Can virtual reality travel help nursing home patients fulfill their bucket list?

Nursing home residents often reflect on their life experiences,1 and may have goals to travel to places that have meaning and value to them based on their past. Engaging in these pursuits alleviates loneliness and augments quality of life,2 but their physical condition may prevent them from traveling. Virtual reality (VR) technology may provide a solution by transporting patients to their desired travel destination(s) through computer-generated simulations.3 This study examines the feasibility of utilizing VR to help nursing home patients fulfill their bucket list desires, and their perception of this technology and its utility (if any). Stanford University's Institutional Review Board approved a qualitative study of 25 older adults (aged 65+, all women) with no prior VR experience in a San Francisco nursing home (see Table 1). Each participant had a private VR session with the investigators. Using Meta Quest 24 and the Wander App,5 participants chose one 360-degree still image of four locations (Basilica in Spain; Cathedral in France; Machu Pichu in Peru; and Coral Reef in Indonesia) for a 3-min session while being seated to avoid side effects (dizziness, falls). The session ended if any discomfort occurred. Post-intervention semi-structured interviews were used to elicit participants' immediate feedback after the VR intervention (Supplementary Material S1) and a 2-month follow-up interviews were used to assess for any delayed side effects (Supplementary Material S1). All interviews were tape-recorded, transcribed verbatim, and analyzed using Grounded Theory.6 Three themes emerged through analysis: Participants' exemplars can be found in Table 2. The most popular virtual travel destination (44%) was the Basilica in Spain. For all participants, wearing the VR headset was easy. For two participants, the headset felt a bit heavy, and for seven participants, it felt a bit loose. Some mentioned how they perceived their body in the virtual environment; others said their fears of heights/claustrophobia were not present in VR. All participants completed the VR intervention successfully. All participants enjoyed “visiting” otherwise inaccessible places. Twenty-two participants felt “present” in the virtual location. Few participants inquired about the option to use virtual videos, as opposed to still images. All participants reported liking the VR travel experiences (Quote 10) and would recommend it to others. Participants said that their virtual travel brought back memories, especially as they were incapable of actual travel to fulfill these bucket list desires. Neither the participants nor the facility nurses reported session-related adverse effects during the session, immediately afterwards or 4 weeks after the VR intervention. During the 2-month follow-up, one participant with a past medical history of seizures reported having an “uneasy feeling” after the VR experience but no other symptoms. Most participants had not documented a formal bucket list, as they felt that their age, health condition, and physical challenges prevented them from fulfilling their wishes. Twenty-two participants (88%) endorsed that VR would be a desirable way for them to fulfill their bucket list. Some participants were interested in a virtual encounter/activity with loved ones who lived in another country (Quote 16) or just to have a new experience. Three participants were not willing to try VR as a bucket list activity. VR technology is a feasible tool to help seriously ill nursing home patients fulfill their bucket lists. VR paired with the Bucket List framework1 could fulfill the travel goals of nursing home patients. Data shows VR allowed participants to “visit” places, bringing memories from the past. The realistic sensory interaction made patients feel that the virtual world was real.3 When VR is used with the Bucket List framework, the reflective process does not rely on imagination but rather on patients' perceptions of the places they visit, bringing a richer and more stable reflective process.7 Spiritual needs are common in seriously ill patients, and unmet needs can lead to poorer psychological outcomes.8 Our study found that virtual visits to a basilica could fulfill spiritual bucket list items and may be a viable option for spiritual fulfillment for patients who are unable to travel due to debility. Headset challenges can be mitigated as VR technology improves.9 Consistent with prior studies,9 participants felt satisfied with no adverse effects. Future research should explore VR's impact on older adults with epilepsy, despite VR being found benign.10 This is a single-site study in a nursing home for women and this limits its generalizability. It is also important to note that all our patients needed assistance using the VR equipment. Our findings show that VR travel is a feasible option for bucket list fulfillment for seriously ill nursing home patients. Future research should explore the utility of virtual bucket list travel experiences in seriously ill patients and the impact on thier wellbeing and ability to complete a life review process1 commonly seen in patients in late life. Conception and idea: Dulce K. Rodriguez and Vyjeyanthi S. Periyakoil; data extraction, data analysis: Dulce K. Rodriguez; data interpretation: DR and Vyjeyanthi S. Periyakoil; first draft of the manuscript and critical revision: Dulce K. Rodriguez and Vyjeyanthi S. Periyakoil; approval of the submitted manuscript: All authors. The authors have declared no conflicts of interest for this article. This work was supported by the National Institute on Aging (NIA) of the National Institutes of Health (NIH) (P30 AG059307 and RO1 AG062239) and by the Stanford University School of Medicine. Dr. Periyakoil's work is also supported by the VA Palo Alto Health Care System. The sponsors did not contribute to the design, methods, analysis, or preparation of this manuscript. None. None. Supplementary Material S1. Post Virtual Reality (VR) semi-structured interview. Supplementary Material S2. Bucket List semi-structured interview. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.