On the basis of projections reported by the World Health Organization (WHO), the number of people aged >60 years will rise from 900 million (12% of the global population) in 2015 to 2 billion (20% of the global population) by 2050 [1]. With the number of people living longer increasing, a new set of challenges arises that needs to be overcome to support the population into old age. The natural decline in physical and mental capabilities as we age poses a serious threat to the quality of life of older adults—particularly when society is not currently equipped to effectively cater to these declines in a way that supports healthy aging [2].

The current digital age offers new opportunities to support healthy aging in older populations. A digital technology that has evolved rapidly in the past 10 years is immersive virtual reality (IVR) [3]. On the basis of the reality-virtuality continuum by Milgram et al [4] (Figure 1), IVR is defined as fully computer-generated environments that are shown on a head-mounted display (HMD). IVR sits on the virtuality end of the reality-virtuality continuum. The reality end of the continuum refers to the real environment in which no computer-generated content is overlaid. Between these 2 ends are augmented reality–based displays, where digital information is overlaid onto the real environment through devices such as see-through HMDs, mobile phones, and computer monitors. Slater and Sanchez-Vives [5] described the technical goal of IVR as its ability to “replace real sense perceptions by the computer-generated ones,” simulating what is known as presence and immersion. Presence refers to the feeling of being present in a place (ie, in a virtual environment), and immersion refers to the level of intensity with which one feels that they are present in that place afforded to them by the technological capabilities of the IVR device [5]. Closely linked to presence and immersion are colocation and copresence, which refer to networked virtual environments that enable IVR participants to interact with others (colocation) and feel as if they are there with them in the virtual environment (copresence) [6]. IVR participants are represented in IVR by avatars, which can be described as “human-like machines” that represent the participant in the virtual environment [7]. This representation is known as embodiment, which refers “...to the process of replacing a person’s body by a virtual one” [5].

In their scoping review, Hughes et al [8] discussed how features of IVR such as presence and immersion can assist older adults in their everyday lives, providing opportunities for health promotion and tackling social isolation and loneliness. IVR offers older adults the opportunity to take part in physical activities from their own home that would otherwise need to be facilitated outdoors (eg, virtual cycling in nature [9]). The comfort and convenience of activities such as these being facilitated in a more accessible environment can offer greater motivation for older adults to adhere to health-promoting activities such as physical exercise [8]. Through the incorporation of avatars into networked virtual environments, IVR also offers older adults the opportunity to connect with others in a more meaningful way compared with other communication mediums [6] where meeting in person may not be possible—a reality forced upon many of us during the COVID-19 pandemic [7]. These features align closely with the goals of the WHO for healthy aging [1], particularly with regard to age-friendly practice [1,10]. Age-friendly practice emphasizes the importance of supporting older adults in maintaining a fulfilling and meaningful life into old age through supportive infrastructures in the environment and society. IVR provides an entirely new set of virtual infrastructures that support an environment in which older adults can connect with family, friends, and other members of society [5].

With the emergence of new, high-quality IVR technologies that are now commercially available in higher-income countries, researchers have begun to examine older adults’ experiences and perceptions of IVR. A number of recently published systematic reviews and systematic review protocols have aimed to synthesize the quantitative literature on this topic [11-13], focusing primarily on IVR’s effectiveness, efficacy, and feasibility in various clinical populations. In recent years, we have also seen an increase in qualitative studies examining older adults’ experiences and perceptions of IVR [14-16]. However, to our knowledge, there has been no systematic synthesis of these studies to inform the design of new, more accessible IVR devices for older adults.

In digital technology development and design, qualitative feedback from end users can be invaluable. It provides developers and other informants with rich information to work with when designing digital technology content, with particular utility in identifying various barriers to and facilitators of using a technology [17]. It also offers the opportunity to explore more deeply whether the end user finds a technology acceptable—which is now considered a key factor in determining whether a technology will be adopted and used by the intended user [18]. When defining technology acceptance, it is important to acknowledge the temporal nature of the term [18], with acceptability defined as one’s perception of a technology before use [19], acceptance defined as one’s perception of the technology after initial use [19], and adoption defined as a multiphase process starting with “deciding to adopt (selecting, purchasing or committing to use it) and then achieving persistent use” [20].

Using the Sample, Phenomenon of Interest, Study Design, Evaluation, and Research Type tool (Textbox 1) [21], the following research questions were formulated to guide the review and synthesis of the existing literature: (1) What are older adults’ experiences and perceptions of IVR? (2) What are the barriers to and facilitators of older adults’ use of IVR? (3) Do older adults find IVR acceptable?

The objective of this study was to systematically review and synthesize qualitative studies exploring older adults’ experiences and perceptions of IVR.

A detailed search strategy was developed to identify studies relevant to the review questions (Multimedia Appendix 1). After consulting with a librarian at the university and examining databases used in previous reviews with similar research questions to this review [11,13,24-30], 3 databases were selected to run the search in: Embase, Compendex, and Scopus. These databases were selected as they covered key fields relevant to this review, including computer science, engineering, human-computer interaction, psychology, and health and social sciences. The search strategy was developed for Embase and adapted where necessary for the other databases. The search terms were informed by previous systematic review search strategies with similar research questions [13,24-30] as well as input from the review team. Relevant keywords and phrases were used in each database, including older adults, virtual reality, perceptions, and experiences. The search terms were organized into relevant categories using the Sample, Phenomenon of Interest, Study Design, Evaluation, and Research Type tool [21] and then combined into a single search strategy. In some databases, certain categories were omitted from the final search strategy to broaden the scope of studies captured by the search. To ensure that the replicability of these searches is possible, these omissions can be examined in the link provided in Multimedia Appendix 1. Owing to the dramatic evolution of IVR equipment in recent years [3], databases were searched for relevant studies published in English from January 2012 to July 2020—an approach also taken in a recently published systematic review exploring IVR [13].

Studies were included if they examined older adults’ experiences and perceptions of IVR. As there is no generally accepted definition of older adults, we included those studies in which the mean age of the study sample was ≥60 years as this is a commonly used cutoff in aging research [31]. Only studies in which complete visual immersion was facilitated through the use of an HMD were included. Studies were included if a qualitative method was used for both data collection and analysis, they were peer-reviewed publications, and they were written in English.

Older adults with a diagnosed neurodegenerative disorder were excluded as there is evidence that their experiences with virtual reality—as well as the application of virtual reality in this cohort—differ considerably from neurotypical individuals’ experiences [32]. Reviews, conference abstracts, opinion pieces, gray literature, and editorials were excluded.

The initial search was conducted by one reviewer (DH). The screening phase of this review consisted of title and abstract screening, full-text screening, and forward and backward citation searching of the included full-text articles. Title, abstract, and full-text screening was completed for studies identified through forward and backward citation searching.

Titles and abstracts were extracted from the chosen databases and combined in EndNote X9 (Clarivate). Duplicates were removed using the Remove Duplicates function in EndNote X9. Records were manually screened for remaining duplicates in EndNote X9. Title and abstract screening was conducted by one reviewer (DH) using the Rayyan (Rayyan Systems, Inc) data screening tool [33]. A random sample of 20% (491/2455) was also screened by a second reviewer (AF). A Cohen κ statistic of 0.96 was calculated, indicating almost perfect agreement between reviewers [34]. Where disagreements arose, unresolved cases were discussed with a third reviewer (JW, OC, or JMS depending on the expertise required) until an agreement was reached. Full-text screening was completed by 2 independent reviewers (DH and AF). Where disagreements arose, unresolved cases were discussed with a third reviewer (JW, OC, or JMS depending on the expertise required). Forward and backward citation searching was completed for all the studies included after full-text screening. This search was conducted by DH. Title, abstract, and full-text screening of the studies identified through forward and backward citation searching was completed by 2 reviewers (DH and AF).

Data extraction was completed following a data extraction protocol developed by DH (Multimedia Appendix 2), with feedback from the rest of the review team. In total, 2 reviewers performed the data extraction (DH and AF) using a prespecified data extraction checklist [22]. The extracted data were organized and analyzed using the NVivo software (QSR International) [35].

The Critical Appraisal Skills Programme tool [36] for qualitative research was used to appraise the quality of individual studies. No studies were excluded based on this appraisal. However, the outcomes of the appraisal were noted for each study and used to inform the synthesis of findings. The Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach [37] was used to assess the confidence that can be attributed to the evidence informing each individual review finding, with ratings of high, moderate, or low confidence being attributed to each finding.

A thematic synthesis [38] was conducted to synthesize the data extracted from the included studies. Thematic synthesis is derived from the qualitative method, thematic analysis [39-41]. Several interpretations of thematic analysis are cited by authors when discussing how they conceptualized thematic synthesis. Thomas and Harden [38] state that their approach “concurs with [Boyatzis’s] conceptualization of thematic analysis”—where thematic analysis is not defined as a qualitative method in its own right but as “...a process that can be used with most, if not all, qualitative methods...” [41]. This concurrence is due to the fact that their approach to thematic synthesis incorporates multiple other established methods as well as techniques commonly described as thematic analysis [38].

For this synthesis, the interpretation of thematic analysis (or reflexive thematic analysis [42]) by Braun and Clarke [39] informed the synthesis approach, structured within the stages of the thematic synthesis by Thomas and Harden [38]: (1) line-by-line coding of the extracted data from each included study, (2) grouping of these codes to form descriptive themes that remain close to the data presented in each included study, and (3) going beyond these data to create new interpretations or theories (analytical themes) of the combined studies. These themes were then formed into a coherent narrative and reported in the Results section. A table detailing exactly how the steps by Braun and Clarke [39] were mapped onto the stages of thematic synthesis can be found in Multimedia Appendix 3.

Qualitative research is generally considered a subjective process [43], meaning that it is essential to be reflexive throughout it. Authors must reflect on how their perspectives, experiences, and worldviews influence the qualitative process. In total, 3 authors have backgrounds in health psychology (DH, JW, and JMS), two of whom are experts in their fields (JW and JMS); one author is a qualified occupational therapist and human-computer interaction researcher (AF); and one author is an expert in computer science (OC). During the review process, the authors’ preconceptions about the topics being discussed were considered when making key decisions relating to the review, analysis, and write-up. The lead author kept a reflexive journal of the review, analysis, and write-up processes as a record of the critical evaluation of the authors’ influence on the study.

Owing to the amount and depth of data analyzed in this review, the analysis predominantly focused on only one of the primary review questions: what are older adults’ experiences and perceptions of immersive virtual reality? The 2 other review questions were formed into secondary review questions—what are the barriers and facilitators to older adults’ use of immersive virtual reality? and do older adults find immersive virtual reality acceptable?—and were addressed to a lesser extent. This deviation is in line with the assertion by Braun and Clarke [43] that qualitative research questions can evolve as the research study progresses as a greater understanding of the data being analyzed is formed.

In total, 2528 records were identified through database searching. An additional 38 records were identified through forward and backward citation searching. Of the total 2566 records, 111 (4.33%) duplicates were removed, leaving 2455 (95.67%) records to be screened. A total of 95.11% (2335/2455) of records were excluded based on title and abstract information, leaving 120 articles to be assessed during full-text screening. Upon completion of the screening process, 13 studies were included in the final synthesis. This process has been illustrated as a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram in Figure 2.

A total of 13 studies were included [9,14-16,44-52]. In total, 77% (10/13) of the studies explicitly reported conducting some form of qualitative data collection procedure [15,16,44-46,48-52], which included focus groups [44,50], exploratory workshops [14], video recordings [9], and self-reported qualitative data [47]. A total of 224 participants were included across the 13 studies. In the 77% (10/13) of studies [9,14-16,44,46-50] that reported participants’ gender, 73 (37.62%) participants were men and 121 (62.37%) were women. The participant age range across the 13 studies was 48 to 99 years. Participants lived across 9 different countries (Australia [14,15,45], China [16,47], United States [44,50], Denmark [9], Northern Ireland [46], Brazil [48], England [49], Taiwan [52], and Thailand [51]) and 5 different continents (Australia [14,15,45], Asia [16,47,51,52], North America [44,50], South America [48], and Europe [9,46,49]).

Of the 10 studies that reported the participants’ place of residence, participants from 5 (50%) studies identified as community-dwelling adults [14,16,44,47,50], and participants from 5 (50%) studies reported living in some form of residential aged-care facility [9,15,45,46,50]. Although it could be assumed that almost all the participants were retired or not working as many lived in residential aged-care facilities, only 31% (4/13) of the studies explicitly reported their participants being retired [9,15,45,50]. In total, 85% (11/13) of the studies reported their recruitment strategy, which included recruiting through community organizations and day centers [16,45,46,49,50,52], posting flyers in public places [14,44], and recruiting through a residential aged-care facility [15] and a physical therapist [9], as well as 8% (1/13) of the studies that described recruiting participants sequentially [48]. Of the 5 studies that reported participants’ mental status, 1 (20%) provided a detailed report on 2 of its participants, with one participant described as being depressed, self-isolating, having a history of behavioral issues, and having mild cognitive impairment and the other participant described as also having mild cognitive impairment [15]. Participants from 23% (3/13) of the studies were generally described as cognitively healthy [9,46,48]. It was reported in 8% (1/13) of the studies that participants were not screened for cognitive impairment, but 3 participants disclosed during focus groups that they had “some dementia” [50]. In total, 46% (6/13) of the studies reported the health status of their participants, with 17% (1/6) reporting some participants being wheelchair users [15], 17% (1/6) having some participants who used walking aids and had a high risk of falling [46], 50% (3/6) reporting participants as having fair health or sufficient health to take part in the activity [9,44,48], and 17% (1/6) reporting cases of arthritis [45].

A total of 54% (7/13) of the studies reported the location where the study took place, including a day center [46,49]; a residential aged-care facility [15]; a community activity center [16]; a laboratory setting [44]; a physical therapy clinic [9]; and a room that had a flat, even floor surface with a trackable area of 2.4×2.4 m [45]. In total, 69% (9/13) of the studies reported participants’ previous technology experience or proficiency [9,14,15,44,45,48-50,52], with experience and proficiency across the studies ranging from high to low.

There was also a range of activities in which participants from each study took part during their IVR experience. The characteristics of these activities are included in this section to further contextualize the experiences referred to in the descriptive and analytical themes reported in the following sections. The specific applications through which the participants completed these activities can be found in Multimedia Appendix 4 [9,14-16,44-54]. The types of activities older adults engaged in across these studies included travel and exploration [15,16,44,45,47,50,51], social connection [14,15,44,48,50,52], entertainment [15,47,49,50], exercise [9,46,48], education [14,47,50], and reminiscence [44,48-50]. Descriptions of these activities and supporting author and participant quotes can be found in Multimedia Appendix 5 [9,14-16,44-52].

A summary of the methodological quality assessment of the included studies using the Critical Appraisal Skills Programme tool is shown in Figure 3, with full details in Multimedia Appendix 6 [9,14-16,38,39,44-52]. All but 8% (1/13) of the studies [49] had a clear statement of their aims. It was unclear whether the qualitative methodology was appropriate in 31% (4/13) of the studies [9,47,51,52] and whether the research design was appropriate in 38% (5/13) of the studies [9,47,49,51,52]. It was unclear whether the recruitment strategy was appropriate in 46% (6/13) of the studies [45,47-49,51,52] and whether the data were collected in a way that addressed the research issue in 31% (4/13) of the studies [45,47,51,52]. The main reason for this uncertainty was that the authors did not clearly justify the rationale for their methodology, research design, recruitment strategy, or data collection technique.

In 31% (4/13) of the studies [47,49,51,52], there was no consideration of the researchers’ relationship with the participant, and it was uncertain in the remaining studies [9,14-16,44-46,48,50]. No ethical concerns were considered in 38% (5/13) of the studies [9,45,47,51,52], and data analysis was considered not sufficiently rigorous in 31% (4/13) of the studies [46,47,51,52].

Confidence in the evidence was assessed using the GRADE-CERQual [37] tool and ranged from high to moderate (Multimedia Appendix 7 [9,14-16,44-52]). There was consistency in the findings across countries, continents, and settings. Ratings of moderate certainty were mostly due to methodological limitations and adequacy. The most common methodological limitation was the lack of reflexivity regarding the relationship between the researchers and participants. The main concern regarding adequacy was the lack of rich data informing a number of the findings.

Three descriptive themes were generated that were related to older adults’ experiences and perceptions of IVR: (1) practical aspects of IVR use, (2) experiencing unique features of IVR, and (3) perceptions of IVR. Textboxes 2 to 4 include illustrative quotes for each descriptive theme and its respective subthemes. Author quotes are italicized to distinguish them from quotes provided by research participants in each of the studies.

Three analytical themes were then formulated by interpreting key patterns present across the descriptive themes, generating new meaning from the synthesis: (1) tolerating the bad to experience the good, (2) buying into IVR (don’t judge a book by its cover), and (3) “it proves to me I can do it.”

A total of 3 analytical themes were developed based on the descriptive themes to go beyond what was reported in the original studies to generate new meaning and tell a story about older adults’ experiences and perceptions of IVR.

This review synthesized 13 qualitative studies exploring older adults’ experiences and perceptions of IVR. The thematic synthesis explored older adults’ experiences interacting with IVR and what challenges arise when facilitating their use of IVR; the unique features of IVR that older adults experienced, such as presence, immersion, and embodiment; and older adults’ overall preconceptions of IVR and perceptions of IVR during and after use. The confidence that could be attributed to each finding, assessed using the GRADE-CERQual approach, ranged from high to moderate, with most findings given a moderate rating.

This review did not intend to be exhaustive in its interpretation of all these topics, nor did it intend to offer an exhaustive list of design considerations for future IVR use in this population. It aimed to tell a story about the key findings of this synthesis that other researchers can draw on when designing IVR experiences for older adults. It aimed to go beyond the practical design considerations already offered in papers such as that by Abeele et al [55] to provide a more empathetic interpretation of the experiences older adults have had with IVR to date. By empathetic, we refer to the researcher or technology designer putting themselves in the shoes of the end user—in this case, older adults—when exploring these individuals’ experiences and perceptions of a technology [56]. This approach responds to the WHO’s call for more age-friendly practice [1,10], which endeavors to build infrastructures that older adults can avail of that will enhance their quality of life.

Conflicting participant experiences were present across the synthesis. These conflicts included differences in older adults’ experiences of dizziness and nausea [14,44], wearing the HMD [9,14,15,44,46,48,50,51], and sitting while using IVR [15,44,50]. These conflicts highlight that there is a need for such features to be adaptive to older adults’ experiences with IVR. This suggests that an assessment of their capabilities could be completed before they use the equipment to tailor the IVR experience to participants’ physical and mental capabilities [47,48]. A key element of this finding is the importance of tailoring the experience to older adults’ needs and preferences. Previous research has generated a list of key design features that can be used to help solve issues identified through older adults’ experiences reported in this review [55].

A striking finding from this synthesis was the level of agency that the IVR equipment afforded older adults while in virtual reality. It was clear that older adults experienced greater levels of agency during their IVR experience, in some cases enabling greater levels of agency than they had in the real world [14,15,44,50]. Parallels between this finding and previous research exploring the applications and implications of IVR can be made, with equipment such as handheld controllers affording participants features such as illusionary agency over the avatar they embody in the virtual environment [5]. This illusory agency affords participants enough autonomy to take part in experiences that may not be available to them in their own reality. Older adults can also be negatively affected by the added agency they experience in IVR, where it may sometimes only emphasize their own limitations in reality [44]. A balance must be struck between what is perceived as a freeing and beneficial activity by older adults through using IVR and what can be perceived as a reminder of their own age-related limitations.

Another salient finding of the synthesis was the change in participants’ generally negative perceptions of IVR before use to generally positive perceptions after use. This is in line with existing research suggesting that the process of accepting a technology resembles a life cycle, with preconceptions of a technology being an essential part of this life cycle as they play a role in whether the participant will eventually adopt the technology [18].

There were clear signs that participants were generally happy to tolerate certain nuisances inherent to some of the existing IVR technology features to experience what they considered to be meaningful activities [15]. Social connection in IVR was one of these sought-after activities for many participants because of the added opportunity it gave them to meet others outside their sometimes restrictive environment [14,15]. These novel interactions experienced by participants incited a newfound sense of excitement, in many cases leading to more motivation to take part in activities in IVR. However, current research supports the need for improvement in existing IVR features to facilitate more meaningful IVR activities such as social interaction [7]. Evidence suggests that older adults appreciate certain features that IVR offers them, such as added anonymity, which encourages introverted participants in particular to share more in IVR social circles [7]. However, IVR is still considered too complicated for older adults to engage with as a means of taking part in these social networking experiences when compared with face-to-face communication as well as other computer-mediated technologies such as FaceTime or Skype [7].

A key finding of this review is the success some researchers had in identifying and offering solutions to some of the nuisances reported by participants through the methodologies they used to explore this topic [7,14,15], such as participatory action research. This approach, along with other co-design approaches such as Patient and Public Involvement [57], can help improve the usability and accessibility of IVR technologies for older adults as the technology continues to rapidly evolve over time. Co-design approaches enable researchers to iterate on versions of IVR hardware and software more rapidly without the need to repeatedly collect and analyze data, which is essential given the rapid turnover of new IVR technologies in today’s market [3].

In line with the primary review question—“what are older adults’ experiences and perceptions of IVR?”—this synthesis offers an insight into the experiences older adults have had with IVR and their perceptions of these experiences. The approach to implementing and exploring IVR needs to be taken with care and empathy for the individual [56] as our results demonstrated variation in experiences and perceptions of interacting with IVR. It is hoped that this empathetic perspective offers researchers in this field more direction when considering how to first approach introducing IVR to older adults and later ensuring that their IVR experiences are facilitated in a way that makes it more meaningful for them. This empathetic approach to design is in line with the age-friendly practice of the WHO [1,10], where infrastructures that are put in place to maintain and enhance older adults’ quality of life are designed to specifically support older adults’ needs and preferences.

With regard to the secondary review question “what are the barriers and facilitators to older adults’ use of immersive virtual reality?” the descriptive themes illustrated the barriers older adults face when using IVR, including challenges regarding health and safety when using IVR, wheelchair and stationary use during IVR activities, physical capabilities when using IVR, and the assistance needed to interact with IVR. As there was little reporting on the facilitators of IVR use in the extracted data, future research needs to focus on exploring solutions that can help older adults and other key stakeholders overcome the barriers outlined in the synthesis. With regard to the secondary review question “do older adults find IVR acceptable?” participants’ perceptions indicated that, once they tried IVR, they generally enjoyed the experience despite some of the shortcomings of the technology. Exploring further why exactly participants find IVR acceptable is important in future research as it is now considered a key determinant of whether a technology will be adopted in the future [18].

As outlined in the Introduction section, older adults require greater assistance as they age to continue leading a fulfilling and independent life [10]. The descriptive and analytical themes highlighted that IVR can provide a platform for older adults to access activities and environments more easily than in the real world because of limitations caused by aging, as well as providing activities that they are able to follow and take part in as they are tailored to their needs. Moreover, it was clear that older adults enjoyed and ascribed meaning to their IVR experiences, with reports that, in some cases, the activities in IVR were more appealing than those offered to them in their real environment [15]. Such outlets increased people’s desire to return and try these experiences again as they afforded older adults more opportunities to take part in activities that they were able to engage in and enjoy.

On the basis of the review and synthesis of findings, there are a number of recommendations for future research conducted in this area. First, it is essential that researchers provide a comprehensive report on the nature of participants’ interactions with IVR. There were several cases where it was challenging to compare features across studies as there was not enough detail given on the features that participants interacted with. For example, participants across a number of studies found the handheld controllers difficult to operate, but it was not specified how many buttons participants were using, which is a key consideration when assessing what level of complexity is within certain participants’ capabilities. In line with the outcomes of GRADE-CERQual, authors also need to explore further their relationship with the research participants. Reflexive practice of this nature offers both the authors and readers a greater understanding of the context within which the study was designed and the perspectives of the authors that could potentially influence future interpretations of the findings [43]. The GRADE-CERQual approach also highlighted the lack of clarity regarding ethical considerations taken in several studies. It is essential that researchers report explicitly on these considerations, especially when working with vulnerable cohorts.

The review protocol was published [22], registered on PROSPERO, and preregistered on the Open Science Framework, where an open-source repository of all the review materials has been stored and updated (Multimedia Appendix 1). The ENTREQ guidelines were followed when writing the report [23]. The review team had a wide range of expertise, ensuring that the interpretations made in the synthesis were accessible across multiple relevant disciplines. Thematic synthesis was an appropriate method for data synthesis as it allowed the reviewers to stay close to the results of the primary studies, which facilitated “...the explicit production of new concepts and hypotheses” [38]. The search strategy was broad. In total, 2 reviewers screened the studies to reduce bias. This review provides a new perspective on how older adults’ experiences and perceptions of IVR can be interpreted, taking a more empathic and experiential approach to data synthesis rather than focusing on irreducible, quantifiable design considerations.

The exclusion of non-English studies is a potential source of bias. However, because of the lack of available resources, no translator could be used for the non-English studies identified. Gray literature was also not searched, which limited the included studies to published works. The reasoning for excluding gray literature was because a scoping review of the gray literature before conducting the systematic review search indicated that there was limited qualitative data available that were not published in academic journals.

This review offers an insight into the experiences older adults have had with IVR to date. With a few improvements to existing IVR hardware and software, focusing also on how it is first presented to older adults, IVR may arise as a new outlet through which older adults living both independently and in residential aged-care facility could take part in a range of meaningful activities that are tailored to their needs and preferences.