Background: Virtual reality (VR) offers potential for enhancing physical activity and engagement among older adults in long-term care (LTC) facilities. This addresses the need for health maintenance and independence. Yet, limited research exists on VR acceptance and its optimization for promoting physical activity. Older adults' VR gaming experiences and the social and contextual factors affecting acceptance are underexplored. This study aims to investigate these unique experiences to inform the design of inclusive VR technology in LTC, enhancing physical activity and well-being. Objectives: My dissertation has two objectives: (1) to examine the individual and social factors that impact the acceptance of VR games among older adults in LTC facilities and (2) to explore LTC residents’ experience with VR games and the meaning they associate with their gaming experience. Methods: To reach these objectives I conducted two studies: (1) a scoping review of 5 articles to identify evidence on older adults' acceptance of physical activity VR games in LTC facilities, describe research designs used, define key acceptance concepts, and identify knowledge gaps for future research and (2) a mixed-methods study, including a series of gaming sessions with 20 older adults residing in a healthcare center followed by a composite questionnaire and semi-structured interviews with 15 older adults and 4 staff members. Results: The scoping review identified a knowledge gap in VR acceptance among older adults in LTC. Varying acceptance levels and inconsistent concept definitions were found, emphasizing the need for an integrated approach combining qualitative and quantitative methods. Only one study used validated tools for assessing acceptance. The quantitative study involved VR gaming sessions with 20 participants aged 65 and older, revealing significant positive correlations between perceived ease of use and Selective Optimization with compensation (SOC) strategies. No significant relationship was found between Technology Acceptance Model (TAM) and Future Time Perspective (FTP). Prior gaming experience led to higher SOC and socioemotional Selectivity (SST) scores, higher game self-efficacy, and increased hedonic motivation. Age and gender had no impact. Participants viewed VR as user-friendly and useful, with positive attitudes toward aging and physically demanding activities. The qualitative revealed themes related to enjoyment, physical activity, social connection, and individual preferences. Staff perspectives addressed relevance, personalization, training, and organizational barriers. The study highlighted the potential benefits of VR gaming for LTC residents, offering insights for technology development. Conclusion: This study offered a comprehensive understanding of VR gaming acceptance among older adults in LTC settings, highlighting the significance of individual and social factors in technology acceptance. Personalized design, support, education, trust, and safety are crucial. Integrating social theories of aging is essential to understand older adults' needs and preferences. Implications for VR design include user-centered approaches, intuitive interfaces, customization, social interaction, and safety considerations. Addressing limitations and biases in future research can promote effective use of VR as a therapeutic tool for older adults in LTC.