This randomized controlled trial examined the effects of using an aging simulation suit on empathy levels among healthcare professionals working in long-term care facilities. A total of 82 participants from four nursing homes in Madrid and Asturias were randomly assigned to an experimental group or a control group. The experimental group received a theoretical session on aging and empathy, followed by an immersive experience using the GERT aging simulation suit, which replicates age-related physical and sensory limitations. The control group attended only the theoretical session. Empathy was assessed before and after the intervention using the Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy - Health Professions version (JSPE-HPS). Results showed significant improvements in the JSPE-HPS total score and in its Perspective Taking and Compassionate Care dimensions in the experimental group, indicating that the immersive experience enhanced both cognitive and affective components of clinical empathy. No significant changes were observed in the IRI scores. These findings suggest that experiential learning through aging simulation can effectively strengthen empathy in active healthcare professionals, promoting more person-centered and compassionate care for older adults in long-term care settings.
Aging is accompanied by physiological, structural, and psychosocial changes that affect mobility, sensory functions, and interaction with the environment. Healthcare professionals working in long-term care facilities play a crucial role in supporting the physical, emotional, and social well-being of older adults. Empathy, understood as the ability to understand and share another person's feelings, is a key component of effective therapeutic relationships and person-centered care. Traditional empathy training for healthcare providers often relies on lectures, role-playing, or observation of patient interactions. However, there is limited evidence regarding the impact of immersive simulation-based methods on empathy among active healthcare professionals. The use of aging simulation suits, which reproduce the physical and sensory limitations of older adults, has emerged as an innovative educational tool to promote understanding of the aging experience and improve empathic attitudes toward older persons. This randomized controlled trial was designed to evaluate the effect of an aging simulation suit (GERT, Niederstotzingen, Germany) on levels of clinical empathy among healthcare professionals working in long-term care facilities. Participants were randomly assigned to one of two groups: Experimental Group: Received a theoretical educational session on aging, functional limitations, and the role of empathy in care, followed by a practical session using the aging simulation suit. During the simulation, participants performed daily living tasks (e.g., walking, climbing stairs, dressing, interacting with others) while experiencing the physical restrictions associated with advanced age. Control Group: Received only the theoretical session on aging and empathy without the immersive simulation experience. Empathy was assessed pre- and post-intervention using two validated instruments: Interpersonal Reactivity Index (IRI) - measures cognitive and emotional dimensions of general empathy. Jefferson Scale of Empathy - Health Professions version (JSPE-HPS) - evaluates empathy specifically in clinical contexts. Data analysis was conducted using repeated-measures ANOVA to assess within- and between-group differences over time. Main findings: The experimental group showed significant increases in total JSPE-HPS scores and in the subscales Perspective Taking and Compassionate Care, whereas the control group showed no significant changes. No significant differences were observed in IRI scores. These results indicate that immersive experiential learning through the use of an aging simulation suit can enhance both cognitive and affective aspects of empathy in healthcare professionals. The study was approved by the Ethics Committee of Universidad Rey Juan Carlos and conducted in accordance with the Declaration of Helsinki and ICH Good Clinical Practice guidelines. This research supports the integration of simulation-based empathy training in continuing professional education for healthcare workers in long-term care, promoting more compassionate, person-centered care for the aging population.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
82
Immersive training session using the GERT aging simulation suit (Niederstotzingen, Germany), designed to reproduce age-related physical and sensory limitations. Participants performed common daily activities (e.g., walking, climbing stairs, dressing, interacting with others) while wearing the suit to experience the physical challenges of aging. This activity was followed by a short debriefing and group reflection aimed at enhancing empathy and awareness toward older adults.
A structured theoretical session covering topics such as aging processes, functional limitations, and the importance of empathy in healthcare and long-term care contexts. Delivered to all participants in both study arms, serving as the baseline educational component for the control and experimental groups.
Universidad Rey Juan Carlos
Alcorcón, Madrid, Spain
Change in total score on the Jefferson Scale of Empathy - Health Professions version (JSPE-HPS)
Mean difference in total Jefferson Scale of Physician Empathy - Health Professional Student version (JSPE-HPS) score between baseline (pre-intervention) and post-intervention for each study group. The JSPE-HPS measures clinical empathy in healthcare professionals and consists of 20 items, with total scores ranging from 20 to 140; higher scores indicate higher empathy (better outcome). The primary analysis was performed using repeated-measures ANOVA to examine time effects and the group × time interaction.
Time frame: Pre-intervention (baseline) and immediately post-intervention (same day)
Change in Perspective Taking subscale of the JSPE-HPS
Mean pre/post difference in the Perspective Taking subscale of the Jefferson Scale of Physician Empathy - Health Professional Student version (JSPE-HPS). The JSPE-HPS consists of 20 items rated on a 7-point Likert scale (total score range 20-140). The Perspective Taking subscale comprises 10 items, with subscale scores ranging from 10 to 70. This subscale assesses cognitive empathy, and higher scores indicate higher levels of empathy (better outcome). Differences were analyzed using repeated-measures ANOVA, including the group × time interaction.
Time frame: Pre-intervention and immediately post-intervention (same day)
Change in Compassionate Care subscale of the JSPE-HPS
Mean pre/post difference in the Compassionate Care subscale of the Jefferson Scale of Physician Empathy - Health Professional Student version (JSPE-HPS). This subscale assesses affective aspects of clinical empathy, with higher scores indicating higher empathy (better outcome). Differences were analyzed using repeated-measures ANOVA, including the group × time interaction.
Time frame: Pre-intervention and immediately post-intervention (same day)
Change in Standing in the Patient's Shoes subscale of the JSPE-HPS
Mean pre/post difference in the Standing in the Patient's Shoes subscale of the Jefferson Scale of Physician Empathy - Health Professional Student version (JSPE-HPS). This subscale assesses the ability to adopt the patient's perspective, with higher scores indicating higher empathy (better outcome). Differences were analyzed using repeated-measures ANOVA, including the group × time interaction.
Time frame: Pre-intervention and immediately post-intervention (same day)
Change in total score on the Interpersonal Reactivity Index (IRI)
Mean difference in total Interpersonal Reactivity Index (IRI) score between pre- and post-intervention. The IRI is a 28-item measure distributed across four subscales (Perspective Taking, Fantasy, Empathic Concern, and Personal Distress), with total scores ranging from 0 to 112. Higher total scores indicate greater empathic disposition. Data were analyzed using repeated-measures ANOVA to evaluate time effects and the group × time interaction.
Time frame: Pre-intervention and immediately post-intervention (same day)
Change in IRI subscale scores (Perspective Taking, Fantasy, Empathic Concern, Personal Distress)
Mean pre/post difference in each of the four Interpersonal Reactivity Index (IRI) subscales (Perspective Taking, Fantasy, Empathic Concern, and Personal Distress), each consisting of 7 items with scores ranging from 0 to 28. For Perspective Taking, Fantasy, and Empathic Concern, higher scores indicate greater empathy (better outcome), whereas for Personal Distress, higher scores indicate greater self-oriented distress (worse outcome). Each subscale was analyzed separately using repeated-measures ANOVA to examine time effects and the group × time interaction.
Time frame: Pre-intervention and immediately post-intervention (same day)
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