Enhancing Emotional Stability and Mental Comfort in Older Adults through a Nostalgic VR Game: A Technology Acceptance Model Analysis

Abstract

Upon observing the daily lives of older adults, they often experience comfort and emotional stability through nostalgic memories. Hence, this study develops a nostalgic VR game from which older adults can obtain a similar sense of comfort and emotional satisfaction. This study extends the technology acceptance model (TAM) to analyze factors influencing older adults’ intention to adopt this VR game. The study involved 102 older adults who participated in the VR experience. The VR game was developed using the Unity engine, designed specifically to trigger nostalgic memories. The analysis shows that the questionnaire was highly reliable. The analysis also revealed that PEOU significantly influences PU (β = 0.559, p < 0.001) and PE (β = 0.694, p < 0.001). PU positively impacts HIPG (β = 0.321, p < 0.05), while ATG strongly influences HIPG (β = 0.270, p < 0.01). The extended TAM model explained 57.3% of the variance in HIPG (R² = 0.573), indicating the substantial impact of these factors on older adults’ intention to engage with the VR game. These results provide valuable insights for developers and healthcare providers aiming to integrate VR as a health tool for older adults.

1. Introduction

In recent years, a significant portion of the population has been entering old age in Taiwan. The World Health Organization defines an aging society as one where senior citizens constitute over 7% of the total population [1]. To enhance their quality of life, it is important to encourage them to adopt healthy lifestyles and continue participating in social activities. These activities provide enjoyment, enrich life, and fulfill psychological needs in ways that support personal goal achievement [2]. Furthermore, older adults actually need to rejuvenate their memories and interest in life for sustainable living in their local societies. Notably, regular engagement in recreational activities can bolster self-esteem and physical health, provide emotional relief, and slow physical decline, thereby improving their quality of life and reducing healthcare expenses.

Healthcare policies specifically designed for senior citizens should be developed to address their socioeconomic disadvantages and healthcare needs, aiming to minimize the wastage of healthcare resources. And providing well-designed leisure activities can significantly enhance the quality of life and health of older adults [3]. This study proposes a leisure activity that improves the physical and emotional states of older adults. Offering older adults activities for socialization and recreation, such as media games, can boost their brain activation and slow down memory degradation. Computer games have been found to be useful in healthcare institutions, government-funded care facilities, and educational institutions for recreational, educational, and medical purposes. Specifically, health-related games, presenting health-related information, have empirically been shown to improve the attitudes of older adults towards playing these games, enhancing knowledge acquisition and boosting cognitive and physical functioning [4,5,6]. They also stimulate memory and contribute to better physical health [7]. Healthcare facilities mostly concentrate on the functional aspects of services, aiding older adults in managing their physical health and daily activities; however, the spiritual and social needs of these adults have often been neglected, leading to depression. When the physical functioning of older adults declines to a certain extent, it results in a loss of control over their lives and the ability to live independently. In such situations, older adults with limited mobility and high dependence on family members or caregivers tend to develop pessimistic attitudes [8]. These observations underscore the importance of developing interactive games that encourage older adults to engage in some activities concerning social interaction and health benefits.

The advancement of digital technology means that traditional games are being increasingly transformed into digital formats, becoming a vital part of human recreation [5,6,7,8,9]. Digital games gain popularity for their entertainment value, rule-based structures, and goal-oriented nature. They are also appreciated for facilitating human–machine interaction, problem solving, and socializing, as well as for engaging with graphical elements and scenarios [10,11]. Notably, digital games, especially those based on virtual reality (VR) technology, have been found to stimulate brain activity, slow down physical decline, and offer enjoyment [12] for those older adults. VR, a relatively new and rapidly growing technology, has been utilized in various contexts. For instance, previous researchers [13] involved participants in interactive storytelling in environments blending digital and physical elements, combining videos and sounds with real-world interactions. The VR setup in their study provided an immersive experience with interactive narratives and compelling storylines. Importantly, past research [6,14,15] has demonstrated that immersive experiences with feedback stimuli foster positive interactions among participants.

This study proposes a VR-based story recollection game, i.e., a nostalgic VR game, that is simpler to play compared to other multimedia games, making it especially appealing to older adults. This game is accessible to people with limited upper limb mobility, offering them enjoyment and a chance to socialize. The immersive experience of the game inadvertently encourages older adults to continue moving and stretching their limbs, aiding in their rehabilitation. In this VR story-recalling game, player actions are influenced by various intrinsic and extrinsic factors, which affect their continued engagement with these games. The authors in [16] used a behavioral theory to explore these intrinsic and extrinsic factors to understand how an online game potentially increased young people’s engagement. Similarly, our study focuses on understanding the relationship between the intentions to play this VR game and behaviors when playing the VR story-recalling game for those older adults, aiming to explore the factors influencing the use of nostalgic VR games among them.

Previous studies tried using extended technology acceptance models (TAMs) to investigate older adults’ acceptance while playing games. For example, previous researchers [17,18] adopted a TAM to analyze users’ acceptance while playing online games in terms of usefulness, ease of use, and attitudes. A past study found that playing these games improved players’ social participation. The authors in [19] also employed a TAM to examine older adults’ intentions to play games and indicated that playing the games has profound implications for older adults who lived on their own in terms of physical activity, perceived mobile maneuvering, social interaction, and entertainment-related newness. In our study, we utilized an extended TAM to analyze the effects of VR story-recalling games on older adults’ sociability, recreational participation, perceived benefits and perceived barriers, and intention to use the games, which is helpful for the development of an adequate leisure activity for elders in healthcare institutions.

2. Literature and Hypotheses Development

2.1. Older Adults’ Cognitive Functioning and Leisure Activities

As the elderly are getting older, their overall physical function gradually declines, and the communication between the brain and the peripheral nervous system weakens as well. Park [20] argued that significant age-related differences exist in cognitive function. Recently, Geiger et al. [21] showed that the moderating role of perceptual capabilities (such as sight, hearing, and the mobility of the four limbs) can help to slow the decline of cognitive functioning. This suggests that stimulating these capabilities is important to maintain cognitive functions. The field of activity theory, which focuses on the relationships between older adults’ leisure activities and their physical and psychological health, argues that the elderly should participate in as many social events as possible to enrich their lives [22,23]. This theory additionally posits that elderly individuals with suboptimal health can make up for their lost social roles by participating in diverse leisure activities. Past researchers state that older adults participating in physical and social activities and economic production have better psychological health and greater life satisfaction [24,25,26]. Lomranz et al. [27] found significant relationships among the leisure activities of older adults in Israel, their frustration, and their psychological well-being. Ruuskanen and Ruoppila [28] also indicated that by engaging in leisure activities, older adults can (a) improve their rate of adaptation to aging, (b) develop new skills and learn self-expression, thereby enhancing their self-worth, (c) gain social support to improve their self-esteem and sense of independence, and (d) re-socialize themselves to create a necessary social network. Furthermore, the type and intensity of leisure activities undertaken can enhance an individual’s physical, psychological, emotional, social, and mental well-being [29]. Since aging and disability impair mobility, involving older adults in suitable leisure activities is essential to prevent further decline in their physical function. Active participation in leisure activities can improve the physical and psychological health of older adults. To address these issues faced by older adults, this study aimed to develop a VR game as a suitable leisure activity for senior citizens.

2.2. Scope of VR Game

VR utilizes a simulator to generate realistic images and sounds and it detects the user’s reactions and transmits them to the simulator, which, thus, creates a real-time human–machine interaction. The researchers revealed that VR has three famous features, “imagination”, “interaction”, and “immersion”, which are called the 3Is [30]. VR development mainly requires creativity and imagination. A typical VR system includes a headset and haptic controllers with which a user can interact with the objects in a virtual environment. The VR system detects the user’s responses and muscular movements through a many sensors. Then, it processes these data and uses 3D models, location tracking, and 3D visual and auditory technologies to simulate the user’s motion, thereby creating a realistic experience.

In the past, there were many studies developing VR applications for some purposes, such as healthcare, tourist simulation, education, employee training, and so on. Verkuyl et al. [31] designed virtual games on the basis of hands-on simulation that can be used to facilitate instructional and learning processes. Shin et al. [32] constructed a VR-based, gamified rehabilitation process and found notable improvements in the health and quality of life for patients undergoing this rehabilitation process. Tussyadiah et al. [33] developed a VR-based tourist route exploration simulation to analyze visitors’ attitudes toward these tourist destinations and their intentions to explore them. The empirical results showed that the VR experience significantly influenced visitors’ attitudes toward tourist spots and visitation intention. These VR applications demonstrate that VR-based games can effectively improve or enhance specific functions that the designer aims to achieve in the real world.

2.3. Technology Acceptance Model (TAM)

The TAM model is the most extensively used theory for evaluating the acceptance of information technologies. The researcher also tried to extend its model for a specified application, such as the World-Wide-Web context [34]. This model has been employed to empirically explain and predict why people accept technology [35]. TAM is also effective in predicting the effects achieved by people using digital games [18,36,37]. A TAM has two features: (a) it excludes subjective norms and focuses on behaviors and attitudes, and (b) considers that behaviors and attitudes are influenced by the beliefs a user holds for a specific goal. Figure 1 shows a TAM, which incorporates perceived usefulness (PU) and perceived ease of use (PEOU) to explain the impact of external variables on a user’s attitudes, intentions, and usage behavior. We give a brief introduction to some variables in an extended TAM.

• Perceived usefulness (PU): the degree to which a person believes that using a particular technology or system will enhance their job performance or effectiveness in achieving their goals.
• Perceived ease of use (PEOU): It encompasses the user’s belief that the technology will not be difficult to understand, learn, and operate.
• Perceived entertainment (PE): It reflects the intrinsic enjoyment and pleasure that the user anticipates or experiences while using the technology.
• Perceived sociability (PS): the degree to which a person believes that using a specific technology or platform will enable social interactions and foster a sense of community or social connection.

The following paragraphs describe the discoveries among these internal variables, user’s attitudes, intentions, and usage behavior using TAM by the researchers.

2.3.1. Attitudes toward Using vs. Behavioral Intention

Past researchers have examined the relationship that attitudes to use significantly affect behavioral intention [38,39]. Heijden [40] also found that behavioral intention is strongly influenced by attitudes toward using multimedia and using websites. Attitudes toward using popular and enjoyable online games positively influence intention [24,40].

2.3.2. PEOU vs. PU, PE and Attitudes toward Using

The components of the games include their mechanisms and user interfaces. Typically, the easier the game is to play, the more likely the user is to immerse themselves in the game scenario. In other words, the ease of using the game makes the user gain greater enjoyment from it and hold a positive attitude using it. Ha et al. [41] found that PEOU of mobile games significantly influences PU and PE of the games and attitudes toward using them. Tao et al. [42] found that there is a positive and significant relationship between PEOU and PE when playing mobile games. Past research also indicated that PEOU of portal websites strongly affects PU and PE of the websites and attitudes toward using these websites [40]. A study about university students playing corporate simulation games also found a positive correlation between the PEOU and PE of games. The research confirmed a positive relationship between the PEOU of digital games and attitudes toward using them [36,43]. For interactive games, PEOU positively affects PU [44].

2.3.3. PU vs. Attitudes toward Using and Intention to Use

Davis [45] indicated that PU influences attitudes toward using, and both PU and attitude tend to affect intention to use. Especially in multimedia research, Lee et al. [18] showed that the PU significantly affects attitudes toward using multimedia and intention to use it. Pando-Garcia et al. [37] proposed that the more useful employees perceive an interactive game to be, the more likely they are to intend to use the game for the web-based business game-training program. The results showed that the PU of games designed for commercial training significantly influenced attitudes toward using the games and intention to use them. Recently, Lin et al. [44] showed that the PU of interactive computer games significantly influences intention to use the games, particularly when users perceive them to be beneficial, in which case users are likely to continue to use the games.

2.3.4. PE vs. Attitudes toward Using

Moon and Kim (2001) [34] suggested that the more entertaining multimedia is perceived to be, the stronger the attitudes toward using them will be. Webster et al. [46] established a strong relationship between PE and attitudes toward using multimedia. The general elements of entertainment have been widely discussed among researchers focusing on children and adolescents (Barnett) [47]. However, recent studies have found that playing electronic games can also improve older adults’ life satisfaction and health. When older adults perceive such games’ entertainment, they show relatively positive attitudes toward playing the games [40]. Additionally, Zhao and Renard [48] argued that PE significantly influences attitudes toward playing them. Furthermore, the entertainment of the quality of this game also triggers players’ intrinsic and extrinsic motivations, which thus prompts them to engage in certain behaviors (e.g., sharing their feedback about the games and willing to share the game with others).

2.3.5. PS vs. PE and Attitudes toward Using

Social interaction is now an important function while developing today’s games because it allows a player develop sustained recognition of a game and derive enjoyment from social participation. Social interaction usually lasts from hours to years. Thus, if the social connection exists for a long time, the game provider can gain commercial benefits from it, and players can derive greater enjoyment from their socialization in the game [49].

Our study introduces PS as an exogenous variable in an extended TAM to assess the effects of older adults’ PS of a VR game on their PE and attitudes toward playing the game. The interactivity in a VR game promotes idea exchange among older adults and, therefore, affects these people’s PE of the games and attitudes toward playing them. Recent studies have suggested that interactive games should provide real-time interpersonal communication, meeting social interaction needs. The PS of a digital game is positively related to attitudes toward playing it [40,50]. In our study, players should develop a sustained recognition of the games, which improves their social connections and helps them gain enjoyment from their social interaction in the games. Social interaction, usually, is very important for those older adults to live happily and healthily.

2.4. Health Belief Model

The health belief model (HBM) was proposed in the 1950s by a group of psychologists. Rosenstock [51] first elaborated the prototype of the HBM, and then Becker and Maiman [52] modified it. Nowadays, the model is predicated on the concepts of “health belief” and “clue to action”. Rosenstock [51] divided the concept of health belief into perceived susceptibility, perceived severity, perceived benefits (PBE), and perceived barriers (PBA).

However, using technology to prevent aging and reduce disability is seldom discussed in HBM research. Hence, our study considers HBM but excludes perceived susceptibility and perceived severity from the HBM. In this study, PBE and PBA are defined as follows.

• PBE: the benefits of taking a certain action from which a person thinks he or she may derive (e.g., reducing the likelihood of illness and alleviating the grave consequences of morbidity);
• PBA: the hindrances or difficulties that a person may encounter when taking a certain action and to the harm or negative influences that arise from the person’s action.

This study explores the effects of elderly people’s PBE and PBA while playing the games. Therefore, PBE and PBA are used as variables to determine whether playing VR games improves older adults’ psychological health and social connectedness. This study also investigates the effects of both variables on continued usage of a VR game. Timo and Mikko [53] showed that adolescents’ PBE of wearing a helmet while riding a bicycle (e.g., improving safety and preventing head injuries) significantly influences their intention, whereas their PBA of donning a helmet on a bike ride (e.g., difficult to wear and looking unattractive) negatively influences their intention. Our study argues that older adults may continue playing VR games if they perceive improvements in their psychological and social well-being through gameplay. This may hold true even if the complexity, intense visual and audio effects, and concerns such as feelings of exclusion or fear of gameplay initially discourage them from engaging with these games.

2.5. Our Hypotheses

Through previous researchers’ arguments, our study defines our hypotheses.

H1:

Older adults’ attitudes toward playing VR games positively affect their intention to play VR games.

H2:

Older adults’ PEOU of VR games positively affects their PU of VR games.

H3:

Older adults’ PEOU of VR games positively affects their PE of VR games.

H4:

Older adults’ PEOU of VR games positively affects their attitudes toward playing VR games.

H5:

Older adults’ PU of VR games positively affects their attitudes toward playing VR games.

H6:

Older adults’ PU of VR games positively affects their health intention to play VR games.

H7:

Older adults’ PE of VR games positively affects their attitudes toward playing VR games.

H8:

Older adults’ PS of VR games positively affects their PE of VR games.

H9:

Older adults’ PS of VR games positively affects their attitudes toward playing VR games.

H10:

Older adults’ PBE of playing VR games positively affects their intention of playing VR games.

H11:

Older adults’ PBA of playing VR games positively affects their intention of playing VR games.

3. Research Methodology

3.1. The Proposed Interactive Nostalgic VR Game

In this study, we designed a desktop-based virtual reality (VR) game with themes from the 1960s, 1990s, and the present era, using the Unity 2017.3.0f3. The game’s virtual scenes are primarily focused on nostalgic scenarios, aiming to evoke memories and emotional responses from elderly participants. Figure 2 shows an older adult operating system.

The toy objects within the VR environment were developed based on the work of Li, Y.-H. [54], which documents a wide range of early childhood toys and objects. These include items, such as wooden tops, wooden guns, kendama, movie boards, film projectors, phonographs, rotary dial telephones, film cameras, wind-up clocks, vintage radios, kerosene lamps, and others. To create these objects, we utilized 3ds MAX 2017, and the resulting models were imported into the VR environment for further development. The virtual scenario in this study employs a narrative-based approach with a chronological sequence, connecting people, events, and objects into a cohesive design. This design choice allows the elderly to experience a flow of memories through different time periods, each linked to significant moments of their lives. Our interaction mechanism is that the elder wears the HTC Vive headset made by HTC, Taipei, Taiwan and uses handheld controllers to interact with the objects in VR game scenes.

Before entering the main VR nostalgic game, we designed an opening scene with the primary purpose of engaging elderly participants and encouraging their involvement in the VR experience. This introductory scene features tables and chairs from earlier eras, as shown in Figure 3. On the table, three types of telephone devices are displayed: a rotary dial phone from the 1960s on the left, a Black King phone from the 1990s in the middle, and a modern smartphone on the right. The elderly participants can wear the HTC Vive headset and use handheld controllers to interact with these objects. This scene serves as a tutorial, guiding them on how to navigate and interact within the VR environment while also capturing their interest for the following nostalgic journey.

The VR game is divided into three main scenarios, each representing a different decade:

• 1960s Scenario: This scene is further divided into three stages—childhood, youth, and middle-to-old age. Each stage features specific objects and activities that resonate with the corresponding life period. Participants can interact with various toys, such as old phones, spinning tops, and wooden guns. Using the controller, the elderly can move around the scene, pick up and admire these nostalgic toys, and trigger memories from their childhood, enhancing memory recall. Some example scenes are shown in Figure 4 and Figure 5.
• 1990s Scenario: In this scene, the elderly can view sketches, pick up an old telephone, and use a wooden gun to shoot rubber bands at paper targets. They can also enjoy early documentary films played on an old projector, providing a multimedia experience that combines visual and physical interaction, further immersing them in the memories of the 1990s. Some example scenes are shown in Figure 6 and Figure 7.
• Modern Scenario: This scene allows the elderly to admire culturally creative kendama, pick up and explore modern smartphones, and take in contemporary interior decorations. The combination of these elements is designed to bridge the past with the present, offering a reflective experience that leaves them with lasting memories. Some example scenes are shown in Figure 8 and Figure 9.

In this interactive nostalgic virtual environment (VE) game, older adults can virtually navigate the environment using a VR headset and interact with game objects by touching appropriate buttons on the user interface, all while remaining seated. In order to facilitate the gameplay process, there are some clues guiding the player to explore the virtual world, as illustrated in Figure 3. The elderly can see three phones and use the controller to pick them up. Our carefully crafted VR design, which spans across different decades and incorporates familiar objects and scenarios, can effectively evoke nostalgia and create meaningful experiences for elderly participants.

3.2. Research Model

Our study adopts the TAM [45], introducing PEOU, PE, PU and PS [50] into the model to analyze how these variables influence older adults’ attitudes toward playing a VR game (ATG). PBE and PBA are alsco integrated as variables into the HBM [51], and the model was subsequently used to consider older adults’ intention to play the VR game (HIPG). Figure 10 presents the study framework.

3.3. Design of the Experiment

To investigate the effects of our variables on ATG and HIPG through game playing, we adopt a field-study approach, utilizing a quasi-experimental design where pretests and posttests are administered. The rationale using a quasi-experimental design stems from the difficulty in gathering all older adults in one place. Therefore, we collect surveys using random sampling. So, this study performs purposive sampling to recruit adults aged over 60 years old. The participants are subsequently divided into experimental and control groups. The experimental group played a VR game, while the control group played conventional games. In summary, this study analyzes the effects of (a) the participants’ PU, PEOU, PE, and PS of playing the VR game on their HIPG and (b) their PBE and PBA of playing the game on their HIPG.

4. Data Analysis

4.1. Descriptive Statistics

Adults aged 60 and over in the Geriatric Day Care Center are invited to join this experiment with an ancillary survey. Research interviewers are also invited to participate in this experiment, and their major duties are to invite those older adults and to explain the purposes of our survey, read the questions, and mark the answers. They are also instructed to assist older adults in completing the questionnaire. Only 2 of 52 questionnaires returned from the experimental group were invalid, while all 50 responses from the control group were valid.

An analysis of demographic data for both groups yields the following results. First, the majority of participants in the experimental group are female (52.00%, n = 26), while that in the control group are male (54.00%, n = 27). Second, the largest age group among the participants was those aged 60–65 years, comprising 44% of the experimental group (n = 22) and 48% of the control group (n = 24). Third, all participants in the experimental group played the VR game, whereas all participants in the control group never played VR game.

Table 1. Descriptive statistics of the experimental and control groups.

Variable	Item	Experimental Group		Control Group
		Number of Questionnaires (n = 50)	Percentage (%)	Number of Questionnaires (n = 50)	Percentage (%)
Sex	Male	24	48.00%	27	54.00%
	Female	26	52.00%	23	46.00%
Age	60–65	22	44.00%	24	48.00%
	66–70	21	42.00%	17	34.00%
	71–75	5	10.00%	4	8.00%
	>75	2	4.00%	5	10.00%
Occupation	Retired	5	10.00%	11	22.00%
	Manufacturing	8	16.00%	10	20.00%
	Service	18	36.00%	9	18.00%
	Financial	5	10.00%	3	6.00%
	Marketing	8	16.00%	9	18.00%
	Freelance	6	12.00%	8	16.00%
Ever experience with VR game	None	0	0.00%	50	100.00%
	Ever played	0	0.00%	0	0.00%
	Limited	14	28.00%	0	0.00%
	Extensive	36	72.00%	0	0.00%

summarizes the statistical analysis. The occupations listed in Table 1, such as “Manufacturing” and “Services”, refer to the participants’ previous occupations before retirement. The individuals categorized under “Retired” in the table chose not to disclose their specific past occupations, and, therefore, we collectively labeled them as retired.

4.2. Reliability and Validity Analysis

The validity of the questionnaires is assessed in terms of construct validity, which comprises convergent validity and discriminant validity [55]. Based on what Fornell and Larcker [56] mentioned, the questionnaire has high discriminant validity if the square root of the AVE of a construct exceeds the correlation coefficients of it and other constructs. Our results indicate high construct reliability (CR) for the questionnaire used in the experimental group, with CR values ranging from 0.867 to 0.943 and exceeding 0.8. The average variance extracted (AVE) also surpassed the threshold of 0.6, varying between 0.656 and 0.807. The level of discriminant validity of each construct exceeds the other values of the construct, with a range from 0.810 to 0.898. A reliability analysis is conducted to ascertain whether the questionnaire results are stable and consistent, as determined by a Cronbach’s α > 0.7 [55]. The analysis shows that for the questionnaire used in the experimental group, the Cronbach’s α for each construct exceeds 0.7, with a range from 0.807 to 0.920, indicating that the CR of the questionnaire was highly reliable.

Table 2. Results of reliability and validity analysis of the experimental group.

Construct	CR	AVE	Cronbach’s α	PU	PEOU	PE	PS	PBE	PBA	ATG	HIPG
PU	0.886	0.721	0.807	0.849
PEOU	0.920	0.793	0.871	0.558	0.891
PE	0.884	0.656	0.824	0.635	0.730	0.810
PS	0.943	0.807	0.920	0.697	0.518	0.626	0.898
PBE	0.913	0.724	0.871	0.658	0.598	0.741	0.630	0.851
PBA	0.891	0.773	0.824	0.310	0.058	0.194	0.136	0.284	0.879
ATG	0.908	0.767	0.850	0.530	0.384	0.585	0.587	0.631	0.365	0.876
HIPG	0.867	0.686	0.865	0.654	0.652	0.706	0.675	0.672	0.274	0.622	0.828

presents the results of reliability and validity analysis of the questionnaire administered to the experimental group.

For the questionnaire used in the control group, construct reliability exceeded 0.8 with a range from 0.820 to 0.974. The AVE of each construct exceeded 0.7, with a range from 0.703 to 0.888; the level of discriminant validity of each construct exceeded the other values of the construct, varying from 0.839 to 0.962. Cronbach’s α for each construct exceeded 0.7, with a range from 0.848 to 0.960.

Table 3. Results of reliability and validity analysis of the control group.

Construct	CR	AVE	Cronbach’s α	PU	PEOU	PE	PS	PBE	PBA	ATG	HIPG
PU	0.949	0.861	0.919	0.928
PEOU	0.974	0.826	0.960	0.671	0.962
PE	0.970	0.888	0.958	0.614	0.789	0.942
PS	0.956	0.846	0.939	0.673	0.701	0.786	0.920
PBE	0.963	0.866	0.948	0.495	0.621	0.719	0.582	0.931
PBA	0.820	0.703	0.888	0.004	0.100	0.071	0.019	0.082	0.839
ATG	0.908	0.767	0.848	0.540	0.737	0.794	0.615	0.682	0.024	0.876
HIPG	0.918	0.768	0.856	0.581	0.515	0.610	0.676	0.644	0.148	0.525	0.876

shows the results of reliability and validity analysis of the questionnaire used in the control group.

4.3. Structural Equation Modelling Analysis

The factor loadings of all constructs in the SEM for experimental and control groups are greater than 0.5 and lower than 0.95. The t-value for both groups is also significant. Therefore, in line with preliminary fit criteria, the structural equation modelling in this study exhibited high goodness of fit [55].

As shown in Figure 11, in the experimental group, perceived entertainment (PE) has an explanatory power of 74.2% (R² = 0.742). Perceived ease of use (PEOU) and perceived sociability (PS) are the factors in PE. Within PE, PEOU (standard coefficient = 0.694) is more important than PS (standard coefficient = 0.264). Attitudes toward playing the VR game (ATG) exhibit an explanatory power of 46.4% (R² = 0.464). PE (standard coefficient = 0.594) and PS (standard coefficient = 0.399) are the factors in ATG. Figure 11 shows that PE exerts greater influence on ATG than PS does. Health intention to play the VR game (HIPG) demonstrates an explanatory power of 57.3% (R² = 0.573). PBE has a higher influence on HIPG than PU does, with the former having a standard coefficient of 0.493 and the latter a standard coefficient of 0.321. PU had an explanatory power of 31.3% (R² = 0.313). It was influenced mostly by PEOU (standard coefficient = 0.559).

As shown in Figure 12, in the control group, PE has an explanatory power of 84.3% (R² = 0.843) and is influenced by PEOU (standard coefficient = 0.667) much more than by PS (standard coefficient = 0.318). ATG demonstrates an explanatory power of 63.6% and is influenced mainly by PE (standard coefficient = 0.703). HIPG exhibits an explanatory power of 54.1% (R² = 0.541) and is significantly influenced by PBE (standard coefficient = 0.480) much more than by PU (standard coefficient = 0.329). PU has an explanatory power of 45.1% (R² = 0.451) and is influenced mainly by PEOU (standard coefficient = 0.671).

5. Discussion

This study proposes an interactive VR game as a leisure activity for older adults. And we focus on the extent of their participation in the VR game and their social experiences within it. We employ an extended technology acceptance model to examine older adults’ attitudes toward a nostalgic VR game and their health intention to play the games. We discuss the findings of our study as follows.

First, in the experimental group, ATG significantly affected HIPG. This finding corresponded with that of [19]. That means that the participants in the experimental group perceive the VR game positively and intend to use and share these games in the future for health benefits. Therefore, H1 is validated. However, in the control group, the effect of ATG on HIPG is not significant, indicating that this hypothesis does not hold.

Second, in both groups, PEOU positively affects PU and PE, and this finding is also consistent with that of [41]. Thus, H2 and H3 are both validated. Notably, participants in the control group find the virtual reality games easy to operate. This is because the designers of these games designed the VR game in a more humanized manner. Therefore, they can more easily attract first-time players and make them more easily perceive the entertainment of this game. This enhances the recreational experience for older adults. However, H4 is just validated in the experimental group and not in the control group. Participants in the control group might just consider playing the VR game as an activity for reducing boredom and, therefore, do not participate actively in the games.

Third, in both the experimental and control groups, PU did not significantly influence ATG. The reason for this result was probably due to (a) older adults commonly consider that playing a VR game is just to reduce boredom or gain entertainment and (b) they have many leisure activities to choose from. Playing VR games is just one of many activities, and it is not a necessary part of their daily life. Thus, H5 is not validated. However, PU significantly influences health intention to play a nostalgic VR game in both groups. It is because playing a nostalgic VR game makes older adults engage in social interaction. Therefore, older adults in the experimental and control groups were keen to play the nostalgic VR game and share memories they have experienced with each other, which actually improves their communication skills and enhances VR entertainment. This finding also agrees with that of [18], and H6 is validated accordingly.

Fourth, in the experimental and control groups, PE significantly affects attitudes toward playing a nostalgic VR game. The participants might consider the nostalgic VR game entertaining and, consequently, may show positive attitudes towards playing it. In particular, when playing such nostalgic VR games, participants in the experimental group expressed stronger positive attitudes toward their experiences than those in the control group. This finding corresponds with that of [57]. Thus, H7 is confirmed.

Fifth, in the experimental and control groups, PS significantly affects PE, which validates H8. Participants in both groups derive enjoyment from playing a nostalgic VR game with others, and this finding corresponds with that of [58]. Therefore, this result suggests that older adults should engage in social connections through participation in such a nostalgic VR game. Furthermore, PS exerted a significant effect on ATG in the experimental group, validating H9. The participants in the experimental group hold positive attitudes toward social events and, therefore, share positive beliefs about playing the nostalgic VR game. Specifically, playing a nostalgic VR game makes them happy and facilitates communication with other players, thus leading them to live positively. However, for the control group, PS does not have a significant effect on ATG. One possible reason might be that participants in the control group did not experience a VR game in the past. Therefore, they did not deem it necessary to achieve social communication through playing a VR game. However, we believe that they can enjoy recreational experiences of playing a nostalgic VR game if they are able to engage in it.

Finally, in the experimental and control groups, PBE significantly affects HIPG, validating H10. Both groups believed that playing a nostalgic VR game helps reduce limb degeneration and alleviate the side effects of degeneration. This result is consistent with those of [53]. This study provides evidence that playing a nostalgic VR game can prevent older adults from limb and brain degeneration and contribute to their physical and mental health. PBA did not significantly affect HIPG in both groups. Consequently, H11 does not hold. This result argues that the participants are somewhat exclusionary and fearful about the VR game, probably because they think they are too old to use such new technology or playing the games may undermine their eye health.

In this study, a significant limitation is the unequal sex distribution between the experimental and control groups. Specifically, the majority of participants in the experimental group were female (52.00%, n = 26), whereas the control group had a higher proportion of male participants (54.00%, n = 27). This imbalance could potentially influence the study outcomes, as existing research suggests that males and females may interact with and respond to virtual environments differently. In future studies, we will place greater emphasis on achieving a balanced sex distribution during the experimental design phase to minimize any potential biases related to sex and to obtain more accurate and representative conclusions.

6. Conclusions and Limitations

This study contributed to the existing literature by using an extended technology acceptance model to investigate older adults’ health intention to play a nostalgic VR game. For older adults, the PEOU of a nostalgic VR game strongly influenced the games’ PU and PE. Notably, the experimental group indicated that PEOU, PE, and PS positively influence attitudes toward playing a VR game. PBE, ATG, and PU positively influence HIPG. The control group may change negative attitudes toward playing a VR game if their friends or family members encourage them. Moreover, the participants in the experimental group had a higher PEOU of playing a VR game than those in the control group. On the basis of this finding, this study proposes that building a social circle helps older adults play nostalgic VR games, thereby enriching their leisure experience and reducing their perceived barriers (e.g., anxiety and health problems) to the VR games accordingly.

Based on our findings, the nostalgic VR game should be designed to be more usable, which would facilitate a multiplayer gameplay process. Such a game, thereby, improves interaction among older adults, facilitating the development of interpersonal relationships. Furthermore, this study shows that a nostalgic VR game can bring pleasure to older adults, stimulate their brains, promote their physical functions, and keep them in a good mood. These health benefits encourage older adults to play such nostalgic VR games. Hence, in practice, we suggest that VR games’ developers could design interactive virtual reality games with nostalgia-induced situations, which serve their entertainment and social needs. VR companies can promote their game products for stimulating older adults’ brains to generate more interesting and entertaining topics to meet older adults’ need for entertainment.

In this study, there are some limitations that should be acknowledged. First, the samples were collected from elderly care centers, and, hence, future research should collect a large number of samples from various places. Second, this study only considers the effect of nostalgic VR games on older adults. The effects of other types of VR games remain unexplored. Then, we also suggest that future studies can focus on the effect of AR interactive games on older adults. Furthermore, our study primarily focused on older adults’ health intention to play nostalgic VR games in terms of several factors, whereas the effects of factors such as media richness and perceived value are not taken into account. Finally, future studies should consider combining other theories (e.g., social gratification, hedonic gratification and utilitarian gratification) with attitude and behavior intention to fully identify the factors affecting the continuance of usage intentions.