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Learn more: PMC Disclaimer | PMC Copyright Notice J Clin Nurs . 2024 Jul 17;35(5):2012–2027. doi: 10.1111/jocn.17375 Search in PMC Search in PubMed View in NLM Catalog Add to search Virtual reality‐based reminiscence therapy for older adults to improve psychological well‐being and cognition: A systematic review Wai Hung Daniel Ng Wai Hung Daniel Ng , BSN (Hons.), RN 1 National Cancer Centre Singapore, Singapore Health Services, Singapore, Singapore Staff Nurse Find articles by Wai Hung Daniel Ng 1 , Wei How Darryl Ang Wei How Darryl Ang , PhD, BSN (Hons), RN 2 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Research Fellow Find articles by Wei How Darryl Ang 2, ✉ , Hiroki Fukahori Hiroki Fukahori , PhD, RN 3 Faculty of Nursing and Medical Care, Keio University, Fujisawa‐City, Japan Professor Find articles by Hiroki Fukahori 3 , Yong Shian Goh Yong Shian Goh , PhD, RN, RMN, FAAN 2 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Assistant Professor Find articles by Yong Shian Goh 2 , Wee Shiong Lim Wee Shiong Lim , MBBS, MRCP, MMed, MHPEd, AGSF, FAMS 4 Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore, Singapore 5 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore 6 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Senior Consultant and Associate Professor Find articles by Wee Shiong Lim 4, 5, 6 , Chiew Jiat Rosalind Siah Chiew Jiat Rosalind Siah , PhD, MHSc, BHSc, RN 2 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore 7 Department of Nursing, Singapore General Hospital, Singapore, Singapore Senior Lecturer and Program Director (UG‐Clinical) Find articles by Chiew Jiat Rosalind Siah 2, 7 , Betsy Seah Betsy Seah , PhD, BSN (Hons), RN 2 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Research Fellow Find articles by Betsy Seah 2 , Sok Ying Liaw Sok Ying Liaw , PhD, MHSc, BHSc, RN 2 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Professor and Head of Department Find articles by Sok Ying Liaw 2 Author information Article notes Copyright and License information 1 National Cancer Centre Singapore, Singapore Health Services, Singapore, Singapore 2 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore 3 Faculty of Nursing and Medical Care, Keio University, Fujisawa‐City, Japan 4 Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore, Singapore 5 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore 6 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore 7 Department of Nursing, Singapore General Hospital, Singapore, Singapore * Correspondence , Wei How Darryl Ang, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Clinical Research Centre, National University of Singapore, Block MD11, 10 Medical Drive, Level 3, Singapore 117597, Singapore. Email: [email protected] ✉ Corresponding author. Roles Wai Hung Daniel Ng : BSN (Hons.), RN , Staff Nurse Wei How Darryl Ang : PhD, BSN (Hons), RN , Research Fellow Hiroki Fukahori : PhD, RN , Professor Yong Shian Goh : PhD, RN, RMN, FAAN , Assistant Professor Wee Shiong Lim : MBBS, MRCP, MMed, MHPEd, AGSF, FAMS , Senior Consultant and Associate Professor Chiew Jiat Rosalind Siah : PhD, MHSc, BHSc, RN , Senior Lecturer and Program Director (UG‐Clinical) Betsy Seah : PhD, BSN (Hons), RN , Research Fellow Sok Ying Liaw : PhD, MHSc, BHSc, RN , Professor and Head of Department Revised 2024 May 12; Received 2024 Feb 2; Accepted 2024 Jul 4; Issue date 2026 May. © 2024 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. PMC Copyright notice PMCID: PMC13068184 PMID: 39020507 Abstract Background Virtual reality‐reminiscence therapy (VR‐RT) has increasingly been applied to older adults to improve psychological well‐being and cognition. Objective This review aims to identify (1) the design characteristics of conducting a VR‐RT and (2) the effects of VR‐RT on the user experience, cognitive outcomes and psychological well‐being. Design Systematic review. Methods Eligible studies were sourced across nine electronic databases, trial registries, grey literature and hand‐searching of the reference list. A narrative synthesis was conducted. Twenty‐two studies were included, and most were appraised as high quality. Most of the VR‐RTs were highly immersive and personalised, with participants having the autonomy of control. VR‐RT has the potential to improve anxiety and depression, and cognitive outcomes for older adults. Overall, VR‐RT was reported to be an enjoyable experience for older adults. Conclusions VR‐RT is a promising innovation that can improve older adults' psychological well‐being and cognition without significant side effects, including cybersickness and with the potential for scalability across various settings. More randomised controlled studies are needed to evaluate the effectiveness of VR‐RT and its features and treatment dosage. These studies could also examine the effectiveness of VR‐RT as an intervention to promote independence in activities of daily living and physical rehabilitation. Relevance to Clinical Practice VR‐RT is a promising intervention for older adults in community settings to enhance psychological well‐being and cognition. VR's versatility enables personalised experiences within dynamic virtual environments, possibly enhancing engagement and therapeutic outcomes. No Patient or Public Contribution This systematic review did not directly involve patient or public contribution to the manuscript. Keywords: older adults, reminiscence, virtual reality, VR‐RT What does this paper contribute to the wider global community? Virtual reality based reminiscence therapy has the potential to enhance older adults' psychological well‐being and cognition without significant side effects such as cybersickness. Further studies are required to evaluate VR‐RT's effectiveness and to explore its scalability and broader application. 1. INTRODUCTION Reminiscence therapy (RT) is a popular non‐pharmacological intervention that uses supporting materials such as music, pictures and objects to reignite the memories of the past (Bogaert et al., 2013 ; Woods et al., 2012 ). RT has numerous benefits, such as an improved quality of life and lower depressive symptoms (Park et al., 2019 ; Siverová & Bužgová, 2018 ), facilitating socialisation and improving self‐esteem (Pilon et al., 2023 ). Furthermore, RT is affirmed by many as it brings out the individual's preserved abilities rather than their impairment (Bogaert et al., 2013 ). Numerous reviews examining the effectiveness of RT attest to its effectiveness on psychological well‐being (Liu et al., 2021 ; Tam et al., 2021 ) and cognitive function (Cuevas et al., 2020 ; Yen & Lin, 2018 ). Given the benefits of reminiscence and its natural phenomenon in an individual's everyday life, RT should not go unnoticed as a form of intervention and a means to facilitate healthy ageing (Sales et al., 2022 ). With the shift toward a community‐based care model, virtual reality (VR) could serve as a medium to conduct RT for patients to reminisce in any setting, such as a nursing home (Baker et al., 2020 ; Dermody et al., 2020 ). VR can be delivered using different levels of immersion (i.e. low, moderate or high). The level of VR immersion can be determined based on (1) inclusive, the number of signals indicating the presence of the device(s) in the physical world, (2) extensive, the number of sensory modalities stimulated, (3) surrounding, the field of view of the virtual world (4) vivid, the extent of the fidelity and visuals or colour resolution of the display and (5) matching, the extent of visual experience matching to the proprioceptive feedback based on the movement of the participant (Miller & Bugnariu, 2016 ). Furthermore, the natural ageing process reduces older adults' physiological functions and mobility (Seidler et al., 2010 ), making travelling to places to reminisce difficult. Compounding this situation, the COVID‐19 pandemic limited the patient's access to effective treatments (Han et al., 2020 ; Lacasse et al., 2021 ). Therefore, VR could be a medium to overcome such barriers while possibly enhancing therapeutic outcomes (Kolbe et al., 2021 ). Furthermore, VR may provide unique opportunities to enhance and support older adults' psychological and cognitive issues through physical activities, travel and social interactions (Freeman et al., 2017 ). Individually, VR and RT are advantageous. Multiple studies have combined both concepts to form VR‐RT as one intervention, reporting a significant improvement in cognitive function (Xu & Wang, 2020 ) and psychological well‐being (Niki et al., 2021 ). The possible mechanism of VR‐RT lies in their mechanisms working in tandem. The four essential components of VR, specifically, a virtual world, immersion, sensory feedback and interactivity (Sherman & Craig, 2003 ), work in unison to facilitate the mechanism of VR. The mechanism of RT lies in the ability to elicit a psychological and physiological response similar to a real‐world environment (Chirico et al., 2022 ; Newman et al., 2022 ), to personalise the contents (Bell et al., 2020 ; Zahabi & Abdul Razak, 2020 ) and to increase participants' engagement during therapy through immersive and enjoyable environments (Bell et al., 2020 ; Huang et al., 2021 ). Various types of RT exist, namely, simple reminiscence, life review and life review therapy (Westerhof et al., 2010 ). Simple reminiscence aims to elicit positive feelings by sharing positive autobiographic memories (Moral et al., 2015 ). Life review chronologically focuses on the individual's lifespan and seeks to strengthen an individual's meaning of life (Woods et al., 2018 ). Life review therapy incorporates therapeutic frameworks such as cognitive behavioural therapy to promote mental health (Woods et al., 2018 ). Cumulatively, the integrated components of VR and RT are postulated to facilitate the improvement of cognitive function and psychological well‐being. Extensive reviews have been previously conducted on VR (Wittkopf et al., 2020 ) and RT (Khan et al., 2022 ). These reviews examined VR/RT in isolation and were not aimed at incorporating VR and RT as one intervention. To the best of the author's knowledge, only one systematic review examined the conduct of RT through VR (Reisinho et al., 2022 ). However, gaps identified in this review include the absence of identifying the design characteristics of the VR‐RT and its effects on older adults' psychological well‐being and cognitive outcomes. 2. AIMS This review seeks to identify (1) the design characteristics of conducting a VR‐RT, namely, the context of the VR, immersion, VR interactivity and delivery and (2) the effects of VR‐RT on the user experience, cognitive outcomes and psychological well‐being, specifically, anxiety and depression of older adults. 3. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist ( File S1 ) (Page et al., 2021 ). The review is registered in the PROSPERO database (CRD42023438113). 3.1. Search strategy and selection criteria A search was conducted in the PROSPERO International Register of Systematic Reviews and the Cochrane Database of Systematic Reviews to locate similar reviews to prevent duplication. A preliminary search was conducted in PubMed based on the terms ‘Virtual reality’, ‘Virtual environment’, ‘Reminiscence’, and ‘Life review’ and keywords were retrieved from eligible studies to develop the final search terms. The search strategy comprising index terms and keywords was also tested for sensitivity and specificity using an iterative process collaboratively developed with a librarian. The entire search strategy can be found in (File S2 ). A three‐step search strategy (Higgins et al., 2022 ) based on the eligibility criteria, performed from inception to 4 April 2023. First, a search was performed in nine databases, namely, Cumulative Index to Nursing and Allied Health, Cochrane Library, Institute of Electrical and Electronics Engineering, Excerpta Medica Database, ProQuest, PsycINFO, PubMed, Scopus and Web of Science Core Collection. Second, clinical trial registries were searched for ongoing trials on ClinicalTrials.gov , the EU Clinical Trials Register and the WHO International Clinical Trials Registry Platform. Lastly, a snowball search was conducted on the reference list of included studies, existing reviews and grey literature through Google Scholar to enhance comprehensiveness and minimise publication bias (Higgins et al., 2022 ). Studies that elaborated on the characteristics of the VR‐RT system and evaluated its effects on older adults, aged above 65 years (United Nations, 2020 ), compared with usual care or active control, were included. The study outcomes are (1) characteristics of the existing VR‐RT system and (2) outcomes of VR‐RT (i.e. VR experience, psychological well‐being and cognitive outcomes) using either subjective or objective measures. The language was limited to only English, with no restrictions on the publication date. Eligibility criteria were detailed in File S3 . 3.2. Review process Titles, abstracts and full‐text screening were done by two reviewers (DN and DA) independently. Differing responses were discussed and resolved with a third reviewer (LSY). A data extraction form was developed (Higgins et al., 2022 ) and piloted in five studies. The data extraction form was modified and refined to ensure the adequacy and flow of the extracted contents. The data was extracted by one reviewer (DN) and verified by another reviewer (DA) for accuracy. The Mixed Methods Appraisal Tool (MMAT) version 2018 was used to critically appraise all included studies and has been described as an efficient and reliable tool for a mixed‐study review (Pace et al., 2012 ). The MMAT assesses the quality of different study designs, and it includes five key criteria to efficiently and critically appraise each type of study design, as well as two screening questions for all study designs (Hong et al., 2018 ). For qualitative studies, the MMAT assesses the appropriateness of the approach, specifically, the methods (e.g. data collection and data analysis process) and the coherence between the data sources, collection, analysis and interpretation in answering the research question. In quantitative studies, it evaluates whether randomisation was conducted appropriately, whether the groups were comparable at baseline, the completeness of the outcome data, the blinding of the assessors and the adherence of the participants to the assigned intervention. For a mixed methods study, all three categories, quantitative, qualitative and mixed methods, were used to ensure each component's unique methodological characteristics were acknowledged and appropriately evaluated. This is crucial for a comprehensive and accurate assessment of the study's quality. Depending on the percentage of criteria met, each study was appraised with a high (75%–100%), moderate (50%–74%) or low (0%–49%) quality (Chou et al., 2023 ). Quality assessment was done independently by two reviewers (DN and DA), and resolution was achieved through a third reviewer (LSY). 3.3. Data synthesis Popay et al. ( 2006 ) suggested a non‐linear four‐key‐step approach for narrative synthesis. The elements are (1) theory development, (2) the development of a preliminary synthesis, (3) exploration of relationships in the data and (4) assessment of the robustness of the synthesis product. The framework proposed was informed by Bell et al. ( 2020 ) which provided the theoretical basis for VR as a valuable tool in a healthcare setting, and Westerhof et al. ( 2010 ) provided the theoretical basis for RT. The preliminary synthesis was developed through textual description, grouping and clustering and tabulation. Exploring relationships was achieved through conceptual model and qualitative case description. The assessment of robustness was achieved using the mixed methods appraisal tool (MMAT) to appraise the methodological quality of included studies, the provision of examples and detailed information about the interventions examined and the comparison of findings to identify relationships within and between studies. 4. RESULTS In total, 10,050 records were identified through the search, of which 10,028 were excluded. Details of the screening process and excluded studies are provided in File S4 , S5 , respectively. This review included 22 articles involving generally healthy participants ( n = 10) and those involving participants diagnosed with health conditions ( n = 12). Among studies conducted among patients with health conditions, three involved participants with either mild cognitive impairment (MCI) or dementia, seven involved participants with dementia, one involved a participant with Alzheimer's disease and one study involved a participant with MCI. Specifically, one study (Yahara et al., 2021 ) only included older adults with MCI, while another study (Riaz et al., 2021 ) involved older adults with either MCI or dementia. The publication years of the included studies ranged from 2014 (Chapoulie et al., 2014 ) to 2022 (Afifi et al., 2022 ). Five studies were conducted in Australia; Three from Japan and the United States of America; two from Taiwan; and one from Canada, China, England, France, Germany, Netherlands, Pakistan, Portugal and South Korea. Most of the included studies were quantitative designs, and only six studies (Benoit et al., 2015 ; Chapoulie et al., 2014 ; Saredakis et al., 2021 ; Tominari et al., 2021 ; Webber et al., 2021 ; Xu & Wang, 2020 ) had comparators such as a conventional photo, blank screen or usual care. The characteristics of individual studies can be found in Table 1 . For quality assessment, most included studies were rated as high, with only one rated as low (File S6 , S7 ) (Tsao et al., 2019 ). TABLE 1. Characteristics of included studies. Author, year (country) Design Participant characteristics Age (M ± SD) Sample size Intervention (name) Intervention method (core contents of RT) Comparator(s) Outcome(s) (measure) Afifi et al. ( 2021 ); USA Quasi‐experimental Older adults with MCI or mild to moderate dementia 83.10 ± 9.76 T: 21 Rendever Virtual adventure and life story NA VR‐related experiences: Live images and videos Anxiety (10‐point Likert scale) Virtual avatar Fatigue (10‐point Likert scale) Experience (10‐point Likert scale) Afifi et al. ( 2022 ); USA Quasi‐experimental Older adults with MCI or mild to moderate dementia 83.10 ± 9.76 T: 21 Rendever Virtual adventure and life story NA Psychological outcomes: Live images and videos Depression (GDSS) Virtual avatar Mental Health (MHI‐5) Baker, Kelly, et al. ( 2021 ); Australia Qualitative Older adults 70–81 (Range) T: 16 School Days Interactive 3D animation NA VR‐related experiences: Virtual avatar VR experience (WSPQ, semi‐structured interview) Baker, Waycott, et al. ( 2021 ); Australia Mixed‐method Older adults 70–81 (Range) T: 16 School Days Interactive 3D animation NA VR‐related experiences: Virtual avatar VR experience (WSPQ, semi‐structured interview) Bejan et al. ( 2018 ); Germany Qualitative Older adults with dementia NR T: 5 VR‐RT Interactive 3D animation NA VR‐related experiences: VR experience (Interview, proxemo watch) Benoit et al. ( 2015 ); France Quasi‐experimental Older adults 68.20 ± 7.80 T: 18 VR‐RT Live images Active control—Familiar Photo VR‐related experiences: Active control—blank screen Cyber sickness (CSQ) Active control—Unknown image‐based VR location VR experience (10‐point Likert scale) Cognitive outcomes: Autobiographical memory (AFT) Chapoulie et al. ( 2014 ); USA Quasi‐experimental Older adults 66.84 ± 4.33 T: 13 VR‐RT Live images Active control—Familiar Photo VR‐related experiences: Active control—blank screen Cyber sickness (MSQ) Active control—Unknown image‐based VR location VR experience (10‐point Likert scale) Cognitive outcomes: Autobiographical memory (AFT) Coelho et al. ( 2020 ); Portugal Mixed‐method Older adults with dementia 85.60 ± 7.40 T: 9 VR‐RT Live video NA VR‐related experiences: Cyber sickness (SSQ) VR experience (3‐point Likert scale) Psychological outcomes: Psychological and behavioural symptoms (SDS, observation) Huang and Yang ( 2022 ); Taiwan Quasi‐experimental Older adults with dementia 79.00 ± 7.80 T: 25 VR‐RT Interactive 3D animation NA Psychological outcomes: Depression (CES‐D) Cognitive outcomes: Cognitive function (CASI, MMSE, CDR) Kim et al. ( 2021 ); South Korea Quasi‐experimental Older adults with dementia 85.80 ± 3.26 T: 10 VR‐RT Interactive 3D animation NA VR‐related experiences: VR experience (5‐point Likert scale, observation, engagement) Cyber sickness (dichotomous question) Niki et al. ( 2021 ); Japan Crossover Older adults 87.10 ± 4.20 I: 10 VR‐RT Live images NA VR‐related experiences: Computer graphic images Cyber sickness (NRS) VR experience (NRS) Psychological outcomes: Anxiety (STAI) Riaz et al. ( 2021 ); Pakistan Quasi‐experimental Older adults with MCI or mild to moderate dementia 68.29 ± 6.04 T: 7 VR‐EE Interactive 3D animation NA VR‐related experiences: Cyber Sickness (VRSQ) Cognitive outcomes: Cognitive function (MoCA) Saredakis et al. ( 2020 ); Australia Mixed‐method Older adults 87.30 ± 6.30 T: 17 VR‐RT Google Maps Street View NA VR‐related experiences: YouTube 360‐degree videos Cyber sickness (SSQ) VR experience (SUS, NRS) Saredakis et al. ( 2021 ); Australia Quasi‐experimental Older adults 84.8 ± 8.00 T: 13 VR‐RT Google Maps Street View Active control—Laptop VR‐related experiences: YouTube 360‐degree videos Cyber sickness (SSQ) Passive control—Usual care Psychological outcomes: Depression (GDSS) Cognitive outcomes: Cognition function (ACE III) Siriaraya and Ang ( 2014 ); England Qualitative Older adults with dementia 80–101 (Range) T: 20 Virtual world Interactive 3D animation NA VR‐related experiences: VR experience (Open‐ended interview) Tabafunda et al. ( 2020 ); Canada Qualitative Older adults with dementia NR T: 3 VR‐RT Interactive 3D animation NA VR‐related experiences: VR experience (Open‐ended interview) Tominari et al. ( 2021 ); Japan RCT Older adults with dementia I: 85.00 (69–98) (Range) T: 52 VR‐RT Live images Active control—Photo Cognitive outcomes: C: 87.0 (68–98) (Range) I: 26 Cognition function (MMSE, MMSE subscales scores, WFT) C: 26 Multidimensional Observation Scale for Older adults Subjects (MOSES) Tsao et al. ( 2019 ); Taiwan Case series Older adults NR NR VR‐RT Interactive 3D animation NA NA Veldmeijer et al. ( 2020 ); Netherlands Qualitative Older adults who feels lonely 71–97 T: 23 Memory lane VR Interactive 3D animation NA VR‐related experiences: (Range) VR experience (life review reminiscence interview) Webber et al. ( 2021 ); Australia Qualitative Older adults NR T: 7 VR‐RT Google Maps Street View Active control—iPad VR‐related experiences: VR experience (Interviews & questionnaires) Xu and Wang ( 2020 ); China RCT Older adults with Alzheimer's disease I: 76.70 ± 6.55 T: 20 VR‐RT Interactive 3D animation Active control—Photo VR‐related experiences: Passive control (Photo): 79.40 ± 2.00 I: 5 Active control—Blank screen Cyber sickness (VRSQ) Passive control (Blank): 78.50 ± 3.40 Passive control (Photo): 8 Cognitive outcomes: Passive (Blank): 7 Autobiographical memory (Free narrative recall of life history) Yahara et al. ( 2021 ); Japan Case series Older adults with mild cognitive impairment 86.00 ± 6.00 I: 2 VR‐RT Google Maps Street View NA VR‐related experiences: Cyber sickness (NRS) VR experience (NRS) Psychological outcomes: Anxiety (STAI) Open in a new tab Abbreviations: ACE III, Addenbrooke Cognitive Examination III; AFT, Autobiographical Fluency Tas; CASI, Cognitive Ability Screening Instrument; CDR, Clinical Dementia Rating; CES‐D, Center for Epidemiological Studies—Depression; CSQ, Cybersickness Questionnaire; GDSS, Geriatric Depression Scale Short‐Form; MCI, Mild Cognitive Impairment; MHI‐5, Mental Health Inventory; MMSE, Mini‐Mental State Examination; MoCA, Montreal Cognitive Assessment; MOSES, Multidimensional Observation Scale for Older adults Subjects; MSQ, Motion Sickness Questionnaire; NA, Not Applicable; NR, Not Recorded; NRS, Numerical Rating Scale; SDS, Self‐Developed Scale; SSQ, Simulator Sickness Questionnaire; STAI, State–Trait Anxiety Inventory; SUS, Slater‐Usoh‐Steed Presence Questionnaire; VR‐EE, Virtual Reality‐Environmental Enrichment; VR‐RT, Virtual Reality‐Reminiscence Therapy; VRSQ, Virtual Reality Sickness Questionnaire; WFT, Word Fluency Test; WSPQ, Witmer and Singer's Presence questionnaire. 4.1. Characteristics of existing virtual reality‐reminiscence therapy The characteristics of VR‐RT were grouped into four categories, context, immersion, VR interactivity and delivery. A summary of the characteristics of VR‐RT can be found in File S8 . 4.1.1. Context The type of context, either personalised or generic, refers to the approach used to design the VR content. 14 included studies adopted a personalised approach. For example, VR experiences were personalised based on the individual's background, interests, wishes or family members' input (Afifi et al., 2021 ; Niki et al., 2021 ). The remaining studies adopted a generic approach, displaying a likely familiar virtual location such as the pyramid of Egypt (Riaz et al., 2021 ). 4.1.2. Immersion The level of immersion for the included studies was mostly high, with only two deemed low (Tabafunda et al., 2020 ; Tominari et al., 2021 ). Both articles were deemed low level of immersion as they have a limited field of view of the virtual environment (VE) coupled with the high presence of the physical world during the VR‐RT session, where participants could easily be disassociated from the virtual world (Tabafunda et al., 2020 ; Tominari et al., 2021 ). Studies that were ranked as high level of immersion could move or change their point of view within the virtual world, and the presence of the head‐mounted display (HMD) further enhances the sense of immersion with the ability to change the field of view in the VE based on the motion of the wearer. For example, Kim et al. ( 2021 ), reported an immersion score of 4.93 ± .16 (5‐point Likert scale) and stated that a high degree of immersion was confirmed among the participants. As for those studies that were ranked as having a moderate level of immersion, they often only allow a change in the point of view in the VE and only stimulate the visual sensory feedback. For example, Yahara et al. ( 2021 ) only showed images of memorable places to the participants via a head‐mounted device, where a change of view within the VE is achieved to increase immersion, however, only one sensory feedback, visual, was stimulated. Audio‐visual stimulations were used to improve the immersion of VR‐RT. For instance, Riaz et al. ( 2021 ) had inter‐changeable graphics such as day/night cycles and terrains like mountains to enhance visual stimulation. Additionally, a spatialised 3D sound system of ambient sounds was used to enhance auditory stimulation (Benoit et al., 2015 ; Chapoulie et al., 2014 ; Siriaraya & Ang, 2014 ). 4.1.3. Virtual reality interactivity The VR interaction was done in two aspects: self and interventionist‐controlled. In most studies, participants independently interacted with the VR. For example, Baker, Waycott, et al. ( 2021 ) had the participants use the HMD and body‐tracking sensor to simulate the movement of the virtual avatar and interact within the VE. Meanwhile, Benoit et al. ( 2015 ) had the participants wear a wireless three‐finger tracker to engage within the VE. In terms of interventionist‐controlled interactivity, Tominari et al. ( 2021 ) employed a trained nurse to manipulate the screen, allowing participants to explore the VE so that the older adults did not need to master the iPad to engage effectively in the VR‐RT session. It was noted that four (Baker, Kelly, et al., 2021 ; Baker, Waycott, et al., 2021 ; Kim et al., 2021 ; Riaz et al., 2021 ) studies reported participants having slight difficulties getting used to the controllers. However, Riaz et al. ( 2021 ) reported that participants were competent after a few sessions, indicated by a significant decrease in input error ratio ( p < .01). Five studies had interventionist‐controlled with reasons such as to mitigate frustration, ensure a seamless experience and not require participants to master the controllers before use (Afifi et al., 2021 , 2022 ; Saredakis et al., 2020 ; Tominari et al., 2021 ; Yahara et al., 2021 ). Only one study with interventionist control included healthy participants (Saredakis et al., 2020 ). Additionally, out of the 12 studies involving participants with dementia or MCI, only four incorporated interventionist control (Afifi et al., 2021 , 2022 ; Tominari et al., 2021 ; Yahara et al., 2021 ). Five studies incorporated virtual prompts, either visual, audio or both, to increase engagement and immersion. Baker, Kelly, et al. ( 2021 ) stated that virtual prompts facilitated discussions and empowered individuals to choose when and how they wanted to contribute. Coelho et al. ( 2020 ) also suggested that the virtual prompts enhanced immersion and engagement as external instructions likely disassociate participants from the VE. 4.1.4. Delivery All the included studies conducted simple reminiscence. Most studies ( n = 17) conducted the VR‐RT sessions individually. Five studies conducted it in a group, and one (Siriaraya & Ang, 2014 ) conducted it in a mixed setting where participants experienced the VE individually and in a group setting. Additionally, three (Afifi et al., 2021 , 2022 ; Siriaraya & Ang, 2014 ) out of the five studies conducted in a group setting had patients with MCI or dementia. In a group setting, two forms of social interaction were identified: participants with their family members or other participants (Afifi et al., 2021 , 2022 ; Baker, Kelly, et al., 2021 ; Baker, Waycott, et al., 2021 ). For instance, Afifi et al. ( 2021 ) conducted a session called ‘Virtual Life Story,’ where both older adults and their family members revisited memorable places using HMDs, such as the participant's childhood home or family vacation sites, and reminisced regarding the past. Baker, Kelly, et al. ( 2021 ) achieved social interactions between participants through the VE, where participants had to collaboratively decide to teleport to the next environment, a classroom, where they would further interact and engage within the VE. On an individual level, participants would explore and interact with the VE independently. For example, participants would sit in front of a projector and use the attached sensors to interact with the virtual environment (Benoit et al., 2015 ; Chapoulie et al., 2014 ). Ten studies had considerations for the conduct of VR‐RT, namely, the group size and having the participants be seated during the conduct. Three studies (Baker, Kelly, et al., 2021 ; Baker, Waycott, et al., 2021 ; Veldmeijer et al., 2020 ) reported that participants preferred a small group size, with a study (Baker, Kelly, et al., 2021 ) reporting a size of no more than four. The next consideration would be for participants to be seated during the conduct of VR‐RT for three main reasons, namely fatigue reduction (Siriaraya & Ang, 2014 ), mitigating cybersickness (Baker, Kelly, et al., 2021 ; Baker, Waycott, et al., 2021 ; Huang & Yang, 2022 ; Saredakis et al., 2020 , 2021 ) and preventing falls (Benoit et al., 2015 ; Chapoulie et al., 2014 ; Huang & Yang, 2022 ; Kim et al., 2021 ; Saredakis et al., 2020 ). 4.2. Outcomes of virtual reality‐reminiscence therapy The three outcomes of VR‐RT are VR‐related outcomes, psychological well‐being and cognitive outcomes. Table 2 summarises the overall outcomes of VR‐RT. TABLE 2. Overview of VR‐RT outcomes. Author (year) Key results VR‐related Psychological outcomes Cognitive outcomes Experience Immersion Cyber sickness Depression Anxiety Cognitive function Autobiographical memory Afifi et al. ( 2021 ) + + NA NA NA NA NA Afifi et al. ( 2022 ) NA NA NA U U NA NA Baker, Kelly, et al. ( 2021 ) + + NA NA NA NA NA Baker, Waycott, et al. ( 2021 ) + + NA NA NA NA NA Bejan et al. ( 2018 ) + NA NA NA NA NA NA Benoit et al. ( 2015 ) + + + NA NA NA + Chapoulie et al. ( 2014 ) + + + NA NA NA + Coelho et al. ( 2020 ) + NA + U U NA NA Huang and Yang ( 2022 ) NA NA NA + NA U NA Kim et al. ( 2021 ) + + + NA NA NA NA Niki et al. ( 2021 ) + NA + NA + NA NA Riaz et al. ( 2021 ) NA NA + NA NA U NA Saredakis et al. ( 2020 ) + NA U NA NA NA NA Saredakis et al. ( 2021 ) NA NA + U NA U NA Siriaraya and Ang ( 2014 ) + + NA NA NA NA NA Tabafunda et al. ( 2020 ) + NA NA NA NA NA NA Tominari et al. ( 2021 ) NA NA NA NA NA U NA Tsao et al. ( 2019 ) NA NA NA NA NA NA NA Veldmeijer et al. ( 2020 ) − NA NA NA NA NA NA Webber et al. ( 2021 ) + NA NA NA NA NA NA Xu and Wang ( 2020 ) + + + NA NA NA + Yahara et al. ( 2021 ) + NA + NA + NA NA Open in a new tab Abbreviations: −, Unfavourable outcome; +, Beneficial outcome; NA, Not Assessed; U, Unremarkable outcome. 4.2.1. Virtual reality related outcomes VR‐related outcomes refer to the experience of participating in the VR, the perceived level of immersion and cybersickness. Most studies investigated the participants' VR‐RT experience. All but one study (Veldmeijer et al., 2020 ) indicated a positive experience during the session. Afifi et al. ( 2021 ) reported that the participants were delighted with their experience with the VR‐RT, with an overall mean score of 9.21 (10‐point Likert scale). However, the VR experience for Veldmeijer et al. ( 2020 ) among healthy participants was deemed unremarkable, as the recollection of positive memories evoked as many negative memories as an unintended consequence. Siriaraya and Ang ( 2014 ) stated that negative memories could be effectively mitigated through playful VE designs, coupled with strategic redirection of participants' attention toward the positive aspects of the activities. Multiple studies explored the participant's degree of perceived immersion during the exposure. All but one study (Benoit et al., 2015 ), indicated a high level of immersion felt by participants. Kim et al. ( 2021 ) reported that the participants experienced a high degree of immersion, with a high mean score of 4.93 ± .16 (5‐point Likert scale). Conversely, Benoit et al. ( 2015 ), the only study conducted among healthy participants reported a medium immersion score, with exact scores not reported. Ten studies investigated VR‐RT‐induced cybersickness. Except one study (Saredakis et al., 2020 ) all reported no significant cybersickness. Chapoulie et al. ( 2014 ) reported that none of the participants experienced any sickness during the VR‐RT session. However, Saredakis et al. ( 2020 ) reported that 6 out of 17 participants experienced temporary negative symptoms or side effects during the VR‐RT, with no indications of the type and seriousness of the negative symptoms. 4.2.2. Psychological outcomes Six studies recorded psychological outcomes, of which two recorded both anxiety and depression (Afifi et al., 2022 ; Coelho et al., 2020 ), two measured only depression (Huang & Yang, 2022 ; Saredakis et al., 2021 ) and two others measured only anxiety (Niki et al., 2021 ; Yahara et al., 2021 ). Both Afifi et al. ( 2022 ) and Coelho et al. ( 2020 ), recruited participants with MCI or dementia, reported no significant changes in depression and anxiety scores post‐intervention ( p > .05). However, Huang and Yang ( 2022 ), recruited participants with dementia, reported a significant reduction in depression scores post‐intervention ( p < .01). Additionally, Niki et al. ( 2021 ), with healthy participants, reported that the mean score for anxiety decreased significantly after the first VR experience ( p = .01), which further decreased after the second viewing ( p < .01). 4.2.3. Cognitive outcomes Seven included studies examined the effects of VR‐RT on cognitive outcomes, namely, cognitive function and autobiographical memory. Specifically, four studies (Huang & Yang, 2022 ; Riaz et al., 2021 ; Saredakis et al., 2021 ; Tominari et al., 2021 ) investigated the effects of VR‐RT on cognitive function, with all four studies having no significant difference post‐intervention. Furthermore, among these four studies, three studies (Huang & Yang, 2022 ; Riaz et al., 2021 ; Tominari et al., 2021 ) had participants with dementia or MCI. Three studies (Benoit et al., 2015 ; Chapoulie et al., 2014 ; Xu & Wang, 2020 ) investigated the effects of VR‐RT on autobiographical memory, and all three reported a significant positive influence on autobiographical memory; among these five studies, only Xu and Wang ( 2020 ) had older adults with Alzheimer's disease as participants. Benoit et al. ( 2015 ) reported that a familiar VE had a significantly higher ‘remember’ response than those in the active control groups, p < .01, and a significantly higher autobiographical fluency task score than those in the active control groups, p < .05. Four studies (Benoit et al., 2015 ; Chapoulie et al., 2014 ; Tominari et al., 2021 ; Xu & Wang, 2020 ) found no significant difference between a photo and VR‐RT regarding cognitive outcomes. However, three studies (Benoit et al., 2015 ; Chapoulie et al., 2014 ; Xu & Wang, 2020 ) reported a significantly higher recall score ( p < .01) in VR‐RT compared to a blank screen. 5. DISCUSSION This review identified that VR‐RT could potentially promote psychological and cognitive outcomes. The included studies indicated a positive VR‐RT experience with generally no significant cybersickness and technical issues. From a technological perspective, VR facilitates a high level of immersion and interaction, mainly through audio‐visual stimulation coupled with participants having full control over the interaction within the VE. VR interactions were further enhanced through virtual prompts. Additionally, the advantage of flexibility was highlighted through a personalised context when designing the VR content, possibly enhancing its therapeutic effects. The evidence demonstrated the potential of VR‐RT to promote psychological well‐being. Two included studies indicated significant improvement in anxiety (Niki et al., 2021 ) and depression (Huang & Yang, 2022 ). Several reasons could explain this phenomenon. With a personalised VR‐RT, participants could relive intimate and fond memories through VR‐RT that trigger positive emotions, which may buffer against anxiety and depressive symptoms (Satorres et al., 2021 ). Furthermore, Lewis ( 1971 ) proposed that reminiscence elicits one's past to mitigate current stresses. This could be associated with the theory of continuity, where the lack of internal continuity causes distress, which could be mitigated by recollecting past experiences to maintain internal structure (Atchley, 1989 ). However, a few included studies reported no significant difference in anxiety (Afifi et al., 2022 ; Coelho et al., 2020 ) and depression (Afifi et al., 2022 ; Coelho et al., 2020 ; Saredakis et al., 2021 ) post‐intervention. It is worth noting that all the included studies only conducted simple reminiscence. Therefore, the psychotherapeutic effect may be less effective than life review and life review therapy. Life review facilitates the recollection of coping mechanisms and values by evaluating positive and negative memories to strengthen an individual's mental health (Webster & Young, 1988 ; Woods et al., 2018 ). Furthermore, the counsellor must be experienced in structuring the sessions and questions to link memories to current life situations (Westerhof et al., 2010 ). Similarly, life review therapy aims to bring about self‐change to reduce psychological issues in older adults (Westerhof et al., 2010 ; Woods et al., 2018 ). However, a counsellor must integrate a therapeutic framework such as CBT to intentionally draw on life stories to steer toward a more positive self‐identity (Westerhof et al., 2010 ). This review found that VR‐RT had no significant impact on cognitive outcomes other than autobiographical memory. This is not surprising considering that VR‐RT aims to recollect an intimate and personal memory of the past. The included studies that assessed cognitive outcomes had participants with dementia, where short‐term memories are negatively affected (Birt et al., 2020 ). However, distant memories can be triggered through RT, which likely explains the significant influence on autobiographical memory (Manav & Simsek, 2019 ). With the influence on autobiographical memory, it may be helpful to incorporate VR‐RT to support the patient's independence in activities of daily living through the recollection of such activities that were performed since they were young. There is a concern that the VR experience of older adults may be diminished by poor digital literacy and side effects, notably cybersickness. However, based on the findings of this review, no significant difficulties were faced using the VR system and no significant cybersickness was observed. Instead, the majority of the included studies indicated an overall positive experience. These findings are consistent with the other systematic reviews regarding older adults and the usage of VR (Reisinho et al., 2022 ; Tuena et al., 2020 ). Furthermore, the duration of each VR session could explain the absence of any significant cybersickness. Best et al. ( 2020 ) reported that a VR session of less than 45 min could mitigate cybersickness. Consistent with this review's findings of no significant cybersickness, all sessions of the included studies were less than 45 min. The review found that the cybersickness symptoms are often transient (Saredakis et al., 2020 ), hence it is paramount for future trials to assess for such symptoms in the acclimatisation phase. Multiple studies had the participants seated during the session to mitigate falls and cybersickness. To further mitigate cybersickness, reviews have indicated the use of visuo‐vestibular sensory re‐coupling method to effectively reduce cybersickness, such as the use of a rotational chair combined with the timely coupling of physical movement with the VR (Arshad et al., 2021 ; Caserman et al., 2021 ). Although unique to one study (Veldmeijer et al., 2020 ), where the recollection of positive memories evoked as many unintended negative memories, a possible means to mitigate such memories could be achieved through the use of playful virtual designs and the redirection of participants' attention toward the positive aspects of engagement, as suggested by Siriaraya and Ang ( 2014 ). Additionally, the types of RT could play a pivotal role in the participants' experience. For instance, life review intentionally evokes positive and negative memories to facilitate the recollection of coping mechanisms, thereby strengthening individuals' mental health (Webster & Young, 1988 ; Woods et al., 2018 ). Furthermore, a meta‐analysis revealed that RT increased quality of life while decreasing depression and neuropsychiatric symptoms (Saragih et al., 2022 ). 5.1. Strengths and limitations To the authors' knowledge, this review is the first to identify and provide a comprehensive characteristic of VR‐RT coupled with its effects on both psychological and cognitive outcomes. Additionally, the information provided here on the technical features and their relationship to clinical findings is not presented elsewhere in this detail. A thorough three‐step search through nine electronic databases, grey literature and trial registries to effectively obtain all possible published or unpublished literature. Also, the majority of the included studies were appraised as high quality. This review, however, is constrained for several reasons. This review could not provide details on the effectiveness of different types of RT (e.g. life review and life review therapy) through VR. Additionally, only English studies were included, potentially leading to publication language bias (Rothstein et al., 2005 ). The included studies had relatively small sample sizes and infrequent VR‐RT conducts, which might affect their generalisability. As a meta‐analysis was not feasible, a narrative synthesis was conducted. Instead, the narrative synthesis provided descriptive conclusions that focused on VR‐RT's characteristics and effects on older adults. 6. CONCLUSION The conduct of VR‐RT is an innovative strategy that facilitates highly immersive and customisable audio‐visual stimulation. It could improve psychological well‐being and cognitive outcomes without significant side effects, including cybersickness. Further RCTs are needed to evaluate the effectiveness of VR‐RT, its features, and treatment dosage. Future studies could also examine the effectiveness of different types of RT through VR and the effectiveness of VR‐RT as an intervention to promote independence for activities of daily living and physical rehabilitation. 7. RELEVANCE TO CLINICAL PRACTICE This review found that the diversification in conducting VR‐RT may be associated with the absence of guidelines, the diverse types of content that can be made and the digital literacy of the older adult. From the included studies, no clear trend could be identified due to the varied components. However, based on the guidelines of traditional RT, the treatment dosage should be at least six weeks long, with one session per week, each lasting no longer than 45 min (Best et al., 2020 ; Gaggioli et al., 2014 ). A review reported that the overall mean effect size was significant, with a minimum of 8 sessions (Park et al., 2019 ). Furthermore, due to the intimate nature of sharing one's past memories, a review reported that a small group of up to six participants would enhance the conduct of RT (Cuevas et al., 2020 ). Through this review, specific to the features, it was found that a personalised context would increase the familiarity of the content (Satorres et al., 2021 ), while engagement is enhanced with the participants having complete control during VR‐RT interaction and the use of virtual prompts (Gentner & Seufert, 2020 ; Violante et al., 2019 ). Given the absence of guidelines on conducting a VR‐RT, this study could provide a basis for practical implications for future trials or conduct at the community level while enhancing the user experience through the suggested methods. Visual‐audio stimulation through virtual prompts and surround sound should be used to enhance sensory feedback. In a technical aspect of VR‐RT, using virtual prompts, either audio, visual or both, would be useful when incorporating a counsellor. Its advantage lies in its ability to guide and enable active participation when immersed in VR without being distracted by external surroundings (Bryant & Hemsley, 2022 ). An immersive VR can elicit a psychological and physiological response in the VR similar to a real‐world setting (Bell et al., 2020 ). As such, participants could experience and reminisce within the VR as though they were there, possibly enhancing the therapeutic effects (Kirk et al., 2019 ). Furthermore, this review found that immersive VR had no significant side effects. Additional studies are required to justify the proposed features and treatment dosage of VR‐RT and to evaluate its effectiveness. Given the utilisation of motion‐tracking devices and controllers used for interacting with the VE, future research could investigate the effectiveness of VR‐RT as a potential intervention to enhance independence in daily activities and physical rehabilitation. Notably, Sánchez et al. ( 2020 ) conducted a review that explored the innovative and feasible nature of using VR with community‐dwelling older adults to enhance functional autonomy in real‐life activities. From a clinical perspective, VR‐RT can be seamlessly introduced to older adults in community settings who may be experiencing poor mental well‐being. Considering the diverse range of reminiscence therapies available for managing various needs, life review and life review therapy emerge as potentially more effective psychotherapeutic tools than simple reminiscence. Moreover, leveraging the flexibility of VR as a medium for conducting RT allows for personalised experiences and dynamic virtual environments, which could significantly enhance user engagement and therapeutic outcomes. VR‐RT could provide significant benefits to older adults within the community. In the rapidly evolving world, where past environments and experiences may no longer exist or be physically accessible, VR‐RT offers a unique opportunity for these individuals to revisit and reminisce about places, activities and items from their past. This is particularly beneficial for those who may be physically limited or unable to engage in these activities in the real world due to age‐related conditions or health issues. However, this review could not conclude which group, healthy participants or those with pre‐existing conditions, might benefit more from VR‐RT. Further studies are necessary to provide a more conclusive determination. AUTHOR CONTRIBUTIONS Wai Hung Daniel Ng: Conceptualization, investigation, data curation, formal analysis, visualisation, writing—original draft, writing—review and editing. Wei How Darryl Ang: Investigation, formal analysis, visualisation, supervision, writing—original draft, writing—review and editing. Hiroki Fukahori: Conceptualization, formal analysis, writing—review and editing. Chiew Jiat Rosalind Siah: Visualisation, writing—review and editing. Yong Shian Goh: Visualisation, writing—review and editing. Wee Shiong Lim: Conceptualization, formal analysis, writing—review and editing. Betsy Seah: Visualisation, writing—review and editing. Sok Ying Liaw: Conceptualization, supervision, investigation, data curation, formal analysis, writing—original draft, writing—review and editing. FUNDING INFORMATION None. CONFLICT OF INTEREST STATEMENT None. Supporting information Data S1. JOCN-35-2012-s001.zip (202.8KB, zip) ACKNOWLEDGEMENTS The review team would like to thank the National University of Singapore's Medical Library for the support in the development of the search strategy and the study authors for providing us with additional information for the purposes of this review. Ng, W. H. D. , Ang, W. H. D. , Fukahori, H. , Goh, Y. S. , Lim, W. S. , Siah, C. J. R. , Seah, B. , & Liaw, S. Y. (2026). Virtual reality‐based reminiscence therapy for older adults to improve psychological well‐being and cognition: A systematic review. Journal of Clinical Nursing, 35, 2012–2027. 10.1111/jocn.17375 PROSPERO registration: CRD42023438113. DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. REFERENCES Afifi, T. , Collins, N. , Rand, K. , Otmar, C. , Mazur, A. , Dunbar, N. E. , Fujiwara, K. , Harrison, K. , & Logsdon, R. (2022). 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