The goal of this clinical trial is to evaluate whether a virtual reality (VR) based social platform can improve mental health and social connection for older adults who receive in-home care. Specifically, the study aims to determine if the VR program reduces loneliness, depressive symptoms, and boredom while increasing social connection and well-being among older adult participants. It also explores whether access to the VR program reduces caregiver burden and depressive symptoms for family caregivers. Researchers will compare an immediate-start group to a waitlist control group to assess whether the VR program improves outcomes compared to standard home care alone. Both groups will eventually receive the intervention. Older adult participants will use a VR headset at home to join group activities three times a week. These sessions include social activities with local peers and live-hosted group activities. A family caregiver or home care professional may be present during sessions if needed for support. Over a 12-week study period, older adult participants will complete three surveys assessing their mood, social connection, and well-being. Family caregivers of participating older adults are also invited to join an optional caregiver substudy. Caregivers who enroll in the substudy will not participate in the VR activities themselves, but will complete three surveys at the same time points over the 12 weeks to share their own well-being and caregiving experiences.
Approximately 90% of older adults in the United States prefer to age in place at home. However, older adults aging at home may experience social isolation and limited opportunities for meaningful social and cognitive engagement, which are associated with depression, cognitive decline, and increased mortality risk. Although home care services are designed to support physical and daily living needs, they may have limited capacity to provide ongoing social and cognitive engagement. The Thrive at Home study tests whether a networked virtual reality (VR) social platform can help address this gap by connecting older adults receiving home care with one another and with residents of nearby senior living communities. This is a decentralized, randomized controlled trial using a waitlist control design. Two hundred fifty (250) home-dwelling adults aged 65 and older who are receiving in-home care will be enrolled from home care agency offices across approximately 25 U.S. cities. Participants span the cognitive range from unimpaired through moderate dementia, with a Montreal Cognitive Assessment (MoCA) score of 12 or above required for eligibility. Participants are randomized 1:1 to either Group 1 (Immediate Treatment) or Group 2 (Waitlist Control). Intervention Timeline \& Dosing: * Group 1 (Immediate Treatment): Begins the VR social program within 1-3 weeks after baseline and participates for a 6-week primary intervention period, followed by a 4-week monitoring period during which platform access continues and spontaneous use is tracked. * Group 2 (Waitlist Control): Continues standard home care alone for the first 6 weeks, and then crosses over to receive an abbreviated 4-week version of the VR social program. Both arms eventually receive the intervention, protecting participant welfare while preserving a rigorous between-group, standard-of-care comparison at the primary 6-week timepoint. The intervention consists of three VR group activities per week: two local social sessions hosted by a community activity director, and one live, expert-hosted session of the participant's choosing. Sessions are conducted entirely from the participant's home while seated. Participants with a MoCA score below 18, or any participant requiring physical assistance, will have a caregiver or home care professional present during sessions for support. Data Collection \& Endpoint Structure: Data are collected at three primary milestones: baseline (T1), end of the 6-week primary intervention period (T2, approximately Week 7), and end of the 12-week study period (T3). * The primary efficacy analyses compare changes from baseline in the immediate intervention group to the waitlist control group at the primary 6-week endpoint (T1 to T2). * Outcomes assessed at T3 are exploratory; they evaluate treatment replication in the waitlist group (T1 to T3) and long-term maintenance of gains in the immediate intervention group (T2 to T3). Primary outcomes for older adults (home care clients) include validated measures of depressive symptoms, loneliness, thriving, and boredom. Secondary outcomes include cognitive function, vitality, mental health (anxiety, positive affect, negative affect), social health (companionship, social connectedness), and satisfaction with home care services. Full specification of each measure, instrument, and assessment timepoint is provided in the registry's outcome measure tables. Additional Exploratory Frameworks: Beyond the primary and secondary endpoints tracked within the registry tables, this trial incorporates an extensive exploratory framework to evaluate broader psychosocial, behavioral, neuropsychiatric, and technical impacts. These observational and hypothesis-generating metrics will be analyzed and reported in subsequent secondary publications to better understand the holistic mechanisms of the intervention. For the primary participants (older adults), these exploratory dimensions are structured across five core domains: * Social Network Dynamics \& Relational Health: Assessment of newly formed interpersonal relationships, including the count and nature of new friendships, psychological barriers to social connection, and the individual's motivation, effort, and success in establishing new social ties. * Psychosocial Well-Being \& Mechanisms of Engagement: Evaluation of sub-domains of mental health, including self-connection, reminiscence behaviors, perceptions of aging and senior living environments, and mid-intervention psychological mediators (such as perceived co-presence, mutual personal disclosure, and group responsiveness). * Behavioral, Cognitive, \& Digital Biomarkers: Analysis of objective telemetry and speech data, including headset-derived kinesic engagement (movement tracking) and recorded session audio to evaluate vocal and linguistic markers of emotion and memory. Subjective cognitive stimulation and behavioral/neuropsychiatric symptom severity are also tracked. * Health Status \& System Utilization: Longitudinal tracking of subjective general health ratings and quantitative healthcare resource utilization over the study period. * Comprehensive User Experience (UX) \& Intervention Feasibility: A robust post-intervention battery evaluating hardware and software usability, physical and cognitive comfort, personal enjoyment, user satisfaction, and long-term platform recommendation metrics. All unlisted exploratory variables will be managed as purely descriptive and hypothesis-generating analyses, with full parameters specified in the trial's internal protocol and Statistical Analysis Plan (SAP). Family Caregiver Substudy: Family caregivers are co-enrolled on a voluntary, non-randomized basis (n ≈ 125) and linked to their primary participant's randomized arm. The caregiver substudy was not included in the trial's power calculations; all caregiver outcomes are analyzed as exploratory, per the Statistical Analysis Plan. For this optional substudy, core exploratory outcomes tracked in the registry include caregiver burden, perceived stress, depressive symptoms, caregiver empowerment (caregiving self-efficacy, and personal self-efficacy), and satisfaction with home care services. Additional exploratory data will be collected and analyzed in subsequent secondary publications regarding broader caregiving relationship dynamics, secondary psychosocial well-being sub-domains, and qualitative intervention feedback. Due to the hypothesis-generating nature of these extended variables, they are fully specified within the internal protocol and SAP rather than listed as individual registry tracking rows.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
250
Participants engage in a 6-week VR-based social intervention that includes three (30-min) virtual reality (VR) group activities per week using the Rendever platform. This includes two Rendever Thrive Program social sessions hosted by a community Activity Director and one live RendeverLive, expert-hosted group programming event (e.g., guided virtual tours, music, trivia). All sessions are completed entirely from the participant's home while safely seated.
Following the completion of the primary 6-week control period and primary outcome assessments, waitlist participants receive an abbreviated 4-week version of the VR-based social intervention. Participants engage in three (30-min) group activities per week using the Rendever platform, structured identically to the experimental group but limited to a 4-week duration for exploratory replication purposes. All data collected during this abbreviated 4-week crossover period are monitored for descriptive and hypothesis-generating purposes as detailed in the internal Statistical Analysis Plan, rather than tracked as distinct registry outcome rows.
Depressive Symptoms (CES-D)
Depressive symptoms are assessed with a modified version of the 20-item Center for Epidemiologic Studies Depression Scale (CES-D). To increase measurement sensitivity, items are rated on a numerical response scale ranging from 0 to 100 rather than the standard 4-point Likert scale. Total scores are calculated as the mean across all 20 items (range: 0 to 100), where higher scores indicate greater depressive symptom severity.
Time frame: Baseline (T1), Week 7 (T2), Week 12 (T3)
Loneliness (UCLA Loneliness Scale)
Loneliness is assessed with a modified version of the 20-item UCLA Loneliness Scale (Version 3). To increase measurement sensitivity, items are rated on a numerical response scale ranging from 0 to 100 rather than the standard 4-point Likert scale. Total scores are calculated as the mean across all 20 items (range: 0 to 100), where higher scores indicate greater subjective loneliness.
Time frame: Baseline (T1), Week 7 (T2), Week 12 (T3)
Thriving (BIT)
Thriving is assessed with a modified version of the 10-item Brief Inventory of Thriving (BIT). To increase measurement sensitivity, the standard 5-point Likert scale is replaced with a 7-point Likert scale for each item. Total scores are calculated as the mean across all 10 items (range: 1 to 7), where higher scores indicate greater thriving.
Time frame: Baseline (T1), Week 7 (T2), Week 12 (T3)
Boredom (Short Boredom Proneness Scale)
Boredom is assessed using a modified Short Boredom Proneness Scale. Items are modified to assess state (vs. trait) boredom. Participants respond to 7 items on a 7-point Likert scale. Total scores are calculated as the mean across all 7 items (range: 1 to 7), where higher scores indicate greater state boredom.
Time frame: Baseline (T1), Week 7 (T2), Week 12 (T3)
Global Cognitive Function (MoCA)
Global cognitive function is assessed using the st andard Montreal Cognitive Assessment (MoCA), covering attention, memory, language, and executive function. Items are scored according to standard clinical administration guidelines to derive a single aggregate performance metric. Total scores range from 0 to 30, where higher scores indicate greater overall cognitive function.
Time frame: Screening (T1), Week 7 (T2), Week 12 (T3)
Anxiety Symptoms (GAD-7)
Anxiety symptoms are assessed with a modified version of the 7-item Generalized Anxiety Disorder scale (GAD-7). To increase measurement sensitivity, items are rated on a numerical response scale ranging from 0 to 100 rather than the standard 4-point Likert scale. Total scores are calculated as the mean across all 7 items (range: 0 to 100), where higher scores indicate greater anxiety symptom severity.
Time frame: Screening (T1), Week 7 (T2), Week 12 (T3)
Positive and Negative Affect (PANAS)
Positive and negative affective states are assessed using a customized 12-item scale adapted from the Positive and Negative Affect Schedule (PANAS), comprising 6 positive items and 6 negative items. To increase measurement sensitivity, items are rated on a numerical response scale ranging from 0 to 100 rather than the standard 5-point Likert scale. Two separate subscores - Positive Affect and Negative Affect - are calculated as the mean across the 6 items (range: 0 to 100), where higher scores indicate greater intensity of that dimension. An overall affect balance score is also calculated as the positive subscale mean minus the negative subscale mean (range: -100 to +100), where higher positive scores indicate greater net positive emotional well-being.
Time frame: Baseline (T1), Week 7 (T2), Week 12 (T3)
Vitality (Subjective Vitality Scale)
Vitality is assessed with a modified 5-item Subjective Vitality Scale. To increase measurement sensitivity, items are rated on a numerical response scale ranging from 0 to 100 rather than the standard 7-point Likert scale. Total scores are calculated as the mean across all 5 items (range: 0 to 100), where higher scores indicate greater vitality.
Time frame: Baseline (T1), Week 7 (T2), Week 12 (T3)
Companionship (PROMIS Companionship)
Companionship is assessed with a modified version of the 4-item PROMIS Companionship Short Form 4a. To increase measurement sensitivity, items are rated on a numerical response scale ranging from 0 to 100 rather than the standard 5-point Likert scale. Total scores are calculated as the mean across all 4 items (range: 0 to 100), where higher scores indicate greater companionship.
Time frame: Baseline (T1), Week 7 (T2), Week 12 (T3)
Social Connectedness
Social connectedness is assessed with a 15-item multidimensional self-report scale written for this study, which incorporates peer, community, global, and societal connection. Items are rated on a continuous bipolar Global Hedonic Intensity scale ranging from -100 (most unpleasant) through 0 (neutral) to +100 (most pleasurable). Total scores are calculated as the mean across all 15 items (range: -100 to +100), where higher positive scores indicate a greater sense of social connectedness.
Time frame: Baseline (T1), Week 7 (T2), Week 12 (T3)
Satisfaction with Home Care Services (CMS HHCAHPS, Adapted)
Satisfaction with home care services is assessed with a 6-item measure adapted from the Centers for Medicare \& Medicaid Services (CMS) Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). The measure includes items assessing perceived quality of care, overall ratings of care, and willingness to recommend the home care agency. Item responses are converted to a common 0-to-100 scale and averaged to produce a total score ranging from 0 to 100, with higher scores indicating greater satisfaction with home care services.
Time frame: Baseline (T1), Week 7 (T2), Week 12 (T3)
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