Enjoyment, excitement, and the novel environment.

This theme represents older adults’ reflections on the pleasure, enthusiasm, and sense of novelty derived from engaging in VR gaming. Participants in the VR gaming experience found themselves immersed in a captivating world, filled with excitement, vibrant environments, and joyous interactions. As one participant put it, "I felt so excited! It was fun! It’s really neat! It just brings happiness" (P5).

Participants found the VR gaming experience enjoyable, with the most cited features being the novel environment and fun nature of the game. Three participants specifically identified their gaming experience as fun, with one stating, "Look at the beautiful fish" (P5), another expressing, "Neat, awesome" (P14), and a third participant exclaiming, "I saw a cat! I thought it was my cat!" (P12). They continually commented on the environment and game details and laughed when surprised during gameplay. One participant expressed their overall enjoyment, stating, "It’s been a fun experience which I am thankful for" (P11).

Participants emphasized the importance of various game characteristics. Vibrant colors, immersive environments, and high-speed dynamics were key factors contributing to their enjoyment. The realistic design elements, such as Egyptian pyramids and underwater worlds, along with animated animals and fish, further enhanced the gaming experience. One participant appreciated the visually stunning environment, stating, "I liked the environment; it was very beautiful, the underwater environment" (P11). Another participant expressed fascination with dynamic elements in the background, particularly observing animals like the lion, which added to their immersion: "Something that I found interesting was in the background. The animals and the other things going on and watching the big cat, the lion…" (P6). These insights provided a deeper understanding of the specific game characteristics that captivated and brought enjoyment to the participants.

The VR game’s fast and seamless responsiveness to participants’ movements was surprising, providing an empowering and liberating experience, especially for those with physical limitations. One participant expressed their astonishment, stating, "How crazy is that in this world? You are not vulnerable even, the VR, move a piece, and it happens right away!" (P5). This quote suggests that VR allows individuals to freely engage in activities without feeling vulnerable, a possibility that may not exist in the physical world.

The game provided a unique and engaging experience, capturing participants’ attention and interest throughout gameplay. It instilled a sense of accomplishment and satisfaction as they progressed. One participant described it as follows: "It was very engaging… it built intensity… it wasn’t just one thing around every minute. It slowly introduced maneuvers, picked up the speed, and became very challenging" (P4).

Many participants appreciated the immersive nature of VR technology, which enabled them to fully engage in the virtual game world and interact with it realistically and intuitively. As one participant expressed, "I feel like I’m facing real life, but the design is not quiet. I want to be immersed more in the game" (P9).

Music played a crucial role in generating excitement during the game. Participants actively paid attention to the songs and recognized their impact on the game’s rhythm and flow. Some even sought out other songs from the game’s playlist to increase the pace and excitement. Perspectives on the role of game music varied among participants. One participant expressed deep appreciation, explaining how it enhanced their personal involvement and enjoyment: "I love music; I love dancing, so then it brought more of me with the music. The music, I would say, I’m present more. [Laugh]" (P7). In contrast, another participant viewed game music as mere auditory disturbance, describing it as "Music is a noise" (P11).

Such findings align with the framework of SOC which proposes that individuals adapt to the aging by focusing on their goals and optimize the meaningful activities while compensating for the limitations. Participants optimized the enjoyment by engaging in VR game, compensating for any physical limitations. The findings align with the SST framework. Participants in this study sought out VR gaming to maximize enjoyment and positive emotions. The SST lens highlights how older adults are driven by emotional motivations, seeking enjoyable experiences like VR gaming to foster positive emotions and enjoyment throughout the aging process.

Physical activity and motivation to exercise.

This theme explores older adults’ perspectives on the role of VR exergaming in promoting PA, motivation, and adherence to exercise routines. Participants recognized the connection between PA and motivation during their VR gaming experience. They acknowledged the importance of PA within the VR context, which provided benefits such as improved coordination, balance, and upper body workout. Two participants highlighted the positive exercise effects; P4 stated, "I have some exercise from it, and I’m conscious of that, as my arms go back and forward and try to catch those Frisbees" (P4). Similarly, P9 described the game as "a good way to exercise" and emphasized the muscular and visual benefits: "For my age, it’s a good way to exercise, for the muscle and for the visuality" (P9).

Another participant mentioned feeling warm during the gameplay and needing to turn on a fan, suggesting that the game provided a demanding PA that raised their body temperature. However, some participants viewed the game as an "add-on" (P2) or an "upper body exercise" (P8), focusing primarily on engaging the upper body rather than the entire body.

In addition to physical benefits, Participating in the VR game also brought awareness to some older adults regarding their physical limitations. One participant expressed frustration with their left hand’s accuracy compared to their right hand, stating, "I was annoyed with myself that my left hand was not as accurate as my right hand. I’ve always been right-handed. I don’t use my left hand very much at all" (P8). This realization showcases how VR has the potential to enhance self-awareness and uncover previously unnoticed physical limitations.

Besides the physical benefits, the challenge of the game and the sense of accomplishment that came with overcoming it motivated the players to perform better, achieve higher scores, and test their abilities. Some players even saw it as a challenge against the VR machine and tried to outsmart the system. As one participant stated: “I think the challenge of getting as highest score as you possibly can, so you do it once, you get a score, the second time you want to beat your score.” (P4)

A participant expressed that the game served as motivation for PA and helped them escape daily life challenges, offering a distraction and alleviating depression, "It takes me out of my everyday tasks and everything and brings me to another world… you see the fishes and things like that and makes you forget you are in the house, and you take the thing [headset] out, and you see oh! I’m in the house" (P12). Another participant emphasized the importance of the VR experience in combating social isolation and building confidence post-COVID-19 lockdowns. The VR experience brought them happiness and a sense of security, preparing them for rejoining society. “A really good space to be in, after you have a bad day, wow! Increase your thoughts and your endorphins, you know, just puts you in a happy mood.” (P5)

The use of SOC revealed that VR gaming gave older adults a sense of purpose, motivating them to improve scores and challenge themselves. It also increased self-awareness, as one participant discovered accuracy differences between their hands. VR gaming contributed to physical well-being by providing a meaningful activity that enhanced self-awareness and personal growth.

Also, SST helps us understand the motivation aspect of the theme. According to SST, individuals choose goals and activities that provide personal satisfaction while minimizing effort. In this case, VR gaming offered a fun way for older adults to be physically active, providing a sense of accomplishment and motivation. It motivated participants to exercise, bringing happiness and well-being by serving as a distraction from daily challenges.

Social connection and support.

This theme refers to older adults’ experiences of social interactions, connection, and emotional support facilitated through VR gaming, including the impact on social relationships. Participants viewed the game as an opportunity to socialize and connect with others, whether with their friends in the facility or family members who live far away: “I wouldn’t mind playing my grandson. [It] Would be a challenge, if I wasn’t successful that was fine, but this is something to do together.” (P7) One participant expressed their preference regarding a possible setup for the game for group gameplaying: “If it could be set up for two players and one hit one colour, and one hit the other colour, that would be a challenge” (P10).

Participants went beyond involvement, recommending friends to the researcher as potential participants. Their proactive approach and follow-up inquiries demonstrated interest in the study’s success and created a sense of community. This highlighted the importance of social support in promoting engagement and participation, showcasing the potential benefits of VR gaming for LTC facility residents.

Participant sharing of VR gaming experiences enhanced self-efficacy and performance, highlighting the potential of social support and knowledge sharing. Technical support increased confidence in technology use, with a desire to continue playing if volunteer assistance is available: "If we have a volunteer, hopefully, we can. Somebody that could be available" (P5). Two participants emphasized the importance of support in navigating the game: "You escorted me through… if I had been there by myself, I might have had difficulties" (P4), "If you weren’t here, I don’t know how I would go through" (P5).

Staff and family encouragement significantly influenced acceptance and enjoyment of VR games. One couple shared their scores with their son, who expressed amazement and motivated them to continue: "I certainly would be interested in another project… I said to my son: I tried that [VR], and I guess I was pretty good at" (P7).

Participants were motivated to engage in VR gaming for socialization, aligning with SOC principles. SST emphasizes prioritizing emotionally meaningful relationships as individuals age. Participants’ enthusiasm and support for the VR gaming study highlight potential benefits for LTC residents and the importance of social support in promoting engagement. Technical assistance during the VR gaming experience was crucial, emphasizing the role of emotional support and guidance.

Individual preferences and challenges.

This theme explores participants’ preferences, challenges, and barriers in VR exergaming, including technical difficulties, physical limitations, and personal preferences for game features. Participants’ experiences were influenced by their interests and prior gaming experience. Some expressed enthusiasm to explore the full potential of VR: "I would like to continue with VR and explore its capacity" (P3, experienced gamer). Others, with less experience or health concerns, appreciated the exercise and novelty: "Good exercise, concentration, focus, and challenge" (P14, with comorbidities).

The gaming experience had some challenges for participants. Those without prior experience found the game setup and menu navigation difficult, hindering their engagement. Some participants, even after adjusting the speed, felt the game was too fast for their reflexes: "Perhaps for an older person, it must be slower" (P7). These challenges impacted their enjoyment and acceptance of the game.

The boxing game involved punching flying objects without button presses, but the controller buttons posed challenges for some participants. Accidental button presses interrupted the game, requiring extra effort to resume: “I was happy to see how easy it was, except about the controllers. I never got master of those.” (P7) Additionally, some participants found the headset weight burdensome, further affecting their experience and interaction with the game.

Some participants prioritized health-related goals to maintain an active and enjoyable life: "to keep a healthy and active life" (P1) and "to reach 100" (P5) to spend time with grandchildren. The goals expressed by participants align with the SOC theory, as they actively select and optimize important goals while compensating for age-related limitations. These goals include maintaining physical activity, controlling blood sugar, and losing weight, reflecting their focus on health and well-being.

The participants in our study actively selected and optimized health-related goals, such as maintaining physical activity and controlling blood sugar, while compensating for age-related limitations, aligning with the SOC theory. These goals were emotionally meaningful, contributing to their overall quality of life. Additionally, goals related to family time and fostering social connections within their living facility were consistent with the SST, highlighting the importance of social relationships and emotional well-being.

Relevance and personalization.

Staff members stress the importance of tailoring VR games to LTC residents’ individual needs and interests for better acceptance. This involves designing games with relevant themes and user-friendly equipment. One staff member stated, "Having whatever they see relevant to their lives may affect them here" (S1). Participants’ experiences support this approach, with one likening the game to the View-Master and another recalling positive memories while playing. VR gaming has the potential to evoke positive emotions and increase acceptance among older adults.

The relevance and personalization of VR games can be analyzed using TAM’s perceived usefulness component. TAM highlights that perceived usefulness and ease of use determine technology acceptance. When games align with players’ interests, they are seen as more useful, increasing acceptance. Additionally, user-friendly equipment enhances ease of use, further promoting acceptance.

Training and guidance.

Staff members highlighted the role that education and support from both family members and staff members play in the acceptance of VR games among residents. They emphasized the importance of educating LTC residents on the proper use and potential benefits of VR games. This education can help increase residents’ understanding and familiarity with the technology, leading to higher acceptance and engagement.

They believed that family members could provide emotional support and act as a source of guidance and information, helping residents feel more comfortable and confident using VR games “If you have a family that is very supportive of this project and trying this new thing, it would play a huge role.” (P3). On the other hand, staff members can provide hands-on assistance and support during VR games, helping residents navigate the technology and troubleshoot any issues that may arise:

A staff member emphasized the need for researchers and staff to prioritize relationship-building when working with LTC facility residents, especially in research or implementing new technologies like VR. Due to the residents’ vulnerability and unique perspectives, it is crucial to consider their specific needs. Older adults who are introduced to VR require trust and a sense of safety to fully embrace the new experience. This can be established through effective communication and comprehensive training provided by researchers: “Taking that time to build those relationships because using a headset it’s like, virtual reality, it changes your reality, so you need to know that you are safe, somebody safe is there with you.” (S4)

Staff members believed that educating LTC residents on the benefits of VR games and providing them with guidance can help increase their understanding and familiarity with the technology, leading to higher acceptance and engagement: “It’s just really a lot about education.” (P4). This aligns with the TAM model’s emphasis on perceived usefulness as a key factor in technology acceptance.

Organizational and individual barriers.

Staff members noted organizational and individual challenges that hinder the acceptance of VR games among LTC residents. These barriers, identified through interviews, can be categorized as affordability, equipment maintenance, and a shortage of staff to assist with VR headset usage and the individual barrier relates to health issues.

One significant organizational barrier is the cost of purchasing VR sets, which can limit availability and accessibility for LTC residents: "How much does it cost for that technology? And then would the facility be able to buy it?" (S1). Troubleshooting, equipment maintenance, and a shortage of staff assistance further hinder the implementation of VR gaming in LTC settings. Technical issues require specialized knowledge, and the limited availability of trained staff to assist residents with VR headset usage poses challenges: "If it takes a long time to set up… whatever it is… But also troubleshooting. Because if there is a problem with it, I know the healthcare team doesn’t have any time to really do it" (S1).

Individual barriers encompass cognitive and physical health issues faced by LTC residents. Cognitive impairments, such as dementia or age-related decline, can hinder their comprehension and engagement with VR gaming: "There are barriers with Dementia… your perception of reality might be disordered" (S3). Mobility limitations can also impact their ability to interact with VR equipment and participate in physical activities within the virtual environment: "Maybe it’s a ball game asking to the left, and the physical problem would be on the left arm. So, the difficulty would be how to reach the ball on time" (S2).

The mentioned organizational barriers, including affordability, difficulties with equipment maintenance, and staff shortage, can be associated with the UTAUT model’s construct of price value and facilitating conditions [22]. Individual barriers, such as physical and cognitive health issues, can be linked to the STAM model’s constructs of physical functioning and cognitive ability [23].

Recommendations for future research.

Future investigations concerning technology acceptance among older adults should strategically integrate social theories of aging, notably SOC and SST. This methodological approach will facilitate a more comprehensive understanding of the multifaceted factors influencing the acceptance of technology among older adults. Analyzing how aging influences their acceptance through experiential lenses can yield nuanced insights, shaping the development of technology tailored to their distinct needs.

To successfully integrate VR gaming into the lives of LTC residents and comprehend the intricate interaction dynamics between older adults and VR games, researchers should explore several key areas. Investigating the enduring effects of VR gaming on physical activity, motivation, and mental health can provide a holistic assessment of its impact on the well-being of older adults. Delving into the influence of diverse music types on gameplay and user enjoyment can contribute to the creation of more personalized and engaging experiences. Additionally, exploring the potential of VR gaming as a form of physical therapy and exercise can enhance self-awareness of physical limitations.

The significance of social support in fostering engagement and acceptance of VR gaming among LTC residents is evident from our observations. Future studies should meticulously incorporate social support mechanisms in their design and execution to optimize the benefits for this demographic. Crafting personalized and relevant VR games aligned with LTC residents’ interests is paramount. Educating and supporting both residents and their families to enhance acceptance and engagement with VR games should be a central focus. Establishing trust and safety when introducing new technologies and addressing organizational and individual barriers are imperative considerations.

Lastly, research endeavors should delve into the potential of VR gaming as a tool to alleviate social isolation, a pervasive concern for many older adults. Comprehensive exploration in these areas can contribute to the effective implementation of VR gaming in LTC facilities and elevate the quality of life for older adults.

Recommendations for designers.

In order to optimize the usability of VR games for older adults, designers are encouraged to integrate specific design principles. Firstly, an emphasis should be placed on cultivating a simple and intuitive interface, characterized by easy-to-navigate menus, larger buttons and text, and explicit instructions. This adherence to a minimalist design philosophy serves to enhance the overall user-friendliness of the interface. Secondly, the gameplay should adopt a deliberately slow-paced structure, incorporating extended intervals for each task to effectively mitigate the occurrence of motion sickness while concurrently heightening the enjoyment factor. Thirdly, designers are advised to judiciously restrict the number of head and body movements required, given the potential challenges older adults may encounter with swift or extensive motions. This strategic reduction in movement requirements stands to substantially augment the accessibility of the game. Finally, the provision of customizable settings, encompassing adjustable parameters such as brightness, contrast, speed, and text/button size, affords older adults the opportunity to tailor the game to align with their specific needs and preferences. The assimilation of these meticulous design principles is posited to empower VR game designers in the creation of games that not only exhibit heightened usability but also elicit a more enjoyable experience for the older adult demographic.