Can virtual reality (VR) improve balance and decrease the risk of unintended falls in our Senior population?  The short answer... maybe.  The long answer... Continual progress depends on the skill of operators and their comfortability using the software in these systems.

So, what is virtual reality (VR)?  It's easy to spot, just look for the person with goggles over the eyes and they seem to moving around aimlessly.  Looking up and down, some may be fighting for thier lives, while others are walking across a tight rope that has been stretched over the Grand Canyon.  But, VR can also come without goggles and be displayed on the TV.  Some of you reading this article may be very familiar with the Nintendo Wii or the X Box Kinect systems.  Both systems have games that simulate snow skiing and it's movements.  The participant stands on a piece of equipment that has been carefully calibrated to detect the pressure from your feet.  Those signals are then sent to the computer inside the gaming unit, Nintendo Wii or Xbox Kinect, then delivered to the TV screen, mimicking your movements from the equipment you are standing on.  I have experience with both systems, and both work well to help improve balance, but they do have some limitations, as I will explain later in the article.  Some of these VR systems, such as Occulus, can offer very realisic views of the world or game simulations.  By definition, virtual reality (VR) is the experience in which users feel immersed in a simulated world, via hardware, headsets and software.  Designers create VR experiences, virtual museums, transporting user s to 3D environments where they freely move and interact to perform predetermined tasks and attain goals and learning.(*2)

Many Seniors wish to spend and live out their lives at home.  In-home health makes that a reality for many but the costs are high, especially for those that need 24-hour care.  Being able to remain strong and mobile also helps increase the odds that living out your days at home will be a possibility.  Nursing homes and facilites are facing staff shortages and financial challenges, according to a study published by the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL).  The studied brought to light some scary realities, such as 78% of nursing homes and 61% of assisted living communities are concerned workforce challenges might force them to close.(*1)  In addition, more than one-third of nursing homes are very concerned about having to shut down thier facility(ies).*(1)  This is an added motivating factor for Seniors and their families to find solutions that they may have not considered before.  Solutions like VR and Balance University!

​So, how can VR benefit Seniors?  VR can help Seniors improve their balance by creating a proprioceptively enriched environment, something necessary to improve balance.  All those big words mean that one must be in an environment where they are stable, but a bit unstable.  Imagine standing on one foot, you're stable but a little unstable.  Skiing down a hill using VR is a great way to create this environment.  Depending on your familiarity and comfortability with technology and making changes to software applications, you can make the ski game easier or harder.  This is where limitations may impede progress.  Someone that is not too comfortable making those changes may not change the settings to the game, thus limiting the effectiveness to improve balance.

Research does indicate that VR can improve a Seniors balance, including a bit of fun too!  VR includes Nintendo Wii and Xbox Kinect in this study and the improvement in balance that they can impact and have real life results. (*1)

Chris R. Williams
Author, Fitness Professional
Balance University

Website:
https://www.emeritushealthfitness.com/

Sources:

1. State of the Long-Term Care Industry
   1. https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Workforce-Survey-September2021.pdf
2. Interaction Design Foundation
   1. https://www.interaction-design.org/literature/topics/virtual-reality

What is cardiovascular disease and how can it increase Senior's chances for an unintended fall?  According to the American Heart Association, heart disease includes numerous problems, many of which are related to a process called atherosclerosis.  Atherosclerosis is a condition that develops when a substance called plaque builds up in the walls of our arteries.(*1)  There are several different types of diagnoses one could have when it comes to heart disease, such as abnormal heart rhythms, coronary heart disease, heart valve disease, stroke and cardiomyopathy to name a few.(*5)

Falls are the leading cause of injury among our Senior population.(*2)  So, let's define injury... for this blog, injury means that it resulted in limited daily activities or a doctors visit for the Senior who experienced the unintended fall.(*3)  There are many factors that can play a role in a fall but I wanted to focus on the impact cardiovascular disease can have and does it increase a Seniors risk for a fall.  Most Seniors do not realize how poor their balance has become until they've experienced a fall and they enter the 'danger' zone.  Most physicians and therapists will tell you that falling is not a natural part of aging, and I will tell you the same thing.

The fall risk for those that have been diagnosed with some type of cardiovascular disease is even higher versus those without that diagnosis.  In fact, those with cardiovascular disease are at a 60% higher risk for a fall. (*4)  Also, the medications that are typically associated with cardiovascular disease play a factor in increasing fall risks.  Medications such as (*4):
- Arrhythmia medications
- Antidepressansts
- Anti-anxiety medications (benzodiazepines)
- Diabetes medications
- Diuretics
- High blood pressure meds (beta-blockers, ACE inhibitors and Angiotensin receptor blockers - ARB's)
- Opiods
- Non-Steroidal Anti-Inflammatorys (NSAIDs)
- Selective Serotonin Reuptake Inhibitiors (SSRIs)

Cardiovascular disorder, or disease, are recognized as risk factors for falls in older adults.  Also, it is worth noting that arterial stiffness was identified as an independent predictor for falls too.(*4)  When working to improve someone's balance who has been diagnosed with heart disease, you must take into consideration the intensity and volume of the movements that are needed to perform in order to improve their balance.  The more the muscles contract and work, the larger the demand for oxygenated blood on the heart.  Especially when leg strength is so important to improving one's balance, it can be a bit tricky on how to manage workload versus what the heart can manage safely.  Muscles as large as the quadriceps (thighs) can elevate heart rates pretty quickly and you should keep a pulse oximeter close by to monitor how high the heart rate is going during and after the actual movement. 

If you have someone that is dealing with a heart that is not at full capacity or malfunctioning for some reason, this person will need more time to recover.  Using your watch or a stopwatch to measure how long the heart rate takes to return to it's resting heart rate (a heart rate when just sitting and relaxing) can be a great way to safely manage someone with heart disease and their balance exercises.  These tools are great and I use them with many clients, not just those with heart disease.  Better balance is absolutely a possibilty for those with heart disease.  The right exercises combined with the right tools can ensure safety and success!

For more information, visit:
www.MyBalanceUniversity.com

Chris R. Williams


SOURCES:

1.  American Heart Association
   1. https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease
2. CDC
   1. https://www.cdc.gov/mmwr/volumes/69/wr/mm6927a5.htm?s_cid=mm6927a5_w
3. CDC
   1. https://www.cdc.gov/mmwr/volumes/69/wr/mm6927a5.htm?s_cid=mm6927a5_w
4. American Heart Association
   1. https://cpr.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/preventing-and-managing-falls
5. WebMD
   1. https://www.webmd.com/heart-disease/guide/diseases-cardiovascular#091e9c5e80011866-1-1​

Healthy aging is a term that could almost be considered an oxymoron.  I belive we all can agree, that as we get older, being healthy and staying healthy can mean two different things.  I took a look into what it healthy aging means, especially as it relates to Seniors and their independence.  Most Seniors that I have spoken too after lectures, classes and/or private sessions express to me their desire to live at home for as long as possible.  In fact, home is the place they would like to remain through the end of their lives.  So, what happens to healthy Seniors that are living independent lives and then end up in a facility in long-term care (LTC)?  

I took some time into this topic to find out what are some of the leading issues that causes folks, whom are healthy, but end up spending the last years of their lives in LTC's.  One research article named four key areas that can strongly predict an elderly person's transition from independent community living to a long-term care facility.  These four areas include:
Falls and fall related injuries
Urinary incontinence
Dementia
Social isolation

The article went on to say, "although estimates of fall rates vary widely based on location, age, and living arrangements of the elderly population, it is estimated that each year approximately 30% of community-dwelling individuals ages 65 and older, and 50% of those aged 85 and older will fall."(*1)  "Of those individuals who fall, 12% to 42% will have a fall-related injury."(*1)  The statistics are not on a Seniors side once they experience their first unintended fall.  "Two-thirds of those who fall will do so again within six months."(*2)  Further digging revealed "that the risk of LTC home admission is over five times higher in Seniors who experienced two or more falls without injury, and over 10 times higher in Seniors who experienced a fall causing serious injury."(*1)

Hope is not lost, however!  There are some things that our Seniors can do to make healthy aging a truly easier process.  One study identified 11 different interventions to avoid LTC's.  They are "exercise programs, vision assessment and referal, cataract surgery, environmental modifications, vitamin D supplementation, vitamin D plus calcium supplementation, hormone replacement therapy (HRT), medication withdrawal, gait-stabilizing devices, hip protectors and multifactorial interventions." (*1)  This study was also interesting to me becuase they took a look at the length of time these exercise programs should last in order to make the biggest impact.  And of course, you guessed it... those that have been in exercise programs that have lasted longer than six months were impacted more positively than any other group.

I have spoken about many of the interventions mentioned in the research article, including vitamin D supplementation and the research showing those that regularly take high levels of vitamin D tend to fall less.  I want those of you reading to understand that exercise does not have to be conventional, i.e. fitness centers.  Get out and walk!  You only need 1% of the time given to us in a week for exercise.  There are 10,080 minutes in a week... start with a 30 minute walk for six months, and you will begin to ensure that you are considered to be, healthy aging.

Chris R. Williams


SOURCES:
*1:  National Library of Medicine  (https://pubmed.ncbi.nlm.nih.gov/23074507/)
*2:  https://www.shellpoint.org/blog/10-shocking-statistics-about-elderly-falls/

I wonder how many Seniors encounter stairs in their daily lives?  Maybe the stairs are in their homes or they come across stairs entering the theatre or movie theatre.  Maybe the stairs are at the entrance of a favorite restaurant or their community.  Wherever our Seniors may face stairs or steps, they pose a serious risk for an unintended fall.  There are several factors that can play a role in a successful or unsuccessful ascent or descent on stairs.  Factors that include leg strength, confidence, vision and familiarity can all impact our Seniors in different ways.  However, there can be a positive side to climbing stairs, especially in our heart rates, exertion (how hard is it for us to climb the stairs) and dynamic balance (balance while moving) (*5).

Leg strength is the most important of all of these factors because of their impact on so many activities.  Things like how long we can walk, stand and the types of terrain we are able to navigate all depend on the strength of our legs.  In fact, leg strength impacts other important systems in the body.  If we can't stand or walk for a mentionable amount of time, how are we able to walk on a treadmill or do any type of meaningful cardiovascular exercise? 

There was a recent study published by the British Journal of Sports Medicine regarding life longevity and the relationship to standing on one leg.  The study found that "middle-aged people who can't stand on one leg for at least 10 seconds appear to be at higher risk of dying within a decade. (*3)"  I have always used one's ability to stand on one leg as an indicator of leg strength.  It is not the only evaluation of balance and strength that I use in my assessments.  If you can stand up from a dinner table chair without using your arms or feeling the need to rock yourself, using the momentum the rocking creates, I would say your leg strength, in most cases, would be strong enough to navigate stairs easily.

Did you know that every 11 seconds, an older person is receiving treatment for a fall in the emergency room (*1).  In addition, the isolation due to the pandemic increases the likelihood of a fall-related injury that results in a Senior being left in a position in which they fell for an extended period of time (*2).  

It is important to consider all these factors I mentioned in the first paragraph as we age.  It can impact where we live, where we vacation and what social activities we will enjoy as we age.
 
SOURCES:
*1:  https://medalerthelp.org/blog/falls-in-the-elderly-statistics/
*2:  https://saintsimeons.org/blog/the-latest-assisted-living-facts-and-statistics/
*3:  This balancing exercise can determine how long you will live | Mint (livemint.com)
*4:  https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-018-0958-1
*5:  https://www.cdc.gov/falls/facts.html
​
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​Also, when you are standing, walking and moving around, your circulation is greatly increased as compared to sitting and remaining sedentary.  Circulation and blood flow moves thoughout the body and through all systems, including our digestive system.  Gravity is a big enemy to our skin and the effects that it has on it.  This is why we are spending so much money on all those great skin products that never live up to their claims!  However, when it comes to our digestive systems, gravity can be a great ally, as it pulls everything down... and out.  And I'll let your imaginations put that puzzle together!  So if you are battling a bout of constipation, get out and move and let the blood circulate and gravity pull!

Sarcopenia is a term we use to describe age related muscle loss.  As we age, some muscle loss is expected, however, not consuming enough daily calories to maintain muscle mass can exacerbate the sypmtoms of Sarcopenia.  "The proteins in your muscles are constantly being broken down.  If you aren't consuming enough protein in your diet, the breakdown exceeds synthesis and you have a loss of muscle mass", this according to Roger Fielding, PhD, associate director of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston.  Dr. Roger Fielding added, "If you aren't consuming enough protein in your diet, the breakdown exceeds synthesis and you have a loss of muscle mass."  And without strong muscles to support your joints, your balance may suffer, leaving you at a greater risk for an unintended fall.

So what can you do?  On average, older adults should consume 0.6 grams of protein per pound of body weight per day.  That's about 90 grams for someone that weighs 150 pounds.  An important note, make sure to spread those protein grams throughout the meals you would eat in a day.

Thanksgiving is right around the corner and this is your official "license to eat"!  Of course, make sure to eat the pumpkin pie in moderation!