Embodying the Aging Experience: How Virtual Reality Is Transforming Medical and Nursing Education

Abstract Virtual reality (VR) has long been standard in healthcare education. Recent advances in VR hardware and software applications have coalesced to allow for higher fidelity, more highly realistic simulations that are also deployable at scale -- not just in highly specialized, single location simulation labs. In tandem, there has been an examination in both the corporate and academic sectors around the efficacy of VR training and learning. While VR has been long proven to be effective in training students and workers in hard skills, its lack of realism has been a barrier to explore efficacy in simulations related to soft skills and emotional intelligence. This symposium will discuss the implementation of virtual reality “labs”, where learners embody in a live 360 film environment the first-person point of view of an older adult -- interacting with gaze, voice, and natural hand motions – into four university’s medical and nursing curriculum. Lab outcomes include decreased ageism and stereotyping, and increased empathy, sensitivity, cultural competency, and disease knowledge. The first paper reports outcomes of increased understanding, comfort, compassion and empathy of students and informal caregivers after experiencing various labs. The second discusses comparative data on knowledge and attitudes of medical students experiencing the virtual labs individually vs. the group distance mode. The third reports the results of an initial study on how embodying an older adult with sensory impairment affects participant empathy using a standardized scale. The fourth discusses how one university transitioned to delivering immersive labs to nursing students remotely during COVID19.

inform who is at greatest risk of developing this disease. We analyzed electronic medical records of 394892 patients from the two largest health systems in Northeast Ohio to evaluate the relationship between Ohio Area Deprivation Index quintiles (defined at the census tract level) and hazard for a composite outcome of AD diagnosis or primary AD death. We included residents of Cuyahoga and neighboring counties, and used the first outpatient visit beyond age 60 occurring between 2005 and 2015 as study baseline. Outcome data were censored at the earlier of a) the beginning of any 3-year time period without visits or b) non-AD death. We estimated a Cox proportional hazards regression model, adjusting ADI quintile effects for the interaction between age at baseline, sex and race as well as birth year. We used quadratic terms for continuous predictors. After adjusting for these factors, ADI quintile was significantly related (χ2 = 83.0 on 4 d.f.; p < 0.0001) to the composite time-to-event outcome. Compared to the lowestdeprivation quintile, ADI quintiles 4 (adjusted hazard ratio [95% confidence interval]: 1.18 [1.10, 1.26]) and 5 (1.37 [1.28, 1.47]) had significantly higher hazard for the composite outcome. In conclusion, neighborhood deprivation may be a risk factor for AD independent of demographic factors. Preventive efforts should target individuals living in neighborhoods with high levels of deprivation.

RACIAL DIFFERENCES IN THE EFFECT OF ALZHEIMER'S DISEASE ON ADHERENCE TO MEDICATION THERAPY FOR CHRONIC DISEASES
Arseniy Yashkin, 1 Anatoliy Yashin, 2 Galina Gorbunova, 2 and Igor Akushevich, 2 1. Duke University, Morrisville,North Carolina,United States,2. Duke University,Durham,North Carolina,United States Multiple dementia (the presence of one or more types of dementia in a single individual) and multi-morbidity (the presence of multiple chronic diseases in an individual) present a major challenge to the U.S. healthcare system. The reduction in cognitive function associated with neurocognitive disorders such as Alzheimer's Disease (AD) and Related Dementias (ADRD) reduce the ability of the affected individual to take care of him/herself. This can manifest as reduced adherence to medication regimens designed to manage other chronic conditions, in reduced ability to engage in healthy behavior such as exercise, or in other ways. The result is an increase in the probability of otherwise avoidable adverse health outcomes and related healthcare costs. In this study, we showcase two high impact chronic conditions common in the elderly: hypertension and type 2 diabetes mellitus (T2D). Using a 5% sample of the total Medicare population we identify groups of individuals with AD/ADRD and i) hypertension, ii) T2D or iii) both. Each group is then propensity-score-matched to similar individuals with hypertension, T2D or both but without a diagnosis of AD/ADRD. The primary explanatory variable of interest is the medication possession ratio (MPR) calculated at 1-year intervals for prescribed diabetes and/or hypertension medications. MPRs were compared between the two groups using t-tests and standardized differences each year after baseline and until death/censoring. A Cox proportional hazard model was then used to estimate differences in survival between these two groups and across race/ethnicity-related strata. Reduced adherence with time and notable race/ethnicity-related differences were identified.

EMBODYING THE AGING EXPERIENCE: HOW VIRTUAL REALITY IS TRANSFORMING MEDICAL AND NURSING EDUCATION
Chair: Marilyn Gugliucci Co-Chair: Pamela Saunders Discussant: Erin Washington Virtual reality (VR) has long been standard in healthcare education. Recent advances in VR hardware and software applications have coalesced to allow for higher fidelity, more highly realistic simulations that are also deployable at scale --not just in highly specialized, single location simulation labs. In tandem, there has been an examination in both the corporate and academic sectors around the efficacy of VR training and learning. While VR has been long proven to be effective in training students and workers in hard skills, its lack of realism has been a barrier to explore efficacy in simulations related to soft skills and emotional intelligence. This symposium will discuss the implementation of virtual reality "labs", where learners embody in a live 360 film environment the first-person point of view of an older adult --interacting with gaze, voice, and natural hand motionsinto four university's medical and nursing curriculum. Lab outcomes include decreased ageism and stereotyping, and increased empathy, sensitivity, cultural competency, and disease knowledge. The first paper reports outcomes of increased understanding, comfort, compassion and empathy of students and informal caregivers after experiencing various labs. The second discusses comparative data on knowledge and attitudes of medical students experiencing the virtual labs individually vs. the group distance mode. The third reports the results of an initial study on how embodying an older adult with sensory impairment affects participant empathy using a standardized scale. The fourth discusses how one university transitioned to delivering immersive labs to nursing students remotely during COVID19.

THE EFFECTS OF A VR TEACHING TOOL ON UNDERSTANDING, COMFORTABILITY, COMPASSION, AND EMPATHY OF STUDENTS AND CAREGIVERS Carrie Elzie, Eastern Virginia Medical School, Norfolk, Virginia, United States
Empathetic care giving is associated with improved patient satisfaction, compliance and outcomes; clinical competence, career satisfaction, and burnout reduction; as well as diminished medical errors and litigation claims. Unfortunately, recent studies have shown erosion in empathy and compassion across the health professions. Virtual reality shows promise as a teaching tool to combat this decline as it has been dubbed the ultimate empathy machine, allowing users to vividly and viscerally experience any situation from any perspective. Embodied Labs allows users to virtually walk in the shoes of different patients, experiencing symptoms, family dynamics, support networks and various components of the health care systems. We have demonstrated that the high level of immersion and presence afforded by these virtual labs are effective pedagogical tools to increase understanding, comfortability, compassion and empathy within various populations including informal caregivers, high school students, health professional students and medical students.

VIRTUALLY TRANSFORMATIVE EXPERIENCES IN GERIATRIC EDUCATION: LESSONS PRE AND POST PANDEMIC Pamela Saunders, Georgetown University, WASHINGTON, District of Columbia, United States
Georgetown University medical students have the option of selecting a two-week rotation in Geriatrics during their third-year. Since Fall 2019, the curriculum has included three immersive virtual reality (VR) labs: hearing & vision loss, Alzheimer's disease, and end-of-life conversations created by Embodied Labs. The curricular goals include increasing empathy and sensitivity of learners to the perspective of older adults, decreasing ageism & stereotyping, and increasing clinical knowledge. In each lab, students are immersed in a live film, first-person point of view of an older adult. They interact with the immersive environment via gaze, voice, and natural hand motions. Pre-pandemic, students viewed the labs in-person using a commercial VR headset. Since the pandemic, March 2020, students accessed the VR labs through the virtual modality of Zoom. This abstract summarizes data on knowledge and attitudes examining differences in knowledge and attitudes pre and post-pandemic.

IMPACT OF VIRTUAL REALITY ON HEALTHCARE PROVIDER EMPATHY FOR OLDER ADULTS WITH SENSORY IMPAIRMENT Suzanne Dutton, Sibley Memorial Hospital/Johns Hopkins, washington, District of Columbia, United States
Virtual reality (VR) is an innovative technology that can simulate dual sensory impairment so that healthcare providers and others can experience this affliction common in older adults. This study investigated whether VR simulation could increase empathy among healthcare workers. Healthcare providers experienced a 7-minute scenario from the viewpoint of "Alfred", a 74-year-old with macular degeneration and high frequency hearing loss on a commercial VR headset (Oculus Rift). Using a one-group pre/post-test study design, we measured knowledge, changes in empathy, and assessed participants' self-reported behavior change. Results showed that participants increased their knowledge and that 9 of 14 empathy items had statistically significant increases. Additionally, 97% of participants agreed or strongly agreed that they would utilize the information learned in their work with patients. In conclusion, evidence suggests VR is an effective intervention to increase empathy and positively change behavior to support persons with sensory impairment.

REMOTE DELIVERY OF VIRTUAL REALITY PATIENT SIMULATIONS FOR NURSING EDUCATION Jaime Hannans, California State University Channel Islands, Simi Valley, California, United States
In the midst of rapid transfers to online teaching for experiential learning opportunities in nursing clinical labs this past spring due to the pandemic, nursing simulations with immersive virtual reality (VR) in VR headsets were deemed impossible. In partnership with Embodied Labs, nursing faculty pivoted to facilitating VR using remote learning approaches in groups. In this new VR approach nursing students engaged in active learning, critical discourse, and reflection guided by faculty delivered VR scenarios remotely with in-session debriefing during discussion pause points. Complex scenarios focused on patient or family perspectives (e.g. during end-of-life care or navigating community and healthcare needs as a LGBTQ individual). These were valuable online learning opportunities for undergraduate nursing education. Student feedback was positive, and faculty perceptions indicated using VR remote learning offers rich, engaging discussion through complex topics important to nursing clinical practice.