Reducing Loneliness of Older Adults in Long Term Care Facilities through Collaborative Augmented Reality

社会联系是预防孤独（感到孤独或孤立）的关键健康决定因素。孤独症在老年人中很常见，并伴有不良后果：心血管疾病、抑郁症、自杀、认知和身体衰退、医疗保健利用和死亡率的风险增加。与社区中的老年人相比，长期护理（LTC）居民特别容易感到孤独（75%对43%）：（1）>50%的LTC居民有认知障碍或痴呆症的诊断，其中阿尔茨海默病（AD）是最常见的诊断（60-80%），（2）孤独感与AD的关系密切，冷漠（72%）和抑郁（40%）的患病率较高。维持社交网络对于延缓AD的进一步痴呆进展和不良事件至关重要。互动通信技术（ICT）的干预措施，如社交媒体和视频介导的访问，最近已经检查了它们对老年人孤独感的影响，结果喜忧参半。一个可能的解释是，在各种信通技术中缺乏对社会存在的关注。社会存在是信息和通信技术的质量以及参与者对其他人在介导的互动中实际存在的感知。信息和通信技术的满意度主要取决于所提供的社会存在的质量。我们的长期目标是通过使用头戴式显示器增强现实（HMD-AR）来最大限度地提高社交联系和参与度，从而减少LTC中老年人的孤独感，特别是那些患有AD的人。第一阶段试点研究的目的是与老年人及其家人共同创建HMD-AR活动，确定可行性，可接受性和满意度，并探索影响接受度和可用性的因素。具体目标是：（1）在患有和不患有AD的老年人及其家人和LTC工作人员中，检查共同创建的协作HMD-AR活动与2D视听ICT的可行性，可接受性和满意度;（2）探索HMD-AR实施的促进因素和障碍。我们将招募8名老年LTC居民和8名家庭成员参加5个参与式研究会议，为期6个月，以创建一个合作HMD-AR活动菜单。我们将招募24名老年LTC居民（8名认知正常，8名轻度认知障碍，8名轻度AD）和一名指定的家庭成员。每对老年人-家庭将使用2组RCT设计参加为期4周的8次会议。参与者将被随机分配到2D视听ICT或HMD-AR。我们的核心假设是，具有高社交存在的HMD-AR技术将比具有较低社交存在的2D技术产生更好的结果。主要结果包括通过定性和定量测量收集的可行性、可接受性和满意度。次要结果是孤独感，在基线、每次治疗后、第4周和第6周测量。最后，将与老年人，家庭成员和LTC工作人员进行一对一的访谈，以确定HMD-AR使用的障碍和促进因素。研究结果将为使用HMD-AR的第二阶段研究的设计和实施提供信息，以解决LTC AD成年人的孤独问题。

Social connection is a critical health determinant essential in preventing loneliness (feeling of being alone or isolated). Loneliness is common among older adults with adverse consequences: increased risk of cardiovascular disease, depression, suicide, cognitive and physical decline, healthcare utilization and mortality. Long term care (LTC) residents are particularly prone to loneliness compared to older adults in the community (75% versus 43%): (1) >50% LTC residents have cognitive impairment or diagnosis of dementia, of which Alzheimer’s disease (AD) is the most common diagnosis (60-80%), and (2) loneliness is highly correlated with AD given its high prevalence of apathy (72%) and depression (40%). Maintaining social networks is critical in delaying further dementia progression and adverse events in AD. Interactive communication technology (ICT) interventions, such as social media and video-mediated visits, have recently been examined for their effects on loneliness among older adults with mixed results. One potential explanation is the lack of attention to social presence within the various ICTs. Social presence is the quality of the ICT as well as the participant’s perceptions that others are physically present in the mediated interaction. ICT satisfaction is based largely on the quality of the social presence afforded. Our long term goal is to maximize social connection and engagement through the use of head mounted display augmented reality (HMD-AR), thereby reducing loneliness among older adults in LTC, especially for those with AD. The purpose of this Stage 1 pilot study is to co-create HMD-AR activities with older adults and their families, determine feasibility, acceptability and satisfaction, and explore factors that influence acceptance and usability. The specific aims are (1) to examine the feasibility, acceptability, and satisfaction of co-created collaborative HMD-AR activities versus 2D audio-visual ICT among older adults with and without AD, their family member and LTC staff; and (2) to explore facilitators and barriers of HMD-AR implementation. We will recruit 8 older adult LTC residents and 8 family members to participate in 5 participatory-research sessions over 6 months to create a menu of collaborative HMD-AR activities. We will enroll 24 older adult LTC residents (8 with normal cognition, 8 with mild cognitive impairment, and 8 with mild stage AD) and a designated family member. Each older adult-family pair will participate in 8 sessions over 4 weeks using a 2-arm RCT design. Participants will be randomized to either 2D audio-visual ICT or HMD-AR. Our central hypothesis is that HMD-AR technology with a high social presence will result in better outcomes than 2D technology with lower social presence. Primary outcomes include feasibility, acceptability and satisfaction collected via qualitative and quantitative measures. The secondary outcome is loneliness, measured at baseline, after each session, at Week 4 and at Week 6. Last, one-on-one interviews will be conducted with older adults, family members and LTC staff to determine barriers and facilitators to HMD-AR use. Findings will inform the design and implementation of a Stage II study using HMD-AR to address loneliness among LTC AD adults.