Effects of an Aging Simulation Suit on Clinical Empathy in Healthcare Professionals Working in Long-Term Care

Mejorar la empatía Hacia el Mayor Mediante la simulación de la Vejez

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.

Study Overview

• Status: Completed
• Conditions: Aging; Empathy Skills
• Intervention / Treatment: Behavioral: Experimental: Aging Simulation Suit + Educational Session; Behavioral: Control: Educational Session Only

Detailed Description

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
• Enrollment (Actual): 82
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Madrid
    • Alcorcón, Madrid, Spain, 28922
      • Universidad Rey Juan Carlos

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Healthcare professional (nurse, nursing assistant, occupational therapist, physiotherapist, physician, psychologist, or social worker).
• Currently working in a long-term care or nursing home facility with direct contact with residents.
• Willing to participate voluntarily during working hours.
• Signed written informed consent.

Exclusion Criteria:

• Failure to provide written informed consent.
• No direct patient contact with older adults.
• Any physical or cognitive limitation that would prevent safe participation in the aging simulation experience.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental: Aging Simulation Suit + Educational Session; Participants received a theoretical session on aging, functional limitations, and empathy in healthcare, followed by an immersive experience using the GERT aging simulation suit. The suit replicates the physical and sensory limitations of aging, allowing participants to perform everyday tasks while experiencing the challenges faced by older adults.	Behavioral: Experimental: Aging Simulation Suit + Educational Session; 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.; Behavioral: Control: Educational Session Only; 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.
Active Comparator: Control: Educational Session Only; Participants received the same theoretical session on aging, functional limitations, and empathy in healthcare as the experimental group, but did not use the aging simulation suit.	Behavioral: Control: Educational Session Only; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	Pre-intervention (baseline) and immediately post-intervention (same day)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	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.	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.	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.	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.	Pre-intervention and immediately post-intervention (same day)

Collaborators and Investigators

• Sponsor: Universidad Rey Juan Carlos
• Collaborators: Participating Nursing Homes in Madrid and Asturias, Spain
• Investigators: Principal Investigator: Rosa María Martínez Piédrola, PhD, Universidad Rey Juan Carlos

Publications and helpful links

General Publications

• Lee K, Han A, Kim TH. Effectiveness of Simulation-Based Empathy Enhancement Program for Caregivers (SEE-C) Evaluated by Older Adults Receiving Care. Int J Environ Res Public Health. 2021 Jul 23;18(15):7802. doi: 10.3390/ijerph18157802.
• Pira GL, Ruini C, Vescovelli F, Banos R, Ventura S. Could Empathy Be Taught? The Role of Advanced Technologies to Foster Empathy in Medical Students and Healthcare Professionals: A Systematic Review. J Med Syst. 2025 Jan 14;49(1):6. doi: 10.1007/s10916-025-02144-9.
• Ebm C, Sarti R, Panico P, Pagliotta M, Vinci V, Oldani S. Enhancing compassion in medical education - a comparative study of the efficacy of clinical clerkships versus simulation-based training methodologies. BMC Med Educ. 2025 Feb 4;25(1):181. doi: 10.1186/s12909-025-06687-w.
• Halton C, Cartwright T. Walking in a Patient's Shoes: An Evaluation Study of Immersive Learning Using a Digital Training Intervention. Front Psychol. 2018 Nov 12;9:2124. doi: 10.3389/fpsyg.2018.02124. eCollection 2018.

Study record dates

Study Major Dates

• Study Start (Actual): January 30, 2024
• Primary Completion (Actual): July 30, 2024
• Study Completion (Actual): September 30, 2024

Study Registration Dates

• First Submitted: December 1, 2025
• First Submitted That Met QC Criteria: December 1, 2025
• First Posted (Estimated): December 12, 2025

Study Record Updates

• Last Update Posted (Actual): December 19, 2025
• Last Update Submitted That Met QC Criteria: December 12, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: randomized controlled trial; Healthcare professionals; Clinical empathy; GERT suit; Aging simulation suit
• Other Study ID Numbers: 2711201916919

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared because the dataset includes information from a small group of healthcare professionals that could potentially allow identification of participants. Only aggregated and anonymized summary results will be published in scientific journals and conference presentations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No