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2nd June, 2020

Wonder VR: creating meaningful experiences for patients in the midst of uncertainty



Dr Nicola Abraham, Royal Central School of Speech and Drama

On Saturday 23rd May 2020, I virtually attended a webinar led by the International Psychogeriatric Association, who detailed the impact of the pandemic focussing on the risks to the wellbeing and mental health of older adults, particularly those living with dementia, who are socially isolating.

This was a conference for mental health professional, I am not a mental health professional. I have been working with Imperial College Healthcare NHS Trust in collaboration with the Dementia Care Team led by Nurse Consultant Jo James for over five years now offering a range of applied theatre and media based projects for patients living with dementia. I was expecting a list of scientific studies from the conference using medical terms I wouldn’t understand, and referring to a knowledge base I am learning. Instead, the conference read as a plea for action and more significant thought to be given to the welfare of our global elderly population who are likely to deteriorate with little cognitive stimulation as a result of fewer social interactions due to social distancing.

The conference gave a strong call to advocate for the human rights of our older population referring to the United Nations Convention on the Rights of Persons with Disabilities (CRPD) which articulates the importance of agency and autonomy in care and support. Professor Carmelle Pesiah (2020) outlined the importance of fighting ageism that has increased in the wake of COVID-19. Professor Myrra Vernooij-Dassen (2020) advised on the importance of continuing to find ways to support cognitive and mental health with people feeling the impact of loneliness from the rules in care homes that prevent visits from relatives. She additionally noted the need for political decision-making in COVID-19 not to just focus on the knowledge of the virus and the economy, but also on the social, cognitive and mental health risks to social distancing. There is a clear advocation of finding new ways to engage, to empathise, to care and support leisure activities that involve social interaction through other means, for example through engagement with virtual technologies.

In 2019, I worked with a Clinical Nurse and Nurse Consultant from the Dementia Care Team to devise and deliver a project using Virtual Reality 360 Video (VR 360) for patients living with dementia. The project is a person-centred approach working on the creation of bespoke VR 360 videos for patients to develop our understanding of places that patients miss, aspire to visit or feel connected too. An applied theatre practitioner (an MA Applied Theatre student or I) work directly with patients alongside Clinical Nurse, Natascha Teszner, to develop basic narratives around the places patients wish to see. We then translate this into a VR 360 video by finding equivalent locations or where possible the exact location the patient would like to see and create a short film bringing to life the narrative of the story developed by the patient. 

The films are created have enabled patients who are distressed, agitated or lonely, to feel a sense of wonder, which often equates to joy – an important aspect of improved wellbeing. Phillip Fisher (1998) discusses the aesthetics of rare experiences creating a sense of wonder, for example the first time we encounter a rainbow. With VR 360 video, the newness of an experience of a familiar place is apparent through the use of the technology to create an immersive environment for patients. Enabling feelings of wonder that may improve subjective wellbeing for patients is at the centre of this project. It also acts to address the issues outlined by Vernooij-Dassen (2020), by creating a way for patients who may have limited mobility to experience a place that would otherwise be very challenging to access i.e. a zoo, or a beach, or a park the other side of London. It also importantly challenges expectations about older people and their relationship with technology providing a counter point for ageism that suggests people don’t want to engage with cutting edge technology. We have found that in fact patients who choose to take part in the project are very responsive, and enjoy engaging with VR headsets, and express delight when explaining what they can see and how they feel in this experience. 

Another challenge discussed in the IPA (2020) conference outlined the importance of listening to older adults living with dementia. This project puts the agency of patients engaging with the project at the heart of the practice. In hospitals, patients may often feel that other people are making decisions on their behalf about their care, their treatment, and their bodies. We hope that Wonder VR, can provide agency for patients to express their ideas, and to feel heard in the VR 360 videos that are not mass produced, but are instead bespoke and tailored for the access needs and ideas of each individual. Nurse Consultant, Jo James discussing the project noted the following:

What has been powerful about this programme is the person centred approach to it. The patients are co-designing the experience that they want and so it is born from a combination of the patient’s wishes and imagination and the practitioner’s skill both in listening and interpreting what has been expressed. It gives a chance for people without a voice to feel heard and to be creative in ways that have not been available before (Nurse Consultant, 2019).

With the continuation of lockdown and social distancing, we aim to continue to offer our project virtually to support not only patients in hospitals, but people at home who are not experiencing the same level of social interaction or exposure to locations they miss. We have also created interactive elements in VR 360 video to provide a further level of discovery and joy for patients wishing to have a multi-sensory experience of their film (see supporting resources for examples).

The consequences of the pandemic are already being felt, which Professor Diego De Leo (2020) explained with the devastating tragedy of older adults taking their lives as a result of the fear that has accumulated from the pandemic, and the resulting anxiety and concerns about low survival rates for older adults, particularly those over 70+yrs, with stats suggesting over 70s form 84% of all individuals who had died from the virus. The suspected suicides that have happened in this population have been linked to increasing depression resulting from loneliness in older adults socially distancing. William E. Reichman offered us an important reminder in his closing comments noting that the pandemic has revealed pre-existing problems for older adults in relation to connections, accessing transportation to travel to seek medical support, and to interact with other older adults. These problems existed before the pandemic, they are now more pronounced and warrant action. Wonder VR can offer at least one step towards addressing the issues outlined in this conference, it can offer hope, it can offer a creatively listening ear, connection and support for older adults living with dementia, though clearly there is much more that needs to be done.

Bibliography:

De Leo, D. (2020) Mental health, Depression, Loneliness, and Suicide from COVID-19, IPA, Online Webinar, 23rd May 2020.

Fisher, P. (1998) Wonder, the Rainbow, and the Aesthetics of Rare Experiences, Harvard University Press: Cambridge, Massachusetts.

Pesisah, C. (2020) Older persons’ human rights and the COVID pandemic: are they compatible?, IPA, Online Webinar, 23rd May 2020.

United Nations Department of Economic and Social Affairs Disability (2020) Article 30 – Participation in cultural life, recreation, leisure and sport, Available at:https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/article-30-participation-in-cultural-life-recreation-leisure-and-sport.html, Accessed [26/05/20]

Vernooij-Dassen, M. (2020) The risks of social distancing for older persons, IPA, Online Webinar, 23rd May 2020.

 

Further Resources:

IPA (2020) COVID-19, social distancing and its impact on social and mental health of the elderly population, Online Webinar, 23rd May 2020.

IPA (2020) COVID-19 Webinar, Available at: https://www.ipa-online.org/events/online-education/covid19-webinar#vlog, [Accessed 25/05/20].

IPA Office (2020) COVID 19 Webinar 5.23.20 – Final, available at: https://vimeo.com/421959533/d91976b950[Accessed 25/05/20].

The Beach & Reggae VR 360 Video Demo https://www.youtube.com/watch?v=l5sWRQulDc8&t=84s

Instructional Interactive VR 360 Training Video Demo https://youtu.be/0rzgJ43Ikp8

Instructional Video with Facilitator VR 360 Demo https://youtu.be/eViKSuZt8nQ


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Nicola Abraham

@EWTCCE @InfoTCCE @CSSDLondon @CHWAlliance Really excited to share insights into our digital applied theatre practice in acute hospital contexts for patients living with dementia.

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