A Personalized Virtual Reality Sorting Task for Older Adults With Diogenes Syndrome and Pathological Hoarding: Mixed Methods Pilot Study of Feasibility, Acceptability, and User Experience (Preprint)

BACKGROUND Diogenes syndrome with hoarding symptoms in older adults is often associated with self-neglect, impaired use of living space, social withdrawal, and reluctance to accept professional help. Conventional psychosocial interventions typically require repeated in-home practice in discarding possessions, which may be difficult to implement in this population. Virtual reality (VR) may offer a controlled and less confrontational way to support engagement in care. OBJECTIVE This pilot study assessed the feasibility, acceptability, and user experience of a personalized VR sorting intervention in adults aged 60 years and older with Diogenes syndrome and hoarding symptoms. METHODS In a single-center, single-arm, mixed methods pilot study, a personalized three-dimensional virtual environment reproducing a room from each participant's home was created and populated with clutter selected by the participant. During a session lasting up to 20 minutes, participants performed a sorting task using a head-mounted display and handheld controllers, accompanied throughout by a professional. Feasibility was assessed through session completion, session duration, and adverse events. Acceptability was assessed through satisfaction, perceived safety, perceived helpfulness, and willingness to repeat the session. Perceived ability to discard possessions was rated before and after the session on a 0–10 scale. Individual semi-structured interviews explored participants' experience and were analyzed thematically. RESULTS Fifteen participants were included (mean age 74.8, SD 6.3 years). All sessions were completed as planned and no serious adverse event occurred. Acceptability ratings were favorable across all four dimensions. Perceived ability to discard possessions increased from a mean of 3.8 (SD 2.1) before the session to 5.7 (SD 2.6) afterwards (P<.001). Thematic analysis identified seven themes: playfulness, tolerance, suggestions for improvement, expressing emotions, improved insight, empowerment, and willingness to accept help. Some participants reported performing in VR a task they described as difficult or impossible in real life. Tolerance was good overall, although a few participants mentioned transient dizziness at the outset, the weight of the headset, or mild fatigue, and some suggested refinements to the system. CONCLUSIONS A personalized VR sorting task appears feasible and acceptable in older adults with Diogenes syndrome and hoarding symptoms, including those with psychiatric or neurocognitive comorbidity. Controlled studies with follow-up are needed to establish clinical effectiveness and impact on real-life discarding behavior.