For the elderly, a fall can alter life permanently. In the US alone, over 700,000 people 65 and older are hospitalized because of a fall, according to the Centers for Disease Control; 250,000 of them are treated for a hip fracture. Any person caring for an elderly loved one will tell you that after a bad fall, the next step is likely to be a nursing home.
Preventing such events, then, could save a lot of misery and a lot of money that would go to treatment for the injury as well as care for the elderly person who may never overcome the damage sustained in the fall.
Researchers at the Sackler Medical School of Tel Aviv University have been studying this problem, and a team led by that institution’s Dr. Anat Mirelman believes that it may have found a way to help prevent or reduce the numbers of those falls.
“Our approach combines treadmill exercise and virtual reality to help improve both physical mobility and cognitive aspects that are important for safe walking. We found that virtual reality plus treadmill training helped to reduce fall frequency and fall risk for at least six months after training,” said Mirelman.
Falls in adults aged 65 and over account for about 2% of all healthcare expenditures in high-income countries, according to OECD statistics. Thirty percent of older adults living in a typical community, and as many as 60%-80% of older adults with mild cognitive impairment, dementia or Parkinson’s disease, fall at least once a year. Even without injuries, falls often lead to fear, with seniors avoiding leaving the house and becoming shut-ins, which in turn often leads to inactivity, muscle weakness, depression, impaired balance and gait, more falls and more social isolation, according to numerous studies.
Why do the elderly tend to fall? According to Mirelman of the Center for the study of Movement, Cognition and Mobility (CMCM), Neurology Institute, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, “falls in older people often occur because of tripping and poor obstacle negotiation while walking. Falls often start a vicious cycle, which has many important negative health consequences. Older people’s ability to negotiate obstacles can be impaired because of age-related decline in cognitive abilities like motor planning, divided attention, executive control, and judgment, yet current interventions for falls in older adults typically focus on improving muscle strength, balance, and gait.”
It follows, then, that providing training for the elderly – providing them with a safe environment to practice their walking – could improve their walking skills, and indeed, many community centers, hospitals, rehabilitation centers, old age homes, and many others utilize treadmills to help the elderly improve their walking skills.
But those skills can be improved even more with the addition of a non-immersive virtual reality element to the exercise mix, a study led by Mirelman and recently published in The Lancet showed. In the study, researchers analyzed data from 282 participants from five clinical sites in Belgium, Israel, Italy, the Netherlands, and the UK between 2013 and 2015. All participants were aged 60-90, were able to walk at least 5 minutes unassisted, on stable medication, and had reported at least 2 falls in the 6 months before the start of the study. Nearly half of all participants (130) had Parkinson’s disease, and some (43) had mild cognitive impairment.
Participants were assigned to treadmill training with virtual reality (146 participants), or treadmill training alone (136). The virtual reality component consisted of a camera that captured the movement of participants’ feet and projected it onto a screen in front of the treadmill, so that participants could see their feet walking on the screen in real time. The game-like simulation was designed to reduce the risk of falls in older adults by including real life challenges such as avoiding and stepping over obstacles like puddles or hurdles, and navigating pathways. On average, participants in each group took part in 16 training sessions over six weeks, with each session lasting about 45 minutes. Fall rates were recorded in the six months following the end of training.
Prior to training, participants in the treadmill-only group had an average of 10.7 falls per six months, and participants in the treadmill plus virtual reality group averaged 11.9 falls per six months. During the six months after training, the incidence rate of falls decreased in both groups, but the decrease was only statistically significant in the treadmill plus virtual reality group; 11.9 to 6.0 falls in the virtual reality group, a 42% reduction; compared to a decrease from 10.7 to 8.3 in the treadmill-only group.
The biggest improvement was seen in participants with Parkinson’s disease, and Mirelman’s team believe that this could be due to a number of factors, including that they had higher rates of falls at the start of the study, or that virtual reality was able to help improve cognitive and motor skills which are affected in Parkinson’s disease.
According to Professor Stephen R. Lord, a top expert on geriatrics from the University of New South Wales, Randwick, New South Wales, Australia, “the finding of a 42% reduction in falls is in line with the most effective fall preventions that have assessed more traditional group-based and homed-based exercise interventions in older people and well above the average reduction of 17% for exercise interventions reported in systematic reviews. It is also notable that the reduction in falls reported in the current trial is made in comparison to a treadmill walking intervention of similar intensity, as opposed to no intervention or usual care.”
“Mirelman and colleagues’ findings have important implications for clinical practice,” added Lord. “Treadmill training with a virtual reality component could be administered in community gyms and rehabilitation clinics, and since the intervention is relatively short term in nature, throughput of many people would be possible.”