Authors (including presenting author) :
Wong KW, Lau KW, Kong SF, Wan LM, Ching WK
Affiliation :
Occupational Therapy, North District Hospital
Keyword 1: :
Virtual reality
Keyword 2: :
Nature relaxation
Keyword 3: :
Occupational therapy
Keyword 4: :
Multimorbidity
Keyword 5: :
Older adults
Keyword 6: :
Mood disturbances
Introduction :
Older adults with complex multimorbidity, such as stroke, hip fracture, chronic obstructive pulmonary disease (COPD), life-limiting illnesses, and cognitive impairments, frequently experience co-occurring mood disturbances. Relaxation skills support physical recovery, cognitive function, and activity participation. However, conventional guided imagery requires vivid mental visualization, sustained attention, and working memory, abilities often impaired in this population, thereby reducing its effectiveness. Emerging evidence suggests that virtual reality (VR) bypasses these barriers by providing immersive external stimuli that promote relaxation, reduce pain, improve mood, and support cognition. Despite promising preliminary findings, detailed clinical applications of VR-based relaxation in routine occupational therapy for this heterogeneous group remain limited.
Objectives :
To explore the use of VR-based nature relaxation as an adjunct to occupational therapy, facilitating relaxation, alleviating mood disturbances, and enhancing activity participation despite physical and cognitive limitations in multimorbid older adults.
Methodology :
A case series. Subject: adults aged 60 years or older attending occupational therapy clinics, day hospitals, palliative care, or community outreach services. Inclusion criteria comprised multimorbidity with co-occurring mood disturbances and cognitive impairment. Exclusion: severe dementia, acute psychiatric conditions, or severe visual/hearing impairment precluding VR use. Intervention: integrated 10–15 minutes of seated multisensory VR-based nature relaxation into routine 45–60-minute occupational therapy sessions. Delivered via head-mounted display with biofeedback devices, featured personalized low-motion realistic or stylized natural scenes paired with guided narration to evoke calm. VR duration was adjusted according to participant tolerance and engagement. Outputs & outcomes: mood (perceived scale), physiological indicators (heart and breathing rates), attention (to characterize cognitive profile), activity participation (personalized functional goals), adherence, VR completion rates, and cybersickness incidence.
Result & Outcome :
All 26 participants showed 100% VR adherence. Three reported transient cybersickness, resolved by adjustments. Seventy-three percent (n=19) had mild-to-moderate attention impairment. Mean heart rate decreased by 12%. Over 70% reported high enjoyment, increased motivation, and perceived carryover benefits to activity participation. VR-based nature relaxation is feasible and well-accepted as an adjunct to occupational therapy for multimorbid older adults. By replacing cognitively demanding guided imagery with immersive stimuli, it mitigates mood- and cognition-related barriers, supporting more patient-centered, holistic and efficient geriatric care.
