, for them is only a short experience.
The reflection of the first intervention and the second intervention：
By communicating with Jack, we adjusted activity to a one-on-one in-depth experience with older people, and we’ve set aside more time to get to know them and let them experience and explore. Next, We invited six elderly people to participate in the event one by one, two of whom were in poor condition and not suitable for the VR experience. Both old people are very emotional, one of the Chinese old people, almost forget how to speak English, it is difficult to communicate with others, but when I saw her, she took the doll as a real doll, she told me in Chinese she worried about the baby, she said that the baby does not cry, do not eat or move, do not know whether it is sick, and the corridor people come and go, it is likely to be picked away by strangers. She could not tell the truth or not. Another old woman was sitting in the living room, and when we came up to talk to her, she burst into tears and, for no reason, she kept apologizing to me. Because of this situation, I didn’t keep trying to get them involved.
The other four elderly people took an active part in the event and experienced VR travel, and they were surprised that they didn’t choose their hometown, but chose the place where they had traveled or wanted to travel. One chose to go to Hawaii, one chose to go to the Forbidden City in China. One went to Africa and the other to Portugal. After the experience, I interviewed them about their interests and experiences of VR, One of which like trying something new and creating stuff, such as painting, doing crafts, and being positive about life. She not only experienced VR travel but also tried VR painting. After a 30-minute experience, she said she would love to spend more time trying and practicing later. One of them had lost his language skills, Carer Jack said he likes watching TV in his room and didn’t want to communicate with others, but he enjoyed this experience, smiling and waving his hands in the air. The third one into the palace and temple around the world, he wants to go to China’s Forbidden City to have a look, we found coordinates, showed him. After a few attempts, he can control and move in the virtual world of the Forbidden City, but he said if he can go inside to see it that would be great. Overall, Virtual worlds can be taken out of place, pointing at the trees, people, cars, buildings, and so on. They enjoy the process without distraction. Because they move slowly, there is no feeling of vertigo.
The reflection of the second intervention and confusion：
After the event, I was in a lot of confusion. First of all, VR is just a new entertainment tool for the elderly, from the current stage, whether from the actual operation, personnel, and economic support, XR technology is not easy to integrate into the lives of the elderly, let alone have a psychological impact on them. Second, emotions are hard to intervene and measure from the outside world, so I wonder if my research is a failure. Finally, combining the teachers’ suggestions, I have the following personal reflections. First, when things don’t go according to expectations, I get anxious and confused. I realized that I had set assumptions for this project, and I was just going to prove my hypothesis. I should learn and explore the mentality to face my project, then the failure I understand is non-existent. Second, I think Stockolder’s needs are different from their own, and I started in a position to solve what I thought was their problems, so I was confused later. Third, loneliness maybe everyone’s, and loneliness is an emotion that is difficult to capture and measure. Perhaps in the present person accompanied, there are external factors to attract their attention, they do not feel lonely, but when a person alone, will feel lonely. Alzheimer’s or ordinary people can not be generalized, they lost memory, reality and imagination have a communion, they can not express, which is even more difficult. Finally, after the tips of tutors, I think for older people, in the final stages of their lives, the most important thing is time, then whether from their time and attention to compare XR technology and real entertainment. So I changed my question to ‘How can Extended Reality and the game with immersive entertainment activities, for time and attention of the elderly residents in care homes?‘.
Two immersive entertainment activities：
I took part in two activities in the nursing home. One is a combination of Music and Playtronica, this activity is to link the different fruits to the current and make a sound when people touch the fruit. Old people like this kind of activity very much, participatory, can communicate with each other. But one person with severe Alzheimer’s, even under the patient instructions of her staff, still didn’t understand how to operate and didn’t recognize the name of fruits, was always guilty and saying sorry. she was involved for about 15 minutes. But it was better for the people with mild cognitive, they’re having a lot of fun communicating, listening to the sound of fruit, they’re trying different styles of sounds. They were involved for less than an hour. Another activity is a musician who goes to the rooms of an old man who wants to listen to a song and sings 2-3 songs for them as they play the guitar, in about 15 minutes. Everyone enjoys it, but there will be a state of being too relaxed and asleep.
The third intervention：
Then I’m planning a new intervention, a creative painting event. Because after a few visits, I found that they regularly organize this creative activity, that is, the residents are likely to complete the activity. So I started talking to nursing home staff, and at first, we tentatively decided that their original creative activity, “eyes”, was to draw their own eyes, but I did the theme “My life” or “my time”. Let the old people draw their lives or like to do things. The carer gave me some advice, and the simpler the theme would be better for them because they might just remember what happened that day or what happened right now, so we ended up with the theme “my… “So they can draw whatever they want, themselves, anything they see, their families, their hobbies, and so on. The whole activity lasted for 1 hour. An elderly man who painted a 10-year-old boy said she was painting her son. Another old woman, who painted two pictures and one with one leg, said it was her leg because she was paralyzed and had to move in a wheelchair, so she wanted to draw a pair of healthy legs. Another picture of Christmas, with windows, lots of presents and a big Christmas tree. The third old lady has great creative ability, a total of three paintings, one is a brightly colored poncho skirt, the other two are two monsters. I told her that I liked her paintings very much, and she excitedly pulled me into her room and showed her usual paintings to me, the handmade work, and her photo album. She’s been involved in previous VR experiences, and she forgets that she showed me that before. Two elderly people drew one with the help of the staff. One drew a football star he likes, and one drew a heater. Three old people fell asleep. During the event, I tried to have a dialogue with them to understand their schedule and hobbies, but they could not answer my questions clearly, so after the end, I interviewed the staff Jack of the nursing home.
Interview with Jack, a nursing home carer：
Through interviews, I learned that the elderly in nursing homes have different degrees of dementia. Nursing homes arrange different activities every day to enrich their lives. But all activities will not exceed an hour, otherwise, they will feel tired. At the same time, I got the timetable of the two old people。
Richard：
9:00-10:00 breakfast time
10:00-11:00 watching television until the activity
11:00-12:00 participate in activities
12:00-13:00 watching TV or listening to music
13:00-14:00 lunchtime
14:30-15:30 participate in activities
After the activity, there is a break, Richard will go to smoke a cigarette, or watch TV and cowboy movies
17:00-18:00 dinnertime
After dinner，watch TV or movies
Jean：
Her hobbies are cross-work, Sudoku, and watching TV series on the computer.
She will have a video call with her daughter from 2 pm to 2:30 pm on Sunday.
Her activity schedule is similar to Richard’s, but she likes to do some creative things.
In terms of time, their time is split into one-hour units, ensuring that they can get enough time off, and that they can sink in on what they want to do, depending on their personal status.
Knowledge boundary and primary research：
When I did the interventions, I found that older people living in nursing homes have varying degrees of cognitive impairment, but understanding the cognitive state of older people is my knowledge boundary, so I searched the Internet, here are some of the information I got:
1. “In the large, population-based Canadian Study of Health and Aging, elderly people were classified as having one of the following conditions: no cognitive loss; cognitive impairment, no dementia; or dementia.
There is also controversy about the best way to objectively measure memory loss, whether utilizing brief cognitive testing or a full neuropsychological evaluation.
2. Mild cognitive impairment (MCI) is a clinical concept that identifies subjects who are in an intermediate state between normal aging and dementia.MCI is a syndrome characterized by an impairment of memory or another cognitive decline, which does not affect a person’s basic activities of daily living, whereas the complex instrumental functions may be minimally impaired. The clinical presentation, etiology, and outcome of MCI are heterogeneous. Most of the amnestic MCI patients have Alzheimer’s disease (AD) in a predementia stage and progress to dementia at a rate of 10–15% yearly in comparison with approximately 1–2% a year in healthy older adults.
Secondary Research:
To get feedback from medical experts, I searched the web for neuroscientists, psychologists, professors from universities, and eventually, on the recommendation of Professor Doherty Patrick of King’s College, contacted Prof. Rob Howard of The Old Age Psychiatry in United London College. I had a zoom meeting with Prof Rob Howard, Professor of Old Age Psychiatry Prof, which focused on my project and raised my questions, and the whole process lasted 20 minutes, and received advice and feedback from the professor. He doesn’t think that I can improve things for people with mild dementia, but I would be able to do a feasibility study – collect qualitative data about how acceptable the technology is and how people get on with it. He also mentioned that if I wanted to do an intervention study, I should contact the Ethics Committee first. I don’t think I’m trying to alleviate the condition of the elderly, so I suggested that technology like virtual is good or bad for people with Alzheimer’s. The professor says the current study does not answer this question accurately.
Analyze:
I did three interventions, two on VR technology and one on painting. Participated in two activities, one is fruits sounds, one is guitar playing activities. All activities are done at Muriel Street Resource Center. The number of residents involved is about 10, who have varying degrees of Alzheimer’s disease.
Severe patients are emotionally unstable and at great risk of participating in the VR experience. Normal aging and mild dementia, with some cognitive abilities, are more willing to try new things. By comparison, they experienced an average of about 20 minutes of unexperienced VR experience, no discomfort such as vertigo, concentration, and the hope of more experiences in the future. There is no interactive activity in immersive entertainment activities, and older people’s attention is quickly distracted or put to sleep. There are interactive activities where they can focus on less than an hour. So interactivity can be an important factor, but unfortunately, I haven’t tested whether interactive VR socialization will make residents willing to spend more time.
Conclusion:
I have learned a lot from the development of the project to the present. Have their understanding of how to do research. First of all, at first, I broke through my comfort zone, because for me on their English language ability is not very confident, personality is more introverted. Contacting pension agencies and experts is a challenging thing for me to do. The same is true of going to a nursing home for face-to-face communication, and although I can’t fully understand it, I can understand at least 70% of the information.
Second, I see the part where I’m not confident, and when there’s an outside doubt or things don’t go according to expectations, I get into self-doubt. But through this project, I understand that self-doubt is because of the boundaries of knowledge, I have to choose the answer, continue to explore and learn, according to the knowledge to adjust the direction, rather than completely subvert.
Also, do not set assumptions and expectations in the course of a project, focusing on the process rather than the results. An objective understanding of Stockholder’s needs. Avoid subjective judgment and draw conclusions. Cycle Plan to Do to Record to Reflect and then Plan to maintain the state of continuous update optimization.
Tutor David asked us to test 16 personalities, which also showed me that some of my inherent weaknesses were reflected in the project. When someone challenges my principles or values, I will become defensive in the face of criticism and conflict, particularly when it comes to issues that are near to their hearts. I find it difficult to open up and be vulnerable about my struggles.
Finally, If there is only time and opportunity to continue this project, I can explore more, such as how to increase social interaction with new technologies that are acceptable to older people. Whether this kind of socialization can exist between different cultures and different generations.
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