# Feasibility and Acceptability of Collaborative Augmented Reality for Older Adults and Companions: Protocol for a Randomized Controlled Trial

## TL;DR

This study tests if using augmented reality with older adults and their companions is feasible and acceptable for reducing loneliness.

## Contribution

This is the first study to use collaborative augmented reality with photorealistic avatars for older adults and their companions.

## Key findings

- All 8 enrolled pairs completed all sessions, indicating high retention.
- The study processes and technology were found to be feasible and acceptable.
- Results will inform a larger trial on the efficacy of the intervention.

## Abstract

Loneliness and social isolation are common among older adults and are associated with dire consequences. Studies using interactive communication technology (ICT) interventions with older adults have yielded mixed results. Advancements in collaborative head-mounted display augmented reality (HMD-AR) can provide older adults who are geographically distant from their families with a more diverse range of interactive activities, thus offering greater potential to enhance social connection.

We examined the feasibility and acceptability of cocreated collaborative HMD-AR activities and 2D ICT (eg, Zoom) activities among older adults and their family members and close friends.

In total, 8 pairs of older adults and their designated companion (family or friend) from the greater Nashville area were randomized to the HMD-AR or 2D ICT groups. Eligibility criteria for older adults included being 60 years or older, being able to tolerate HMD-AR, being cognitively and physically able to participate, and having a companion willing to participate. For long-term care settings, participants must have been a resident for at least 3 months. All participants lived within a 1-hour driving distance from the investigators’ university. Each older adult–companion pair participated in eight 30-minute sessions over 4 weeks. Participants randomized to the HMD-AR group had photorealistic avatars created; they participated in collaborative activities (ie, fireplace decoration, checkers) that were cocreated in an earlier study. Those randomized to the 2D ICT group had the opportunity to play virtual checkers or house décor games. Engineers remained on-site for all participants to assist as needed. The primary outcome was the feasibility of the study processes (ie, recruitment, retention, and data collection) and the technology (ie, viability, usability, comfort, ease of use, and acceptability). The study used face-to-face questionnaires and observations to collect data.

Funding was received from the National Institute on Aging in August 2022 and from the National Science Foundation in October 2022. This study was approved by the local institutional review board. Following the initial design and testing of the HMD-AR activities, recruitment and data collection for the feasibility and acceptability study began in April 2024 and were completed in May 2025. Of the 8 enrolled older-companion pairs, 8 (100%) completed all sessions. The final data acquisition has been completed, and data cleaning is currently ongoing. Results are intended to be published in 2026.

To our knowledge, this study is the first collaborative augmented reality study using photorealistic avatars between older adults and their family members or friends. Our study will determine whether the use of HMD-AR is feasible, and the results of this pilot study will inform a full-scale randomized controlled trial evaluating the efficacy of the intervention to reduce loneliness among older adults.

ClinicalTrials.gov NCT06179225; https://clinicaltrials.gov/study/NCT06179225

DERR1-10.2196/83864