Can a Virtual Nature Environment Reduce Anxiety and Agitation in People With Dementia?

PURPOSE AND BACKGROUND: The purpose of this pilot study was to test whether a simulated virtual nature environment could reduce stressful emotions of agitation and anxiety in people with dementia. Over 90% of people with dementia experience agitation or anxiety accompanied by associated behaviors that may be difficult for caregivers to manage, creating high levels of stress and high turnover rates for dementia care staff. Although use of psychotropic medications to manage negative emotions and associated behaviors is prevalent, their use should be minimized because of the associated health risks. A variety of care management strategies have been proposed, but limited evidence is available to support them.

Several studies have indicated that direct contact with nature has many health benefits for people with dementia, including reduction in stress, agitation, negative emotions, and need for psychotropic medications. Among the general population, abundant research supports the benefits of simply viewing nature, including improvement in mood and reduction in stress and negative emotions. The extensive body of research supporting the benefits of viewing nature scenes and of direct contact with nature by people with dementia gives support for this study.

METHOD: A counterbalanced crossover design was used to efficiently compare treatments. The sample was small because the memory care unit used for this study had a maximum capacity of 17 residents with moderate to severe dementia; all residents of this unit were recruited to participate in the study if they had a history of the study’s identified emotions and associated behaviors.

All recruited participants were exposed to a virtual nature environment and a generational movie. The treatment intervention was exposure to a virtual nature environment that included a 1-hr fixed-angle nature video with natural sound, and the control intervention consisted of viewing a generational movie. Participants were exposed three times to both the treatment and control interventions in a counterbalanced fashion of alternating exposure days. Before and after each exposure to the interventions, heart rate was measured and emotions were assessed with the Observed Emotion Rating Scale and the Agitated Behavior Scale. Results were analyzed using repeated measures analysis of variance.

RESULTS: Participants displayed significantly lower heart rates after the nature intervention (69.8 ± 11.2) than before the intervention (78.3 ± 10.8; p = .03). Pleasure decreased significantly in the movie intervention (p = .04) and increased in the nature intervention, although the latter finding was not significant. Anxiety also decreased to a greater extent in the nature intervention than in the movie intervention, but the difference was not significant.

CONCLUSION: This study indicates that a simulated virtual nature environment used as an adjunctive strategy in care management can reduce stress and negative emotions and increase pleasure while requiring minimal staff involvement. The findings of this study are promising for use of a virtual nature environment that is integrated into a comprehensive care management program. The study results indicate great potential for virtual nature environments to improve quality of life of people with dementia, reduce caregiver burden, and decrease reliance on pharmacological agents in dementia care. Treatments that elicit these positive effects for both residents and caregivers may facilitate more effective overall treatment as patients experience and demonstrate fewer negative emotions and associated behaviors.

References

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