“For older adults who cannot travel or attend family events, the real world can become very small and stifling. But they may be able to escape their isolation to a degree through virtual reality.”
British-born Alma, shown here in 2017, had moved to Northern California as a young mother and thought that she’d never again travel to her home town. So I outfitted Alma and her daughter with these lightweight goggles that have smart-phones snapped into the case. The gear lets you view special “360º” or “spherical” imagery — also called virtual reality. I launched Google Earth in street map view, then entered the address that Alma remembered, and whoosh! suddenly she and her daughter were “visiting” Fort Royal Hill, a park in Alma’s beloved Worcester, England. A reserved 91-year-old suffering from lung cancer, Alma happily reminisced as she looked around, especially when she spotted the playground roundabout she enjoyed as a child.
Catching on to how Google Earth works, Alma asked to visit the New Jersey home where she’d lived as a young mother married to a U.S. Air Force officer. This triggered memories of raising children “here.” Alma concluded her virtual reality adventures by flying through a whimsical 3D version of Van Gogh’s Starry Night.
After effects
After Alma removed the headset, her daughter asked, “Isn’t it amazing?” Alma said, “It’s MORE than amazing! Wow!” She looked around her living room and said, “I can’t believe I’m still here!” Two months later, she was gone. After Alma’s death, her daughters expressed gratitude for the pleasure their mother experienced while seeing Worcester one final time.
Better living through neuroscience
Alma’s physical health was not good, her brain, still sharp. At 92 years, she got lucky; 37% of Americans over age 85 have cognitive impairment.
In conjunction with living longer, physically healthier lives, we are learning how to do the same for our aging brains.
Neuroscientists have learned this: stimulating the aging brain boosts recall and thinking scores of people who have memory problems.
After frail elders engage in a mentally stimulating activity, they communicate and interact more effectively than before. Caregivers report improved quality of life. Apparently this sort of activity can build “cognitive reserves” to replace damaged brain cells — and cognitive stimulation may help reduce symptoms associated with dementia.
Gentle Reader: cognitive stimulation is job #1 for maintaining brain fitness — because today there is NO medical treatment or prevention of dementia, one of the top ten causes for death worldwide.
Top techniques for keeping brains fit
Start with the basics, excellent diet, exercise, sleep, and stress management, all shown to reduce risk of developing cognitive problems. And now scientists believe that pushing the brain’s thinking capacity puts another arrow in the cognitive quiver. If, as it’s said, people grow when they are loved well, imagine how your self-love can boost your healthspan.
“Approaches to Cognitive Stimulation in the Prevention of Dementia” is a report by European gerontologists (Niederstrasser et al., 2016). They analyzed studies of cognitive intervention strategies for people with mild memory loss or moderate dementia. They concluded that the practice of cognitive intervention (stimulation) has 3 fundamental goals, each using multiple strategies:
1— Educational training teaches people who develop memory problems about their symptoms, such as onset and duration of decline, and ways to cope;
2— Functional memory improvement uses memory aids (calendars, memory books, etc.), reality orientation (repeated presentation of name, date, time, place, weather, other basic info), and methods of loci (mnemonic systems for linking an item with a place);
3— Cognitive functioning techniques exercise your ability to memorize, calculate, perceive, and react, and include reminiscence therapy, a clinical intervention that evokes discussion of positive nostalgic experiences, increases motivation and focus, and fosters self-worth, psychological resilience and improved well-being (Yamagami et al., 2007*).
Most elders love to tell and re-tell old stories. Why? Recalling and sharing life experiences produces the lovely neurotransmitter dopamine, which plays a role in human motion and emotion. Low dopamine levels lead to lack of motivation, fatigue, addictive behavior, mood swings, and memory loss. Hence, increasing dopamine levels likely improves mood and reduces memory loss.
And if an elder is struggling with short-term memory recall (recent acquaintances’ names, meals eaten earlier in day), the ability to recall and share long-term memories truly is a gift.
Get back to where you once belonged
Reminiscence therapy is a fantastic application for mobile virtual reality (mobile VR); i.e., “immersive,” 360-degree, spherical imagery.
French neuroscientists set out to prove this point in 2014, the year when low-cost “mobile VR” display devices (Google Cardboard, above; and Samsung GearVR, shown on Alma at top) appeared on the market:
In the journal Neuropsychiatric Disease & Treatment, neuroscientist Michel Benoit and his team described a feasibility study testing the hypothesis that visual cues provided by “image-based rendering virtual environments” to people with dementia can enhance production of autobiographical memories. They concluded that cues involving an environment related to the subject’s life increase the quantity of conscious recollections of memories.
Researchers today also are developing 360º video and real-time VR and augmented reality applications for cognitive assessment and training applications. An excellent overview of VR use in this field appears in a 2015 “Frontiers in Aging Neuroscience,” by Madrid researcher Rebeca Garcia-Betances and her team.
My work showing virtual reality to the elderly
“Virtual reality-based cognitive rehabilitation systems support procedures for mitigating behavioral and psychological symptoms of patients having mild cognitive impairment and early-stage Alzheimer’s disease.” — American Journal for Alzheimer’s Disease and Other Dementias
In 2015, equipped with Google Cardboard viewer and iPhone, I showed NY Times VR and random 360º YouTube videos to residents and caregivers at assisted-living and dementia-care facilities in San Francisco, Berkeley, Oakland, Walnut Creek, and Alameda. They were mildly amused. Many recalled their kids’ ViewMasters. Some were dismissive, frustrated by the cheap optics.
Last May, 2016, I met two grad students, Dennis Lally and Reed Hayes, who developed a business school project into a startup, Rendever, while attending MIT Sloane School of Management. Both in their 20s, they had seen older relatives languish in assisted-living facilities, and decided to create a business delivering mobile 360-video experiences to offer engaging activities for frail elders. They teamed with other students to design an app, code a mobile architecture, and prototype a method enabling one tablet device to control selection and presentation of curated, streaming 360º content displayed in multiple Samsung GearVR headsets and smartphones.
They planned to sell the gear and offer content-subscriptions to assisted-living and skilled nursing companies, and enable subscribers to add and deliver their own content to their relatives via VR, selling custom content-production services to subscribers (e.g., live-stream a wedding via 360-degree camera for remote observation).
Dennis, Reed, and I aimed to compile feedback from senior-living providers, end users (residents, care-givers, activity leaders), geriatric health specialists, and 360º content developers.
Demo content included 360º slide shows of scenic and historical landmarks, annotated photo tours of cultural sites, and spherical videos of circus performers, animals, underwater life, mountain-climbers, race-cars, orchestras, abstract art “walkthroughs,” NYTVR clips, and so on. Also, my favorite, Google Earth.
After guiding hundreds of participants through experiences of 5 to 20 minutes in duration, I saw distinct engagement trends. Regardless of age, cognitive health, gender, or race, all preferred 3 genres: — visiting exotic locales — viewing natural and wildlife scenes — flying and other out-of-body adventures
Typically a single viewing of each video or slideshow was sufficient. No one ever requested a repeat experience, with one exception: people couldn’t get enough of visiting familiar settings via Google Earth.
In this setup, everyone in the group sees the same single scene, although they can each look around the scene independently. I observed these results at every care facility, in every city: When one participant recalled an old home address and the resulting street scene appeared, that person became excited, twisting around in their chair, pointing at recognized landmarks, marveling at changed foliage or new structures, gesturing to a garden or garage or window, saying “Look over there, by the red car! My father planted a magnolia tree right there!,” etc.
Fellow participants responded enthusiastically as they learned something new about each other. This provides residents living together due to happenstance, not choice, to build interpersonal connection and enhance understanding, in addition to self-worth and motivation. It elevates conversation between resident and caregiver beyond, “Do you want to wear this jacket today?” or “It’s time for your shower.”
It’s exciting to bring these experiences to our elders, and all people who no longer freely have access to the outside stimuli that normally would enhance motivation and focus. These are the people for whom virtual reality applications can provide excitement and wonder that would otherwise be impossible for them to experience.
Besides, there’s nothing quite so rewarding as blowing the mind of a 90-year-old.
As Alma said: “It’s MORE than amazing — It’s, WOW!”
Benoit, M., Guerchouche, R., Petit, P. D., Chapoulie, E., Manera, V., Chaurasia, G., Drettakis, G., & Robert, P. (2015). Is it possible to use highly realistic virtual reality in the elderly? A feasibility study with image-based rendering. Neuropsychiatric Disease and Treatment, 11, 557–563. https://doi.org/10.2147/NDT.S73179
García-Betances, R. I., Arredondo Waldmeyer, M. T., Fico, G., & Cabrera-Umpiérrez, M. F. (2015). A succinct overview of virtual reality technology use in Alzheimer’s disease. Frontiers in Aging Neuroscience, 7, 80. https://doi.org/10.3389/fnagi.2015.00080
Laver, K. E., Lange, M., George, S., & Cameron, I. D. (2015). Using virtual reality for cognitive training of the elderly. American Journal of Alzheimer's Disease & Other Dementias, 30(1), 49–54. https://doi.org/10.1177/1533317514545866
Niederstrasser, N. G., Hogervorst, E., Giannouli, E., & Bandelow, S. (2016). Approaches to cognitive stimulation in the prevention of dementia. J Gerontol Geriatr Res S, 5, 2.
Yamagami, T., Oosawa, M., Ito, S., & Yamaguchi, H. (2007). Effect of activity reminiscence therapy as brain‐activating rehabilitation for elderly people with and without dementia. Psychogeriatrics, 7(2), 69-75.
