Source: Mediatheque L'Echo// Le Club des Seniors Gamers// Flickr Earlier blog posts from the Aging Brain, Aging Body blog series have addressed the potential negative impacts anxiety—or, fear of falling—can impose on older adults’ abilities to maintain safety and stability while walking. (If you have not yet read these previous posts, then a brief overview of how fear of falling can increase elderly fall risk can be found in last month’s post.) As a result, there is an urgent need to develop interventions aimed at targeting these psychological aspects of fall-risk.
Although traditional training programs designed to reduce falls in elderly populations focus predominantly on the physical components of fall-risk (for example, strength, flexibility and mobility), more recent research has demonstrated the effectiveness of interventions that also target psychological functioning. For example, Huang and colleagues (2016) described significant reductions in fear of falling in older adults who participated in 8-weeks of cognitive behavioral therapy combined with strength training. These individuals also displayed significant increases in both strength and mobility, as well as a reduction in incidence of falls. This suggests a clear the benefit of interventions that target both physical, and psychological, functioning.
The Role of Videogames in Reducing Elderly Falls
To be more specific, I am referring to exergames—videogames which combine gameplay with exercise. Games which require physical command of a virtual interface to achieve the within-game goal. You know, games you might buy for your Wii Balance Board. And while the early research from this area utilized commercially available exergames with some success to train older adult balance, more recently, researchers have demonstrated the effectiveness of training programs featuring custom-designed exergames (i.e., Whyatt et al., 2015; Young, Ferguson, Brault, & Craig, 2010).
So why are exergames so effective for training balance in older adults?
For starters, games can be designed to target the specific areas of at-risk balance (such as abnormal postural sway or the inability to make a rapid reactionary step) rather than simply training the broad areas of physical functioning that can contribute to fall-risk (such as strength). For example, if an individual has difficulties maintaining their balance when making a lateral step, within-game objectives can be designed to train this movement. Through training these areas of balance directly, successful within-game performance, therefore, corresponds to real-world benefits.
Exergames may also maximize the positive effects of balance training on psychological functioning, with research demonstrating that exergame balance training can successfully enhance both functional balance and balance confidence (Whyatt et al., 2015; Young et al., 2010).
But through what mechanisms can exergames promote changes in psychological functioning linked to fall-risk?
Bandura’s (1997) self-efficacy theory posits that self-efficacy, an individual’s belief in their abilities to successfully execute a behavior in order to produce a desired outcome, is derived primarily from past performance accomplishments. Reduced self-efficacy is intrinsically linked to increased fear of falling. In fact, the most commonly utilized definition of fear of falling describes this construct as “low perceived self-efficacy at avoiding falls during essential, nonhazardous activities of daily living” (Tinetti, Richman & Powell, 1990). Therefore, it may be possible to reduce fear of falling—and all the negative consequences of this, such as loss of independence, activity avoidance and future falls—through balance training which addresses an individual’s perceived self-efficacy at avoiding falls.
And exergames can do just that. But how? Let’s revisit where Bandura (1977) suggests self-efficacy is primarily derived from: Past performance accomplishments. As exergames can be designed to directly train the specific areas of balance which the individual has difficulty executing (and are likely contributing to this reduced self-efficacy), any observed improvements/accomplishments will be likely attributed to an improvement in balance ability thereby leading to increased balance self-efficacy. (In contrast to programs which, for example, train strength, where observed improvements are likely to lead to increases in self-efficacy relating to strength training rather than overall balance.)
THE BASICSConcluding Remarks
While designing exergames to reduce elderly fall-risk (including psychological functioning) is an emerging area of research, the results are promising. However, the specific mechanisms through which different elements of game-design can be modified to maximize the positive impact of training on the psychological mediators of elderly falls remain relatively under-explored. To this end, research is currently underway in our FP² (Falls Prediction and Prevention) Lab at Brunel University, London which we hope will further illuminate how certain elements of game design can contribute to specific aspects of psychological functioning linked to fall-risk.