Quality of life.

Quality of life was measured at pre-VR tourism program assessment and at post-VR tourism program assessment using the Older People’s Quality of Life Questionnaire (OPQOL-35; [29]). The OPQOL-35 is a 35-item self-report questionnaire that assesses participants’ levels of satisfaction with their quality of life in various domains including life overall, health, social relationships, independence and control, home and neighbourhood, psychological and emotional well-being, finances, leisure, and religion. Responses were made on a 5-point scale ranging from “strongly agree” to “strongly disagree.” Possible scores range from 35 to 175, with higher scores indicative of greater quality of life.

Social engagement.

Social Engagement was measured at pre-VR tourism program assessment and at post-VR tourism program assessment using the Social Engagement Scale (SES). The SES is a 5-item scale adapted from Krueger et al. [30], which measures frequency of engagement in activities outside of the residence with family or friends, engagement in church or religious activities, engagement in sports or physical activity, and engagement in other recreational activities. Participants are required to indicate the frequency with which they have engaged in each of the aforementioned activities in the past two weeks on a 4-point scale with the following four response options: zero times, one to two times, three times, or four to five times. Possible scores range from 0 to 13, with higher scores indicated greater social engagement.

Depressive symptoms.

Depressive symptoms were measured at pre-VR tourism program assessment and at post-VR tourism program assessment using the Geriatric Depression Scale (GDS). The GDS is a 15-item measure of depression in older adults [31]. Participants are asked to respond “yes” or “no” to questions that tap into mood. Possible scores range from 0 to 15, with higher scores indicate of greater depressive symptoms.

Momentary affect and cybersickness.

Momentary affect and cybersickness was measured before and following each VR exposure session during the 6-week program. Assessment of momentary affect in response to VR exposure was measured using a Visual Analogue Scale (VAS) consisting of three dimensions of affect: unhappy/happy, bored/engaged, and anxious/relaxed. Cybersickness in response to immersive VR exposure was assessed using a modified version of the Simulator Sickness Questionnaire (SSQ; [32]). Six items of the original 16-item questionnaire were chosen (general discomfort, nausea, fatigue, headache, eye strain, and dizziness) to minimize burden of reporting over the 6-week program. Greater score on the SSQ is indicative of greater cybersickness.

Qualitative interviews.

Semi-structured one-on-one interviews were audio recorded and transcribed verbatim. Interviews consisted of open-ended questions that elicited discussion regarding individual experiences of the VR tourism program and thoughts on VR technology.

Personal experience with tourism and virtual tourism.

Three sub-themes were identified within the theme of personal experience with tourism and virtual tourism: 1) experience with tourism, 2) short term benefits of virtual tourism, 3) and the opportunity to learn and reminisce through virtual tourism.

Experience with tourism. Participants had varying levels of travel experience prior to the study, with some participants reporting frequent tourism around the world, and others noting that they had never travelled outside of their home town. Regardless of the level of past tourism, all residents reported that their current travel was minimal and mostly consisted of visiting family within southern Ontario, or outings with their retirement home to the local mall. All participants voiced that tourism was an activity that they would like to engage in, but were unable to do so due to financial or mobility constraints. One participant shared “I did do travelling… although my daughter, she thinks we should go to [foreign country] … she’d have to put me in a wheelchair, I don’t know. Anyways I consider my travelling days are over” (female resident, 84 years old). Another participant shared “I have multiple sclerosis and … for an unbelievable immediate time space, I have become so much more disabled. In terms of being physically able to be mobile, I can’t. Like yesterday they went to [name of park in the city] and I didn’t go because they couldn’t find out whether they had a disabled bathroom!” (female resident, 88 years old). Overall, participants’ thematic accounts presented challenges with the ability to travel, even to engage in local tourism. Due to these challenges, participants expressed that virtual tourism addressed a need within residential care settings. Regardless of past travel experience, current tourism was seen as an activity that participants enjoyed and would like to engage in. One participant shared “I stopped travelling in my 30s, for various reasons, and, um, so it was nice to see the world again” (male resident, 77 years old).

Benefits of virtual travel. Participants reported that virtual travel was something for them to look forward to, that it promoted positive emotions, and that they were immersed in the VR tourism content. A number of participants reported that they looked forward to participating in each VR tourism session. One participant stated “Well, that 10 minutes was pretty… exceptional! [..] I looked forward to it, before each one” (female resident, 71 years old). Another participant shared that the program was interesting and different from their usual scheduled programming, stating “it [VR tourism program] was interesting to do because I don’t go to any of their [resident programming] stuff… they have bingo and they have people coming in to entertain and all that. I don’t do any of those” (female resident, 80 years old); along a similar vein, another participant shared “You know, you go into different activities, and this is the one I was looking forward to for 6 weeks!” (female resident, 86 years old).

An important element of the program which served to promote anticipation was the ability to see something new and exciting each week, and that it broke up the monotonized and predictable schedule of their current setting. One participant shared “Well, I put in most of my time sitting in a chair watching television, so it gave me something to look forward to and to know that I was going to be able to do something else today […] the anticipation is what was wonderful for me. The anticipation that I was going to be able to look at something, and I wouldn’t know what it was until I got here” (female resident, 90 years old).

Residents also reported that they enjoyed virtual travel and that they felt that the activity lifted their spirits. Namely, participants reported that they “really loved” participating in virtual tourism, and that it had “uplifting value” such that they felt happy leading up to, during, and after participating. One participant shared “I came out of there [VR tourism viewing] and I was like, on a high! […] I was happy” (female resident, 86 years old), and another participant expressed “I found most of the tapes energized me and that energy level carried through to the rest of the day” (male resident, 77 years old).

The level of immersion experienced by participants was an important contribution to their level of enjoyment. Residents reported that they felt transported to other places and could almost feel the physical sensations of being there. One participant shared “I felt privileged as if I was exported to other places…the videos were very realistic…I could feel the sand in my toes” (female resident, 90 years old). Another participant expressed “I really got into it. I really loved it. I did feel that I was really travelling because I lost complete sense of where I was. If my hand hadn’t automatically touched the chair [laughs]… like it stunned me for a minute” (female resident, 86 years old). Additionally, greater levels of immersion increased the ability of VR to serve as a distraction and contributed to a sense of “escaping” from the routine of residential care living. One resident reported “I’m handicapped because I can’t walk, ya know. Three times a week I was able to escape and travel to some parts of the world […] when I would be watching, I would notice that my pain threshold was minimum. I didn’t feel as much aware of my pain as I was watching, I escaped” (female resident, 90 years old).

Although participants shared several immediate benefits from engaging in virtual tourism, long-term benefits of VR tourism were less clear. One participant stated “I only see virtual reality as a tool. It’s a help, that’s all. It does not cure depression, or anxiety…it broadens my vision” (male resident, 83 years old). However, another participant shared “I think it contributed to doing other things that made me feel good. So I think, in terms of its general effects for people right now, it could have quite a range. Some people might find it very encouraging, and exciting” (female resident, 81 years old). One benefit that a majority of participants reported was that the VR tourism program provided a conversation piece to discuss with family and friends, and a topic to write about for residents who were part of a writing group. One participant shared that she was now able to virtually visit places that her husband had travelled to in the past; she shared “it may have been obvious to my husband that I was very upbeat when I knew I’m going into a session. He could see I was excited. He travelled the world before he met me. Every time I mentioned it, [husband would say] I’ve been there. Well good. Well now I’m going!” (female resident, 86 years old).

Discovery and Reminiscence. Virtual travel presented something different for experienced travellers and for those who had not travelled in the past. For the inexperienced traveller, the VR tourism program provided an opportunity to learn, see, and experience something new. Participants reported the enjoyment of being able to virtually travel to destinations that they had never seen, and would never have an opportunity to see otherwise. In discussing potential advantages of virtual tourism, one participant noted “Visiting countries that I’ll never, never visit… the space station, things like that that I’ll never see” (male resident, 86 years old). When virtually touring new places, participants reported the experience as a learning activity, such that they were able to learn about a place that they had never visited before. One participant noted that they had “learned a lot, especially the different places… I was really absorbed in a lot of it” (female resident, 84 years old), and another participant shared “Just being there [the Great Barrier Reef], even if you’re not a snorkeler or diver… things that you would never do in your real life, they’re approachable by this, that’s what I really enjoyed about that” (male resident, 83 years old). Participants also reported enjoying seeing different ways of living and architecture, and that it broadened their vision of the world. For example, one participant shared “To me it was great seeing parts of the world I had never been to. They opened me up to seeing people living in a totally different lifestyle […] the buildings were great to see too, but to see the people and markets… something totally different from here” (male resident, 96 years old).

For those who had previously travelled to the selected destinations, participants reported that it brought back memories, provided comfort, and that it added another dimension to their tourism experience. One participant shared “I have travelled quite a lot, been all across the world…so it was interesting in that respect, you know? Because some of the things, I knew about it, but it also added another dimension” (female resident, 71 years old). Further, some participants were able to see sites that they had not seen during previous travels, whereas others felt as though they were revisiting; as one participant shared “In the VR I felt like I had visited back” (male resident, 79 years old). Two residents reported that they were “sad” that they could not travel to these places anymore, however they still appreciated the ability to travel to them virtually.

Feedback on virtual tourism.

After participating in six weeks of virtual travel three times a week, participants had several points of feedback regarding VR for tourism, including strength of the video content and areas for improvement. Residents also voiced their anticipation for VR in the future in the hopes that it can further address the travel needs for older adults in residential care settings.

Strengths of video content. Frequently reported favourite virtual travel destinations included Elephants and Orangutans, the Great Barrier Reef, and Prague and Spain. These locations were referenced due to their creative filming, novelty, scope, and their level of immersion. One participant shared “[…] my favourite one would be the elephants and orangutans. I loved it so much and that elephant, when it started walking towards you…and it was so beautifully done and it was like he was going to step right on your head!” (female resident, 71 years old). Others specified that they enjoyed seeing people engaging in culturally relevant activities, “real people doing real things” (male resident, 86 years old), so that they could get a sense of different ways of life. Another participant noted that having a narrator was essential. Specially, they shared “I think Paris was good because they actually had an interviewer who was giving you background” (female resident, 80 years old). Finally, some participants shared that having good quality music that complimented the destination helped to bring the VR experience alive; one participant shared “I found the music would lift it up so much, that it would be fun to watch” (female resident, 71 years old).

Areas for improvement. Suggestions for improvement revolved around the need to increase contextual cues and information in the videos, the importance of culturally appropriate music, quality of the images and length of videos to capture the scope of each destination.

Participants reported that having informative labels, descriptions or auditory commentators is necessary to promote learning, enjoyment and immersion. One participant shared “I needed to know exactly what I was looking at, for instance, in many of the places, they did not identify what it was we were looking at… some of the buildings that we saw, there were a lot of buildings that were not identified” (female resident, 88 years old).

As much as music could enhance the virtual experience, it could also compromise the experience for some participants. Participants expressed that the music was very important to their overall experience; however, in several videos, the music was not relevant to the virtual destination (e.g., Johnny Cash in Hong Kong). Some participants reported that music is very specific to each culture and having culturally appropriate music playing during each destination is important to the experience. In fact, participants voiced that incongruent music brought them out of the experience, and when the music was congruent, the quality of the content was less vital. In sharing their experience of the Hong Kong video, one participant expressed “I thought I would know almost right away by listening to the music whether I was going to enjoy it or not… the first one for example was Hong Kong […] the film disappointed me because all you could see in my mind was the tops of buildings and for me […] I thought the music was inappropriate… I said “my God, this is rock and roll.” And it just didn’t suit the film at all … it should be very beautiful Chinese music” (female resident, 71 years old).

A final area of improvement was the scope of content within each video. Especially for shorter videos, participants reported that they did not feel that they were able to experience much of the destination. Participants wanted a more wholistic perspective of each location. One participant noted “I think the length of the video was not long enough. Yeah, so it should have been much longer because, Australia being so big, there are more things to look at than the opera house” (male resident, 75 years old). Another participant noted “They were all interesting. I just find that […] lots of times it didn’t show what I was expecting of a place” (female resident, 86 years old). Overall, participants reported that they would appreciate longer videos as some were less than ten minutes, and that the VR quality could be improved with respect to clarity of the images.

Hopes for virtual reality in residential care. Participants understood the preliminary nature of VR tourism in residential care settings. They were provided the opportunity to share hopes for virtual tourism in the future. Participants also suggested the possibly of recording live events in VR so that they can be appreciated by those who cannot attend these events in “real time”. In discussing the ability to see a local opera, one participant noted “I wouldn’t mind seeing a metro opera live in New York that I could see here, or something like that” (male resident, 83 years old). One participant also expressed an interest in more active VR experiences, much like scuba diving, suggesting “I wanna be in a fighter jet, I wanna fly, I wanna skydive, like you know, hopefully that will be possible in the future” (female resident, 80 years old). Finally, one participant stated “Well I’ll tell you what I’d like to say, and I think [naming of two other participants] both agree to this, that when this becomes more perfected […] Because I know you’re gonna use this to get the apps going much better […] so when all that is perfected, I would love to come back and do that again (female resident, 86 years old).