Feeling Aging: How Embodied Simulation Shapes College Students’ Psychosocial Understanding of Older Adults

Study Design

This study employed a qualitative research design based on secondary analysis of written reflection data collected during the implementation of the DTISLM across five universities in Taiwan. DTISLM was originally developed and evaluated using a mixed-methods design that combined quantitative pre–post surveys with qualitative after-class reflection notes to examine changes in college students’ empathy toward older adults, age stereotypes, intergenerational relationships, well-being, and health-related behaviors (Hsiao et al., 2022). In the original DTISLM evaluation, quantitative measures assessed intervention effects at the group level, while qualitative reflections contextualized and explained observed changes.

The present study focuses exclusively on the qualitative component of the DTISLM dataset, drawing on students’ written reflection notes following participation in aging simulation activities. By isolating and reanalyzing this qualitative corpus, the study aims to provide a more in-depth examination of how students made meaning of their embodied experiences during the simulation. This approach allows for a theoretically driven analysis of learning processes that may not be fully captured through survey-based measures alone.

The qualitative analysis was guided by embodied cognition theory, which posits that cognitive, emotional, and attitudinal change emerges through physical and sensory–motor engagement with the environment. From this perspective, the aging simulation activities embedded within DTISLM were intentionally designed to immerse students in bodily experiences of aging, thereby activating perceptual, emotional, and cognitive shifts. Thematic analysis was therefore an appropriate analytic strategy for capturing how students articulated, interpreted, and reflected upon these embodied encounters.

We approached the analysis from an experiential–realist epistemological stance, which aligns closely with embodied cognition theory. This perspective assumes that students’ written reflections provide meaningful access to their lived sensory, emotional, and perceptual experiences during the simulation, rather than treating the texts as purely discursive or socially constructed artifacts. This stance guided our analytic focus on bodily sensations, affective responses, and perceptual shifts and informed our interpretation of how embodied experience shaped students’ empathy, stereotypes, and emerging professional orientations.

The DTISLM Aging Simulation

DTISLM is an 18-week course module that integrates experiential learning, sustained intergenerational contact, and collaborative problem-solving. In its early phase, students participate in an aging simulation that replicates common age-related changes in vision, hearing, mobility, and dexterity. This activity aligns with embodied cognition principles by creating a full-body experience of sensory and functional limitations, prompting learners to reflect on how the body’s constraints influence perception, emotion, and interaction.

During the simulation, students wear specialized equipment, such as vision-blurring goggles, weighted vests, joint restriction devices, earplugs, and multi-layer gloves, and attempt everyday tasks, including reading newspapers, climbing stairs, and using utensils. The simulation lasts approximately 75 minutes and is conducted in small groups, with participants rotating through roles as primary participants (wearing the equipment), assistants (helping and ensuring safety), and observers (documenting reactions and behaviors). Immediately afterward, students complete a structured written reflection to capture their sensory, emotional, and cognitive responses while the experience is still vivid.

Participant Recruitment Procedure

Participants were undergraduate students enrolled in courses or workshops implementing DTISLM in Taiwan. At the beginning of the courses, instructors or trained research assistants introduced the study purpose and procedures, and eligible students (aged 18–30) were invited to participate in DTISLM activities, including aging simulation and intergenerational service learning. Participation in the research component was voluntary, and students were informed of their right to withdraw without academic penalty. Prior to data collection, all participants provided written informed consent for the use of their survey responses and written reflections as part of the original mixed-methods DTISLM project, which included quantitative pre- and post-surveys and qualitative after-class reflections.

Between 2021 and 2022, a total of 514 students initially participated in the DTISLM program. Of these, 451 students (87.7%) submitted complete written reflections following the aging simulation activity and were included in the present qualitative analysis. Participants ranged from first- to fourth-year undergraduates (mean age = 19.7 years) and represented multiple disciplines, including social work, nursing, occupational therapy, medical technology, and foreign languages. Approximately 65.6% of the participants were female. The present study constitutes a secondary qualitative analysis of anonymized reflection data collected as part of the original DTISLM project.

Reflection Prompts

Students were guided by five open-ended prompts:

1. Which aging simulation activities did you participate in?

Because students rotated through roles as primary participants, assistants, and observers during the simulation, Question 3 was intended to capture observational insights from those who temporarily assumed assistant or observer roles. This allowed reflection on both personal experiences and observed challenges, providing an additional perspective on aging-related limitations.

These prompts were designed to elicit descriptions of bodily sensations, emotional reactions, cognitive insights, and perceived professional relevance, dimensions consistent with embodied cognition’s integration of sensory, affective, and reflective processes. Written reflections were selected as the primary data source because they effectively capture immediate embodied, sensory, and emotional reactions while students’ experiences are still vivid. Prior research in experiential and embodied learning indicates that written reflections are a valid method for accessing perception-based meaning-making following physical simulation activities.

Data Analysis

The research team, with interdisciplinary backgrounds in aging, communication, and social work, conducted a thematic analysis following the six-phase approach (Braun & Clarke, 2006). The team first familiarized themselves with the data by reading all reflections multiple times and noting recurring descriptions of physical sensations, emotional reactions, and cognitive interpretations. Second, the team generated initial codes informed by sensitizing concepts derived from embodied cognition theory (e.g., empathy, stereotypes, embodied discomfort, and professional orientation), while also incorporating inductive coding to capture unanticipated patterns within the data. Through this inductive process, additional themes, specifically fear of judgment, social withdrawal, and environmental awareness, were identified beyond the initial coding framework. Codes were iteratively refined and organized into broader themes that captured how students interpreted their embodied experiences. Third, the team organized these codes into preliminary themes that captured broader patterns in how students described the learning experience. In the fourth phase, the team reviewed and refined these themes to ensure internal coherence and clear distinctions between thematic categories. Fifth, the team defined and named the themes, focusing on interactions between bodily sensations and cognitive–affective shifts. Finally, the team produced the analytic narrative by selecting representative quotations to illustrate each theme and linking the findings to embodied cognition and aging-education literature. Three members of the research team independently coded the data, then compared and reconciled codes through discussion to enhance credibility. NVivo 12 software was used to manage the dataset and facilitate coding. Thematic saturation was achieved through iterative review of the dataset.

The researchers engaged in ongoing reflexive memoing to examine how their disciplinary perspectives shaped their interpretations of the data. For example, initial coding tended to emphasize physical and functional limitations; through team discussion, greater attention was directed toward participants’ descriptions of psychosocial vulnerability, such as fear of judgment and social withdrawal. These reflexive discussions helped ensure that the analysis captured both physical and emotional dimensions of embodied experience rather than privileging a single interpretive lens. This process strengthened the credibility of the findings by grounding interpretations in participants’ accounts while critically examining researchers’ assumptions.

Trustworthiness

To enhance trustworthiness, several strategies were employed. Credibility was supported through independent coding by three researchers, followed by iterative discussions to reach consensus. Dependability was ensured by maintaining an audit trail documenting coding decisions and theme development. Confirmability was addressed through reflexive memoing and team-based analysis, which helped minimize individual bias and ensure interpretations remained grounded in participants’ accounts. Finally, rich descriptions and illustrative quotations are provided to support transferability by allowing readers to assess the applicability of findings to other contexts.

Ethical Considerations

The original DTISLM project received approval from the Research Ethics Committee of Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan (IRB110-045-B). Participation in the study was voluntary, and all students provided written informed consent prior to data collection, including consent for their survey responses and written reflections to be used for research purposes. To protect participant confidentiality, all quotations are labeled using anonymized participant codes.

Theme 1: Embodied Sensations as a Catalyst for Empathy

Analysis of the 451 reflection texts revealed four overarching themes that align with embodied cognition’s proposition that bodily experience directly shapes perception, emotion, and judgment (Barsalou, 2008; Gallagher, 2005; Niedenthal, 2007). Students consistently described how discomfort, perceptual distortion, and motor restriction reshaped their understanding of aging, enhanced empathy, attitudes toward older adults, and led to new commitments to professional practice. These themes show how sensory–motor engagement facilitates learning beyond purely cognitive instruction (Barsalou, 2008; Gallagher, 2005; Kolb, 1984).

Experiences involving continence care were particularly salient in evoking emotional empathy. Several students described the diaper experience as physically uncomfortable and psychologically distressing, noting sensations of heat, dampness, restriction, and shame. These sensations prompted reflection on the loss of dignity and autonomy that older adults may experience when bodily control is compromised, extending empathy beyond physical limitation to encompass emotional vulnerability (Chen et al., 2015).

“I also experienced wearing an adult diaper to sleep. It was really not comfortable at all. When I added a little water, the wet and sticky feeling made it hard to fall asleep.”

Beyond discomfort, students emphasized how the simulation heightened awareness of safety, fear, and physical insecurity during movement. Restrictions in vision, balance, and joint mobility created anxiety about falling or making mistakes, fostering a visceral understanding of the constant vigilance many older adults must maintain in daily life.

“When my knees were restricted, I felt scared going down the stairs because I couldn’t see clearly. I was afraid of falling, and I finally understood the fear older adults carry when they move around.”

Together, these sensory and emotional responses illustrate how embodied experience, particularly experiences involving discomfort, shame, and fear, can evoke empathy more powerfully than passive or purely cognitive learning approaches (Daikoku et al., 2025). By situating learning within lived bodily encounters, the simulation enabled students to grasp aging not as an abstract concept but as an ongoing physical and emotional reality.

Interpretations of older adults’ behaviors shifted following the simulation. Rather than attributing actions such as slowness or disengagement to personal characteristics, participants increasingly understood these behaviors as shaped by physical limitations and environmental constraints, indicating a reframing of age-related stereotypes.

Theme 2: Reframing Age Stereotypes Through Bodily Insight

Before participating in the aging simulation, many students acknowledged holding implicit assumptions about older adults, often framing them as slow, dependent, or socially disengaged. Experiencing sensory and mobility limitations firsthand challenged these interpretations by revealing how behavior is shaped by bodily constraints rather than personal deficiency. This shift aligns with stereotype embodiment theory (Levy, 2009) and prior research indicating that immersive aging simulations can alter attribution processes and reduce deficit-based interpretations of aging (Sari et al., 2020).

Several students described a shift in how they interpreted older adults’ behavior during everyday interactions, particularly in terms of responsiveness and social engagement. Rather than attributing delayed reactions or limited participation to indifference or stubbornness, students began to recognize the role of sensory decline and physical effort.

“I used to think older people were impatient or uncooperative when they didn’t respond right away. After the simulation, I realized how much effort it takes just to hear clearly and react. It changed how I judge their behavior.”

Beyond interpersonal judgments, students also became more aware of how environmental design reinforces age-related stereotypes. Physical spaces that assume full mobility and sensory acuity were recognized as sources of exclusion, shifting blame away from individuals and toward structural conditions. This recognition echoes gerontological research on age-friendly environments and person–environment fit (Iwarsson & Ståhl, 2003; World Health Organization, 2015).

“When I had trouble climbing stairs and there was no ramp, I realized that older adults are often labeled as incapable because spaces are not designed for them.”

Through these embodied insights, students shifted from individual blaming to contextual and structural understanding. Stereotypes rooted in assumptions about motivation or personality were reframed as outcomes of physical limitation and environmental mismatch, consistent with findings from experiential gerontology education that emphasize attributional change as a key mechanism in reducing ageism (Levy, 2009; Rudolph et al., 2021).

Beyond changes in behavioral interpretation, students reported gaining insight into the psychosocial dimensions of aging. Embodied experiences of limitation prompted reflection on emotional vulnerability, leading participants to recognize how fear of judgment, embarrassment, and reduced confidence may shape older adults’ social engagement.

Theme 3: Understanding Older Adults’ Psychosocial Perspectives Through Embodied Experience

Beyond stereotype reframing, participants gained insight into older adults’ psychosocial experiences by inhabiting bodies marked by physical limitation. Experiencing sensory decline, restricted mobility, and dependence prompted students to reflect on the psychological consequences of aging, including fear of judgment, diminished confidence, and social withdrawal. Several students described heightened self-consciousness and shame during the simulation, particularly when their movements were slow, unsteady, or visibly different from others. These feelings led students to consider how older adults may internalize stigma associated with aging and bodily decline.

“After putting on the equipment, I didn’t want people to look at me. I felt embarrassed when I moved slowly, even though I knew it was part of the activity. I realized older adults may feel the same kind of shame in daily life.”

In addition to embarrassment, students described avoiding social interaction as a psychological response to physical limitations. Rather than interpreting withdrawal as disinterest or antisocial behavior, students came to view it as a protective strategy to reduce discomfort, exposure, or emotional strain.

“During the experience, I didn’t want to talk much because I was afraid of responding slowly or making mistakes. It helped me understand why older adults may avoid social activities, not because they don’t care, but because it is stressful.”

Through these embodied psychosocial insights, students developed a more nuanced understanding of older adults’ emotional worlds. Physical limitation was no longer viewed solely as a functional challenge but as a source of psychological vulnerability that shapes social behavior. This theme highlights how embodied learning can foster empathy not only by revealing physical difficulty but also by illuminating the emotional and relational dimensions of aging that are often invisible to younger adults.

Embodied insights were translated into reflections on future professional roles. These accounts suggest that experiential engagement not only reshaped understanding of aging but also influenced students’ developing commitments to age-sensitive practice and advocacy.

Theme 4: Translating Embodied Understanding Into Professional Commitment

Many students connected their embodied learning to future professional goals, describing heightened commitment to age-friendly design, patient-centered practice, and advocacy. This reflects experiential learning theory’s emphasis on transforming concrete experience into professional action (Kolb, 1984) and aligns with gerontology studies showing that simulation can increase motivation to pursue aging-related careers (Chen et al., 2015).

“After the simulation, I realized that professionals need to slow down, not rush older adults. If I move too fast or speak impatiently, it only increases their stress. This experience changed how I imagine myself working with older clients.”

Other students focused on structural and environmental responsibility, linking embodied discomfort to the need for age-friendly design and systemic change. These reflections demonstrate how embodied learning extended beyond interpersonal empathy to broader considerations of accessibility and policy.

“During the experience, I kept thinking about how many places are designed without considering older adults. In the future, I want to help improve environments so people don’t feel excluded just because their bodies change.”

Together, these themes demonstrate how embodied engagement during aging simulation shaped students’ empathy, psychosocial understanding, and professional orientation by grounding learning in lived bodily experience.

Limitations and Future Directions

Several limitations should be acknowledged. First, using written reflections as the sole data source may limit the depth and nuance of students’ meaning-making. Written narratives can compress complex emotional and cognitive reactions, and participants may underreport discomfort or socially undesirable attitudes due to self-presentation concerns (Fisher, 1993). Future studies incorporating interviews, focus groups, or observational approaches may offer richer insight into how students process embodied experiences.

Second, the sample consisted exclusively of Taiwanese university students enrolled in courses using DTISLM. Cultural norms surrounding aging, familial expectations, and intergenerational relationships in Taiwan differ from those in Western and other Asian contexts, which may limit generalizability (Triandis, 1994). Cross-cultural comparative work is needed to examine how cultural values shape interpretations of embodied simulation.

Third, reflections were collected immediately after the simulation, capturing short-term reactions but not the durability of attitudinal or behavioral change. Because empathy and stereotype reduction may fluctuate over time, it remains unclear whether embodied insights persist or translate into sustained behavioral shifts (Batson, 1991; Eisenberg & Miller, 1987). Longitudinal studies are needed to assess long-term impacts on empathy, communication, and professional aspirations.

Fourth, because the simulation was embedded within a broader intergenerational and design-thinking curriculum, the design does not isolate the simulation’s unique contribution from other course components. It is unclear whether similar outcomes would emerge from a stand-alone simulation or whether embodied experience interacts synergistically with sustained intergenerational engagement. Comparative designs that experimentally vary curricular components are needed to clarify underlying mechanisms.

Finally, the study focused on physical simulation tools and did not incorporate emerging technological modalities such as virtual or augmented reality. These technologies may reproduce sensory and functional decline differently and offer distinct advantages in accessibility, scalability, or emotional impact. Future research comparing physical, virtual, and hybrid simulation methods could clarify the relative strengths of each modality.