Unpacking the diversity and complexity of roles and participation in virtual reality design for older adults: A systematic review

As virtual reality (VR) technologies become increasingly embedded in health and aging contexts, the meaningful participation of older adults in VR design remains limited. This systematic review synthesizes 77 studies published between 2016 and 2024 to examine how older adults engage in the design of VR interventions. Using Arnstein's Ladder and the Double Diamond model as guiding frameworks, we analyze the roles older adults assume, the methods used to support their involvement, and the evolving tasks of designers. Our analysis shows that while consultation is the most common form of involvement (34 %), only 13 % of studies achieve genuine co-design partnerships, with a significant 62 % of engagements remaining at tokenistic or lower levels. Results show that older adults are mostly involved at lower levels of participation (e.g., informing, consultation), while high-level co-design remains rare. Participation barriers include cognitive and physical limitations, technological complexity, and insufficient facilitation. However, iterative feedback mechanisms, adaptive design tools, and structured support strategies contribute to more inclusive engagement. We conclude by proposing a multidimensional understanding of participation that considers user agency, design phase, and feedback integration. This framework provides a novel lens for evaluating and planning participatory endeavors, moving beyond a binary view of co-design. These findings offer actionable insights for human-computer interaction (HCI) researchers and designers aiming to create more equitable and responsive VR systems for aging populations.