Population ageing raises crucial issues about the greater risks to develop age-related diseases (i.e. dementia). The most common form of dementia is Alzheimer's Disease (AD). During the last decades, many studies focused the attention on AD caregivers' (CGs) population, which is considered at higher risk of developing age-related diseases and social isolation due to daily living stress levels. In order to promote CGs psychological adjustment and their possibility to cope with this situation, according to Bandura's Social Cognitive Theory (SCT), self-regulative abilities, namely perceived self-efficacy, should be promoted. Our research proposal wants to exploit the advancement of new technologies to create a high immersion Social Cognitive theory driven virtual reality (VR) intervention addressed to caregivers population and to identify new algorithms returning feedback to users and operators, emerging data from different devices and tools. We aim to increase coping strategies and self-efficacy of CGs; to improve healthy lifestyles; and reduce risk of developing cognitive deficits improving indirectly AD patients quality of life.
AD caregivers (N=90) will be recruited and randomized in three groups to participate to three different kind of interventions: the first group will receive VR intervention, smartphone app services and the access on website. (VR+APP+INTERNET, N=30); the second group will be able to take advantage of smartphone app services and the access on website. (APP+INTERNET, N=30); the control group will not receive any intervention. (CONTROL GROUP, N=30). Furthermore, the relative AD patients will be evaluated (clinical, global cognitive status questionnaires).
We expected that the intervention will improve positive outcomes (coping strategies, self-efficacy) and reduce negative ones (stress level, unhealthy lifestyles, cognitive impairment) on CG participants and will improve the well-being of AD patients with CG involved in VR intervention.
From a scientific point of view, this project proposal represents an innovative experience in the field of medicine prevention. The use of modern technologies and the focus on the concepts of well-being self-efficacy and "lifestyles" are in line with the current scientific literature, that underline the importance to safeguard the adult "at risk" populations. In particular, the needs of AD caregivers are often neglected and they are more likely to suffer psychological problems and become "invisible patients" (Xia et al., 2014). The choice of this population derived from an analysis of literature data: AD caregivers complain prolonged stress and frustration conditions (Butcher, Holkup, & Buckwalter, 2001) that are associated to depression, poor quality of life and risk of cognitive decline (Schulz et al.,2006).
A significant impact of the project for AD caregivers will be also the capacity to timely gather and transmit relevant information about ongoing CGs performance data and also of pertinent psycho-physiological data and any other multimodal information useful for emotional state recognition and cognitive stress detection. Collected data would provide valuable, up-to-date information about the subject's performance evolution, adherence to training and rehabilitation routines, as well as about synchronous physiological reactions of the subjects. Moreover, to this should also be added the possibility to immediately obtain accessible real-time feedback, to enable specialist controlled intervention during the course of the sessions.
The confirmation of the hypothesis of this research could easily lead to many potential applications: the VR intervention could be spread in different clinical and research environments. It could be reproduced in hospitals, nursing home, schools and research laboratories and it could be applied to many groups of healthy and pathological populations. In addition to the intervention, this kind of VE could also represent a scenarios for the phase of assessment: it could be possible to reproduce in VR the validated traditional assessment methods, overcoming their limits in terms of reliability and validity.
The intervention enhances the contribution that caregivers offer to society facilitating the adoption of specific active lifestyles and health behaviours, preventing stress and social isolation. We are confident that our project will impact on the quality of life of AD caregivers. Moreover, the project could cause a social impact through the realization of remote support groups that in other studies proved to lead to important benefits, including reduced anxiety increased overall psychosocial well-being (Brodaty et al 2003). The direct improvement in CGs' cognitive functions could allow to an indirect positive impact on AD patients and the whole family quality of life. The project promotes a culture of active ageing able to exploit the useful contribution of elderly people to society and economy through the use of concrete job opportunities and support to familiar life.
Furthermore, it is well known the negative impact of AD pathology on the socio-economic state: it costs over $815 billion per year and, with the longer life expectations, the costs are intended to increase along time. This costs are all related to the assistance and health care that following this trend will fall without any chance. On the basis of all these data, the psycho-education, counselling and support paths addressed to AD caregivers could have a great utility: ensuring the ability of AD caregivers' to take care of their parents could reduce a great part of socio-economic costs of this pathology. In particular, thanks to the availability on the market of low-cost VR devices, the proposed system should be deployed and evoluted like a home application boosting the benefits of the performed training for the CGs.
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