Immersive Nature-Based Wellbeing Program in Older Adults With Cognitive Impairment

This study evaluates the effectiveness of an immersive virtual reality program based on nature environments to improve cognitive function, emotional well-being, functional ability, and quality of life in older adults with mild to moderate cognitive impairment.

Cognitive impairment is common in older adults and can negatively affect independence, emotional well-being, and quality of life. Non-pharmacological interventions using emerging technologies, such as immersive virtual reality, offer new opportunities to support cognitive and emotional health. Nature-based virtual environments may help reduce stress, improve mood, and increase engagement, even in individuals with limited mobility or access to natural settings.

The study takes place across services affiliated with Suara Cooperativa. In Phase 1, researchers test and validate immersive virtual environments in healthy participants. Participants attend individual sessions where they view nature-based virtual scenarios. Researchers collect behavioral, subjective, and physiological data, including electroencephalography, heart rate, electrodermal activity, and respiration, to assess safety, usability, and emotional responses to the virtual environments.

In Phase 2, researchers conduct a quasi-experimental pre-post study without a control group. The study includes 200 participants (100 with mild cognitive impairment and 100 with moderate cognitive impairment) recruited from day care centers and residential facilities managed by Suara Cooperativa.

Participants take part in a structured group-based intervention consisting of 10 immersive virtual reality sessions. The program combines exposure to nature-based virtual environments with mindfulness practices, cognitive stimulation activities, and breathing techniques to promote emotional regulation and cognitive engagement. The intervention is accessible, engaging, and adapted to the needs of older adults with cognitive impairment.

Primary outcome measures include cognitive function, emotional well-being, functional capacity in activities of daily living, and quality of life. Researchers also assess participant engagement and acceptability of the intervention as secondary measures.

Researchers analyze data using descriptive and inferential statistical methods to assess changes between pre- and post-intervention measures. They also evaluate adherence to the intervention and participant satisfaction.

This study aims to generate evidence on the potential of immersive virtual reality as an innovative, safe, and accessible non-pharmacological intervention to support cognitive health, emotional well-being, and autonomy in older adults, contributing to active and healthy aging.

Inclusion criteria

• Age ≥ 65 years
• Diagnosis of mild or moderate cognitive impairment
• Ability to understand study procedures and follow instructions
• Ability to provide informed consent (or consent provided by a legal representative)
• Attendance at participating day care centers or residential facilities (Phase 2)
• For Phase 1: healthy adults without cognitive impairment

Exclusion criteria

• Severe cognitive impairment or diagnosis of advanced dementia
• Severe visual, auditory, or motor impairments that prevent use of virtual reality
• Neurological or psychiatric conditions that may interfere with participation
• History of epilepsy or conditions contraindicating virtual reality exposure
• Severe behavioral disturbances or agitation
• Participation in other clinical studies that may interfere with results