The recent buzzword in healthcare and medicine is “Metaverse”, a new, virtual, three-dimensional world that is accessible through a head-mounted display or screens, controllers and the internet (S.-G. Lee et al., 2011). This virtual world allows its inhabitants, represented via avatars, to perform actions simultaneously and to interact with each other directly irrespective of the actual physical distance, representing a true integration of the real and the digital world, enhancing the possibilities of the former (Román-Belmonte et al., 2023). While originally thought as mostly social and commercial environment, research in health and medicine is starting to investigate its potential (McWilliam & Scarfe, 2023; van der Kruk et al., 2022).
In phobia treatments, substance disorders and depression, among others, virtual reality (VR) technology has been introduced to produce crucial exposure scenarios for the patient (Cieślik et al., 2020; Yen & Chiu, 2021). The advantage of VR in relation to psychological disorders, such as phobias or PTSD, is that virtual scenarios are controllable and fictional, which enables a safe method of exposure therapy (Botella et al., 2015). The metaverse could therefore enable patients to move on from simple isolated scenarios to more complete experiences, such as moving on from the virtual interaction with one spider to the visit of a virtual oversized terrarium full of spiders in the case of arachnophobia. Next to exposure that comes close to real experiences, VR offers the possibility of captivating virtual experience that distracts from the real experience. This approach is investigated in pain management research, where promising results have been found in a variety of studies with engaging VR experiences for the patient, such as improved emotional wellbeing and diminished cancer-related psychological symptoms for cancer patients, reducing procedural pain for patients suffering from severe burns, and higher engagement, diminished fear and pain during rehabilitation exercises with patients suffering from chronic musculoskeletal pain (Chirico et al., 2016; Indovina et al., 2018; Simons et al., 2022).
VR is accessed through head-mounted displays and controllers. It allows a full immersion in a completely synthetic world by the user, with which they can also interact (Milgram & Kishino, 1994). It is thus the preliminary to the metaverse, where realities can be a mix of the virtual and real world (Román-Belmonte et al., 2023). The sensory input (through visual, sound, and haptic feedback through controllers) makes users feel fully immersed, present and embodied in the virtual environment (Zahiu et al., forthcoming; Seinfeld et al., 2022; Slater & Sanchez-Vives, 2016). These unique features of VR thus allow the creation of experiences that trigger behavioral responses similar to the ones in real life. In a meta-analysis of current literature on therapy opportunities of VR, Riva et al. 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 and the metaverse as a (moral) education tool that is potentially able to reduce racial bias and improve empathy (Francis et al., 2017; Maister et al., 2015; Zahiu et al. forthcoming).
Looking at the vast amount of benefits of the metaverse and VR technology, envisioned and confirmed, we need to extend its potential to a demographic that's often overlooked: older persons. Several studies have been conducted in the use of VR to improve older adults’ health and wellbeing. VR-based cognitive and exercises, such as simulation of a virtual supermarket, where ingredients had to be picked out or a store clerk had to be found, or a virtual closet where pairs of shoes had to be organized, improved execution of daily activities, verbal memory and global cognitive function (Liao et al., 2020; Oliveira et al., 2021; Son & Park, 2022), fall prevention (Phu et al., 2019; Yen & Chiu, 2021), and quality of life (Appel et al., 2020; Kang et al., 2021; Lin et al., 2018; Roberts et al., 2019). Despite these efforts, VR currently remains a technology used by younger persons and for different purposes, such as entertainment or education (Di Natale et al., 2020). 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 for older adults (Rendever Inc., 2023; Sonida Senior Living, 2023). Furthermore, old age can be often accompanied by a reduction in mobility and an increase in fall risks (Campbell & Buchner, 1997). The fact that users can tap into to experiences without physically leaving one’s home means that VR can offer activities to older persons that are not accessible to them in the real world (Shu & Woo, 2023). Nevertheless, acceptance among older persons regarding VR and new technologies in general is currently relatively low (Fowe & Boot, 2022; Shah, Hameed, et al., 2022). Main reasons for VR include the unfamiliarity with the technology (Han & Oh, 2021), skepticism regarding its usefulness or even fear of potential downsides such as accidents (Shah, Karlsen, et al., 2022) and the lack of social connectedness (meaning other people the older person wishes to connect with through the use the technology) (Shah, Hameed, et al., 2022) 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 (Chen, 2020).
Incentivizing older adults to accept VR as a healthcare technology may be worth considering, given the previously mentioned benefits. Successful incentives will however depend on the actual needs and wishes of older adults and their caregivers to tailor them accordingly, as well as understanding their fears and concerns regarding VR, to avoid realizing them. In order to fill these gaps, we conducted a qualitative study to explore the opinions of older adults, as well as their caregivers (formal and informal) on VR. Our findings illuminate 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.