Perspectives and Experiences
In order to gain insight into the main stakeholders’ opinion and ex- perience on the EldersVR platform, 30 semi-structured open-ended interviews were conducted. of these were with support personnel and with senior citizens, with a minimum age of 60. These interviews were either in groups or individually taken in homes, care homes, nursing homes and other local activity centers in The Hague which organize activities for the elderly. The interviews followed the questions that can be found in the appendix. What is more, a hierarchy chart produced in NVivo 12 is also provided in the appendix, which illustrates the distribution of the coded attributes in this study, such as positive and negative attitudes towards the EldersVR experience.
Elderly Perspective. The initial feedback on the EldersVR platform was mainly positive, especially the safari and the diving experience are favorites within the elderly community, according to care takers that have the platform in use. Normally quiet residents who did not communicate which each other suddenly had common ground on which friendships could bloom after using EldersVR Shared. Some elderly even started using the experience without guidance together with their initial partners weeks after the first experience.
During these interviews I was often introduced to the group before the activities started, after which I often let the elderly settle in first. I always had the sense that the elderly were quite happy that there was someone active in researching new solutions to support them. Before they even knew what it is about or what VR actually is, they would respond with phrases like; “that’s great!”. I have not been met with any negative response by any of the care takers or the elderly in anyway. Everyone I met was very open and enthusiastic towards new technologies and were quite excited to try out the VR experience.
My procedures sometimes changed, depending on how close the elderly were sitting together. When they were relatively close to each other, I observed the people surrounding the person with the VR experience as well, since they were all interested and often started conversations about it with me and others around them. However, I tried to put emphasis on the person undergoing the experience.
The results are quite positive in general. Only a couple of elderly did not enjoy the VR experience and took the VR headset off before the end of the video. Some people described the experience as being nauseating and uncomfortable. A small minority experienced this and I did not encounter situations where this was serious in any way. All other participants had a contrastingly positive experience and enjoyed it intensely. Interestingly, even the elderly that found the experience as uncomfortable, still believed it could be a useful tool, since it is more dynamic than just a folder. For most people it was the first time they experience a virtual reality, but even people that already have had more than one experience were still excited and enthusiastic towards it. “It was quite an experience” was something that was said more than once, together with “how is this even possible?!”.
Before the start of any VR video, a horizon is displayed with a text overlay. This text overlay consists of the text: ‘video will start in’, followed by a numerical countdown of 10 seconds, accompanied by a decreasing bar from two sides. I would always start with whether they can read what is displayed and if not so, I would adjust the VR headset to fit better. Even without reading glasses, the text should be readable, and the goggles simply need some adjusting to display correctly. The enthusiastic reactions often started here with phrases like: ‘how is it even possible?!’. Others started counting and did so for all ten seconds. Most elderly found the letters clear and readable, there were however many seniors that struggled reading the letters and preferred a bigger font size. The 10 second countdown was mostly experienced as a good duration as well.
For the elderly in particular, the VR experience of the Amarath Kurhaus at Scheveningen beach was showed first. This is a very famous and old hotel and landmark in The Hague’s beach district. I picked this video in order to find out whether the elderly would recognize were they were. Some people did confuse the Kurhaus with a well-known train station in The Hague called Hollands Spoor. They all figured out within the first minute where they actually were, and to be fair, the locations have similar architectural styles.
The video also contained a gentleman in that welcomed the peo- ple into the main hall in the Kurhaus, providing some background and historic information. This was not always understood well as a result of poor audio quality, but most elderly did find it positive that there was a host welcoming you in. Some elderly even talked back to the man and replied with “thank you!” or “good day sir”. Some elderly were not able to hear him properly and did not understand what was going on. When asking the elderly about this topic after the VR experience, most of them clearly stated that they would prefer to have a guide in the video and more context and info. “It’s nice to have people in the videos, that makes it real”. One reason for this was that people wanted to learn more about what they saw in the videos: “Having a guide would be nice, I would like to know what I am looking at” and “a guide is great, I would like to know more about Scheveningen.” However, the audio quality needs improvement for this to be useful; “a guide would be nice, if I could hear him properly”.
The Kurhaus video was also selected because of its length, which is close to the average of all video’s the EldersVR platform currently has. The length is 3 minutes and 15 seconds. The elderly were asked after the video how long they thought the video was. Most of the elderly thought the video took between 4 and 8 minutes and did say it took some time to get used too. When asked whether the length of the video was too long or too short, most people stated that they would prefer longer videos; “it may last as long as possible!”, where some people’s opinion was that it was long enough. The videos were found to be on the short side, rather than on the long side in general, also taking other longer videos into consideration. The elderly clearly interacted with their perceived environment. Some elderly tried to touch things around them, others replied to the gentleman welcoming them inside of the Kurhaus. Multiple elderly tried to stand up. I had to keep some of them seated, because safety reasons.
After the experience, questions about how the elderly felt in general about the experience and how they feel towards using this in the EldersVR home scenario were asked. On both topics all elderly were very positive. One of the seniors stated that there was no form of information 10 years ago about any of the topics the EldersVR platform provided. The 360° aspect of the experience was very well received: “You can look all the way around you, quite an experience”. Others just responded with powerful words such as;
“fantastic!” and “beautiful!”. Especially for people being mostly at home alone it was suggested to be a useful experience. Almost all the elderly interviewed would use EldersVR to learn something new or to be transported to a different place. Some even asked where a VR headset could be purchased.
Almost everyone was positive towards the idea of using EldersVR in the home setting to decrease social thresholds that the elderly might experience. Many appreciated the initiative: “This is a good initiative, there should be done more for the elderly who cannot do much anymore or are not comfortable doing so.” Many agreed that it would help them and that they would use it themselves. Most elderly believed it could improve safety too: “many accidents happen with mobility scooters, it would be useful to have an explanation.”
Old memories resurfaced together with long smiles. The energy in the room often changed during and after the watching of a video in VR. Several people that were interviewed had witnessed no one less than the Rolling Stones in the Kurhaus in 1964. Others started talking about the time that the Kurhaus was still a casino. Other videos also made memories resurface and often started meaningful conversations. One person immediately started talking about a sibling, who worked as a diver while experiencing the diving video. Others started talking about holidays they enjoyed in Italy after seeing the gondola tour in Venice.
A reoccurring topic is how much the elderly are interested in the changes in their city, and more specific, their neighborhouds. They would all love to re-experience how their neighborhoods were when growing up. Many described the rapid changes as sucking out the soul and energy of most neighborhoods. They did often not like grandiose architectural changes, in both infrastructure and buildings. “It was all simpler and cozier.”
Support Personnel Perspective
The second key group of stakeholders are the support personnel, of which some are nurses, elderly consultants, caregivers, facility attendees, and volunteers. X-TRA Welzijn deploys many elderly consultants, which are specialized in assisting the elderly. When someone reaches the age of 70, a local elderly consultant schedules a home visit to find out what the specific needs of that person are. The main role of the elderly consultant is to provide information about available possibilities and to support the elderly with a happy life. They help open up channels, such as with the local municipality or with the nearest activity centers. They were also the first to use the EldersVR platform and are still using it. Learning more about their perspective is pivotal for the platform, since they are the ones that have to deliver the product to the target audience. If the platform shows any deficiencies in any way, it could result in the consultants simply not using it all together. To gain insight into this group, a total of 12 semi-structured open-ended interviews were conducted. All these interviews were conducted in their offices or the location where they work most.
All support personnel were positive about the platform and found that it had a positive effect on their clients. “It’s user-friendly and it should not be an issue using it.” Some leaned more towards the Shared experience and did not feel much for the Home experience;
“The elderly are more interested in relaxation and are not keen on Home”, “I use Shared rather than Home.” While others suggested that they simply do not have time in their busy schedule to use the Shared experience, and only use the platform to help their clients with their struggles. Some support personnel also used it during events, which worked well to draw the attention of senior citizens: “providing something new that activates them, that is what they often say as well!”. Their experience also showed that it supported breaking social isolation that some elderly experienced. Being transported outside, sometimes accompanied by loved ones, was really powerful and could make someone’s day. This especially when they have been out of social circles for a while.
Two hurdles that were often encountered were poor audio quality and unsharp visuals. When the headset was not seated properly, the visuals were experienced as being poor of quality or unsharp. This is however hard to test, since it could also just be the decreased sight that elderly often have, or the overall lesser quality of VR over real world vision and videos on modern televisions. The visuals often improved when the headband was tightened, unfortunately, not all support personnel knew that this could help. Furthermore, audio was often a nuisance. It was often not loud enough, especially for those with hearing impairment. This group is often lonely, because communication gets increasingly harder. Hearing aids sometimes interfered with the VR headset, which resulted in high pitched tones that were uncomfortable for anyone in the room.
Another topic most support personnel struggled with, was the system, or lack thereof, revolving around the availability of the EldersVR platform. As of now, the set has to be picked up at a separate location, signed for and returned within a specified period of time. It is also often unclear whether there is any availability. This is quite disruptive to some: ”Since it has a playful character, it also needs a spontaneous character for it to work naturally.” A proper system for the distribution of the platform was suggested, together
with a better means of transportation. Some even indicated that they got the set to borrow in a paper bag, which of course is less than ideal. A colorful and playful case or bag designed especially for the set was suggested by the care takers, not only for convenience purposes, but also in order to create enthusiasm for the elderly.
It was also not clear to many of the support personnel what the platform could do and what it is for. “I have worked here for a year, I know that Stef Beun is working on this project but I did not know that I could use this for the elderly. I do not have this in my system for a home visit.” The goal of the platform and how it can be reached is unclear to many. The notion that it is a gimmick, or that is hard to use surfaced multiple times.
Some safety issues were also brought to light by the support personnel, of which some were in line with my personal experience with EldersVR. The elderly tend to stand up during the experience. This can be quite dangerous, since you cannot see the real world around you. They could also move slightly and miss their chair when they try to sit back down again. Nausea and dizziness can also stick around for a while, which can result into falls after the experience. Fear is also something that can be triggered: “I am not going to stand up, because then I will fall into the water.” One of the clients could not swim and was shocked when seeing the VR experience of diving under water. It can be a sensitive tool, and some would not send just anyone to someone’s home to use it. One care taker did not use it often, because the risks of using VR with this sensitive audience is not well known.
Teachers and Professionals in the Field
During my research I presented the EldersVR platform at a sympo- sium the ROC mondriaan organized. This symposium theme was the future of MBO education, which nursing is a part of. After a short 10 minute presentation on the topic of the elderly, loneliness and VR, a focus group of 8 people experienced EldersVR live. 7 of the 8 were teachers and there was one principal present.
The first question asked was what their opinions are on the El- dersVR platform. All eight were positive and believed this could be very well implemented in the future, not only in the healthcare system, but also as a teaching method. “It was instructive, very in- teresting practical education and a fun experience. “They especially appreciated the mobile aspect of the system. Not having to carry around heavy and complex equipment, but using the company phone you already have at hand.
Furthermore, I asked this group what they think would be good videos for future use. For the elderly, they suggested activating videos, such as swimming, running, dancing, and climbing. Activ- ities that are hard for fragile elderly, were found very applicable for EldersVR. Besides this, all eight agreed that this could very well be used for teaching purposes. Some sensitive situations are better handled in the field when the future care takers can train with it first. The immersion of virtual reality, together with the simple set up of EldersVR, convinced them that this could be used for many use cases in the teaching environment.
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