Supporting Social Engagement in Long-Term Care Through Paired Socially Assistive Robot-Virtual Reality Activities for Older Adults with Cognitive Impairment and Apathy.

Introduction: Older adults living in long-term care settings, particularly those with cognitive impairment and apathy, frequently experience reduced social engagement. Socially assistive robots and virtual reality systems may help support engagement, but little is known about whether they can sustain engagement during real-world deployment while also facilitating interaction between older adults. This study examined whether socially structured socially assistive robot-virtual reality (SAR-VR) systems could sustain engagement and support human-human interaction during repeated use in long-term care settings. Methods: This analysis focused on the SAR-VR intervention arm of a larger eight-week study and included 60 older adults with cognitive impairment from 23 long-term care sites. Participants were exposed to two SAR-VR systems featuring different robot embodiments (dog-like and humanoid), roles, and activities. Across 756 repeated intervention sessions, engagement was observationally assessed using observed ratings of attention, activity attitude, robot attitude, and conversational targeting. Results: Sustained attention and activity attitudes remained consistently positive across both SAR-VR systems over repeated exposure. Peer-to-peer and research-staff directed speech occurred across both systems. While robot-directed speech was more common in the dog-like condition, partner-directed communication remained stable, indicating that increased human-robot interaction did not occur at the expense of human-human interaction. Baseline cognitive functioning was associated with attentional engagement but not with attitudinal evaluations. Baseline technology acceptance did not strongly predict post-interaction impressions. Participants who anthropomorphized the robots at baseline demonstrated more positive engagement during sessions. Discussion: These findings suggest that socially structured SAR-VR systems can sustain meaningful engagement while preserving peer interaction in naturalistic dementia care. The results also support the feasibility of designing SAR-VR activities around shared goals and coordinated actions to promote reciprocal human engagement, while recognizing that the study design does not allow definitive conclusions about clinical efficacy or the effects of specific robot features.