Redefining Fall Risk Management

Can we really afford 1,000,000 Tai Chi Instructors? According to the CDC,  we spend over $34 billion in direct medical costs each year to treat older adults who have fallen. Those costs are expected to increase exponentially as the baby boomers age.

Many falls, especially those experienced by older adults < 80 years of age can be prevented with the right type and amount of exercises. So, how do you get 46 million people to do balance and strength exercises for 2 hours a week?

One option: Hire 1 million Tai Chi Instructors

The CDC, NCOA,  and the Administration for Community Living have invested in building the infrastructure to disseminate evidence-based fall prevention programs like Tai ChiStepping On, Matter of Balance and the Otago Exercise Program in certain regions of the country. The results of these efforts to train instructors and offer classes are truly impressive, with several hundred thousand older adults reached. However, these programs are delivered in real time and are limited by the number of trained instructors, facility space, transportation needs ,and time to actually get to and attend the class. These significant barriers dictate that bringing these programs to scale will require a paradigm shift in delivery.

A better option: Telehealth and Fall Prevention?

Telehealth and virtual systems like the Reflexion Health VERA platform provide an incredible opportunity to redefine how health and wellness programs are delivered to the older adult population. Virtual systems can bring programs to scale to reach millions of users by eliminating the time and resources required to hire, train and retain an instructor. There is no need for fidelity monitoring because the avatar will only deliver content that is programmed. The program can be done in the home for those who have limited access to transportation, at the user’s preferred time and day, and the results are monitored by trained personnel to identify any potential declines in function.

But wait, can older adults even use these technologies? Do they even want to? The answer is a resounding YES. The intuitive nature of gesture controlled technologies, like the Microsoft Kinect, creates unprecedented opportunities with this population. In our work with older adults, we have had several users that have had limited to no interaction with a computer prior to our study. In all cases, our users were able to master the logging in and navigation technology within 2 supervised sessions. Individuals with less than a high school education, non-native English speakers, even those with mild cognitive impairment have demonstrated mastery of this system. And all users indicated they really wanted to use a virtual technology to improve their balance and help prevent a fall. These findings were recently published in the Journal of Medical Internet Research.

Given the desire by the target audience to use this technology, we translated the Otago Exercise Program, an evidence-based program proven to reduce falls in high-risk older adults by 35% into Stand Tall, a Kinect-based virtual strength and balance exercise program delivered by the VERA platform. We were interested to see if older adults would want to use the program long term and what the adoption of these technologies would look like. Future blogs will discuss this experience but here is your spoiler alert – These technologies are the paradigm shift that will be the first intervention to truly “move the need” in fall prevention.

by Tiffany Shubert, PT, PhD.
Tiffany is a fall prevention expert and strategic advisor for Reflexion Health