Video games to prevent falls in community-dwelling older adults

In a recent study published in Natural medicine, group of researchers evaluated the effectiveness of home-based cognitive and exercise training interventions compared to a control group in preventing falls among community-dwelling older adults.

Background

Falls in older people, leading to disability and high mortality, are a growing public health concern due to the aging of the world population. This challenge is straining health systems and impacting communities. Effective, scalable fall prevention strategies are critical. Exercise, especially balance training, helps prevent falls, but problems with engagement and consistency persist. Cognitive decline associated with increased fall risk points to the potential benefits of cognitive training.

Combining physical and cognitive exercises, gamified training offers an engaging approach, improving adherence and addressing key risk factors. Further research is needed to confirm the findings, examine long-term effects, and optimize intervention strategies to prevent falls in older populations.

About the research

The present study, a pragmatic assessor-blinded parallel three-arm randomized controlled trial, was designed to evaluate the effectiveness of the smart±step system, delivered as seated cognitive training or exegesis training, against a minimal intervention control group. This assessment focused on the rate of falls in older people over a 12-month period and was conducted with the approval of the Human Research Ethics Committee of the University of New South Wales, Sydney, and registered with the Australian and New Zealand Clinical Trials Register .

Participants were recruited in Sydney, Australia, through a variety of methods, including advertisements and invitations from health insurance companies. Eligible participants were over 65 years of age, English speaking, living independently, able to walk without assistance, and willing to consent. Those with unstable medical conditions, neurological disorders, acute psychiatric conditions, or significant cognitive impairment were excluded. After screening for eligibility and obtaining written informed consent, participants’ baseline data were collected.

Participants were assigned to one of three groups: two intervention groups receiving a smart±step mini computer with cognitive challenge games and a control group. The exercise group used a wireless mat for physical activities, while the cognitive group used a touchpad for mental tasks. Both intervention groups received 120-minute weekly training for one year, supervised by research staff. The primary outcome measured was the rate of falls over 12 months, along with secondary outcomes assessing physical and cognitive performance, health and mobility. Data were analyzed using an intention-to-treat approach with negative binomial regression to compare fall rates.

Research results

Between October 27, 2016 and May 10, 2019, a total of 1009 individuals were screened for eligibility for a study focusing on falls prevention in older adults. Of these, 769 participants were randomly assigned to one of three groups: cognitive training (262 participants), exercise training (252 participants), or a control group (255 participants). During the 12-month trial, 53 participants withdrew (21 from exam training, 23 from cognitive training, and nine from the control group), and 61 participants from the intervention groups discontinued the intervention but continued to provide falls data.

Participants who withdrew were on average 2.5 years older than those who completed the study, but did not differ significantly by gender or number of medical conditions. Baseline characteristics in the three groups were similar in terms of age, education, body mass index, sex, medical conditions, and medications, which did not result in adjustments in the analyses.

For the primary outcome, which was the rate of falls during the 12-month follow-up, the exegesis training group reported 163 falls, the cognitive training group 197 falls, and the control group 231 falls. The extreme gaming training group had significantly fewer falls than the control group, in contrast to the cognitive training group. The exergy group also reported fewer people experiencing at least one fall, while the cognitive group showed no significant difference from the control group. There was no significant difference between groups in terms of repeated or injurious falls, nor in physical and cognitive outcomes.

The exercise group improved on fall efficacy, disability, and depressive symptoms, but the cognitive group did not differ significantly from the control group on general or psychological health. However, prior fallers in the cognitive group had a reduced fall rate. No serious side effects were reported. In terms of adherence, participants in the exergame group exercised on average about 80 minutes per week, and those in the cognitive training group about 95 minutes per week. Overall ratings of usability and enjoyment of the system were high for both intervention groups.