Does smart home technology prevent falls in community-dwelling older adults: a literature review.

BACKGROUND: Falls in older Australians are an increasingly costly public health issue, driving the development of novel modes of intervention, especially those that rely on computer-driven technologies. OBJECTIVE: The aim of this paper was to gain an understanding of the state of the art of research on smart homes and computer-based monitoring technologies to prevent and detect falls in the community-dwelling elderly. METHOD: Cochrane, Medline, Embase and Google databases were searched for articles on fall prevention in the elderly using pre-specified search terms. Additional papers were searched for in the reference lists of relevant reviews and by the process of 'snowballing'. Only studies that investigated outcomes related to falling such as fall prevention and detection, change in participants' fear of falling and attitudes towards monitoring technology were included. RESULTS: Nine papers fulfilled the inclusion criteria. The following outcomes were observed: (1) older adults' attitudes towards fall detectors and smart home technology are generally positive; (2) privacy concerns and intrusiveness of technology were perceived as less important to participants than their perception of health needs and (3) unfriendly and age-inappropriate design of the interface may be one of the deciding factors in not using the technology. CONCLUSION: So far, there is little evidence that using smart home technology may assist in fall prevention or detection, but there are some indications that it may increase older adults' confidence and sense of security, thus possibly enabling aging in place.

Primary and secondary prevention of cardiovascular disease: is there a place for Internet-based interventions?

PURPOSE: Internet-based interventions to manage and prevent chronic diseases are becoming increasingly popular, especially for those with limited access to health services. This article reviews Internet-based interventions for the prevention of cardiovascular disease (CVD) and reduction of cardiovascular risk factors. METHODS: MEDLINE, EMBASE, and Cochrane databases were searched using terms for telemedicine and CVD (heart disease* OR myocardial infarction OR cardiac event* OR heart attack* OR cardiovascular disease* OR cardiovascular risk factor* OR blood pressure OR hypertension OR cholesterol OR LDL-C OR HDL-C OR cardiac rehabilitation) AND (telemonitor* OR tele-monitor* OR teleconsult* OR tele-consult* OR telemanagement OR tele-management OR telerehab* OR tele-rehab* OR Internet-based intervention OR internet based intervention OR Internet intervention* OR web based or web-based). Studies that investigated Internet-based interventions delivered directly to patients and resulted in improvement of cardiovascular-related health outcomes were included. RESULTS: Studies were identified (N = 23) investigating the reduction of cardiovascular risk factors. Five studies investigated patients diagnosed with CVD, 6 targeted participants with diabetes, 6 targeted participants with increased cardiovascular risk, and 6 investigated the general population. The majority of studies reported improvement in blood pressure and HbA1c levels in participants diagnosed with type 2 diabetes. Other outcomes included a decreased number of cardiovascular events, improved lipid profile and eating habits, decreased weight, and increased physical activity. CONCLUSIONS: There is emerging evidence that Internet-based interventions may reduce cardiovascular risk in cardiac patients and in populations with a heightened risk of CVD. Such interventions may also represent an alternative method of providing CVD prevention strategies.

Using commercial video games for upper limb stroke rehabilitation: is this the way of the future?

BACKGROUND: The increasing number of people living with poststroke sequelae has stimulated the search for novel ways of providing poststroke rehabilitation without putting additional stress on overburdened health care systems. One of them is the use of commercially available technology and off-the-shelf video games for hemiparetic upper limb rehabilitation. METHODS: The MEDLINE, EMBASE, and Cochrane Library databases were searched using key word synonyms for stroke, upper limb, and video games. Included studies investigated upper limb stroke rehabilitation using commercially available consoles and video games, reported outcomes that included measures of upper limb functionality, and were published in a peer-reviewed journal written in English. RESULTS: Thirteen studies were identified - 6 published as full articles and 7 as abstracts. Studies were generally small and only 3 were randomized. The gaming systems investigated were the Nintendo Wii (n = 10), EyeToy PlayStation (n = 2), and CyWee Z (n = 1). The Nintendo Wii appears to provide the greatest benefits to patients, with improvements seen in upper extremity function measures such as joint range of motion, hand motor function, grip strength, and dexterity. Three studies indicate that video therapy appears to be safe and that long-term improvements continue at follow-up. CONCLUSIONS: At present, the evidence that the use of commercial video games in rehabilitation improves upper limb functionality after stroke is very limited. However, this approach has the potential to provide easily available and affordable stroke rehabilitation therapy in settings where access to therapy is limited by geographical or financial constraints.

Using commercial video games for falls prevention in older adults: the way for the future?

BACKGROUND AND PURPOSE: Falls in older adults are an increasingly costly public health issue. There are many fall prevention strategies that are effective. However, with an increasing population of older people and ever-decreasing availability of health practitioners and health funding, novel modes of intervention are being developed, including those relying on computer technologies.The aim of this article was to review the literature on the use of exergaming to prevent falls in older adult persons living in the community. METHODS: The Cochrane, Medline, and Embase databases were searched using prespecified search terms. To be included, studies had to investigate the effect of using commercially available consoles and video games on outcome measures such as a decrease in falls, improvements in balance control or gait parameters, decreased fear of falling, and attitude to exercise in older adult persons living in the community. All study designs with the exception of single-person case studies were included. Articles had to be published in peer-reviewed journals in the English language. RESULTS: Nineteen studies fulfilled the inclusion criteria. The following outcomes were observed: (1) using computer-based virtual reality gaming for balance training in older adults was feasible; (2) the majority of studies showed a positive effect of exergaming on balance control; (3) some studies showed a positive effect on balance confidence and gait parameters; (4) the effect was seen across the age and sex spectrum of older adults, including those with and without balance impairment. CONCLUSIONS: There is as yet no evidence that using virtual reality games will prevent falls, but there is an indication that their use in balance training may improve balance control, which in turn may lead to falls prevention.

Self-management and rehabilitation in osteoarthritis: is there a place for internet-based interventions?

The electronic databases Cochrane, MEDLINE, and SCOPUS were searched to collect evidence on the impact of community-based Internet interventions for adult patients with osteoarthritis (OA) on health outcomes. Five studies met our review criteria. We found that Internet-based OA self-management interventions modestly but significantly improved four of six health status measures compared with usual care and have been met with high acceptance and high user satisfaction. Preventive physiotherapy exercise delivered via videoconferencing for patients with OA-related knee pain significantly improved health measures including pain, stiffness, and physical function compared with the initial health status. Postoperative rehabilitation performed by a physical therapist via videoconferencing and "in-person" resulted in similar health measure improvements. The review findings show that the Internet may be successfully used as a medium for providing community-based self-management and rehabilitation interventions in OA.