Collaborative Augmented Reality for Older Adults and Family/Close Friends: Protocol for a Feasibility and Acceptability Study (Preprint)

BACKGROUND Loneliness and social isolation are common in older adults and can result in increased risk of mortality, cognitive and physical decline, and reduced quality of life. Studies using interactive communication technology (ICT) interventions with older adults have been limited and with mixed results, highlighting the need to design and evaluate ICT to address loneliness in older adults. Advancements in collaborative head-mounted display augmented reality (HMD-AR) can provide older adults who are geographically distant from their families a more diverse range of interactive activities, thus having greater potential to enhance social connection and decrease loneliness. OBJECTIVE The aim of this pilot study was to examine the feasibility and acceptability of co-created collaborative HMD-AR activities and determine study procedures for a future RCT comparing HMD-AR with photorealistic avatars versus 2D ICT (e.g., Zoom) on loneliness among older adults and their family member/close friend. METHODS Twelve older adults and their designated family/friend were recruited from the greater Nashville area and randomized 1:1 to the HMD-AR or 2D ICT groups. Older adults eligibility:60 years or older, able to tolerate the HMD-AR, cognitively and physically able to participate, and had an adult family member/friend willing to participate. For long-term care settings, participants must have been a resident for at least 3 months. All participants lived within one hour driving distance from the investigators’ university. Each older adult-family/friend pair participated in eight 30-minute sessions over four weeks. Those randomized to HMD-AR had photorealistic avatars created; they participated in collaborative activities (fireplace decoration, checker) co-created in an earlier study. Those randomized to the 2D ICT had the opportunity to play virtual games that are readily available (virtual checkers, house décor game). Engineers remained onsite for both arms to assist as needed. The primary outcome was feasibility of the study processes (i.e., recruitment, retention, data collection) and of the technology (i.e., viability of HMD-AR in home/LTC setting, usability, comfort, ease of use, and acceptability). The study used face-to-face questionnaires and observation. RESULTS The study was reviewed and funded by the National Institute on Aging. The study was approved by the local institutional review board and registered at ClinicalTrials.gov. Recruitment for the pilot RCT study began in May 2023 and was completed in April 2025. Final acquisition of data has occurred and currently undergoing data cleaning. Results are intended to be published within one year. CONCLUSIONS To our knowledge, this is the first collaborative AR using photorealistic avatars between older adults and their family member/friend. Our study will determine if the use of HMD-AR is feasible, and the results of this pilot study will inform a full-scale RCT focused on the efficacy of the intervention with the goal of reducing loneliness among older adults. CLINICALTRIAL ClinicalTrials.gov NCT06179225