Tamara Afifi, Nancy Collins, Kyle Rand, Jennifer Stamps, Erin Naffziger, Nikki Truscelli, Paige Harris, Thomas Neumann, Allison Mazur, Yuval Rosen, Abdullah Salehuddin, Chloe Gonzales, Christopher Otmar, Veronica Wilson, Jade Salmon, Ken Fujiwara, Joan Monin, Yifan Lou
Older adults in senior living communities (SLCs) often face barriers to maintaining emotional well-being and family ties. This stratified, unblinded, parallel-group randomized controlled trial tested a four-week virtual reality (VR) intervention ( Thrive ) designed to improve well-being for older adults with cognitive impairment and their adult children living at a distance, compared to an active video conferencing (VC) control. A total of 186 dyads - each comprising a parent with mild cognitive impairment (MCI) or mild-to-moderate Alzheimer's disease and related dementias (ADRD) and an adult child - were recruited from 23 SLCs and randomized 1:1 to VR (n=90) or VC (n=96). Primary outcomes - including personal, social, and relational well-being for parents and adult children, and perceived stress and caregiver guilt for adult children - were assessed at baseline, one week post-intervention (primary endpoint), and one and three months post-intervention using intention-to-treat linear mixed models; secondary outcomes captured session engagement via self-report and behavioral coding. Retention was high (89% at post-intervention). Parents with ADRD showed significantly greater improvement in VR than VC for psychological well-being, social connection, and relationship quality, while parents with MCI showed a comparable pattern favoring VC for relationship quality and social connection. Adult children in both conditions reported improved personal, social, and relational well-being, with VR showing more sustained reductions in caregiver guilt through three months. Overall, VR sessions elicited more engagement than VC. These findings indicate that both VR and VC improved well-being and family connection, with VR conferring additional benefits for parents living with dementia and a sustained caregiver-guilt benefit for adult children, suggesting that tailoring technology to cognitive abilities may enhance outcomes in senior care settings.