CHAPTER 2. STATE OF THE ART-LITERATURE REVIEW
2.2 B ACKGROUND OF THE RESEARCH
2.2.5 PRQ2, 3.: Pilot study-II
literature that suggest the elderly’s negative stereotypes towards exercise [28, 83]. The exercise intervention needs a more enjoyable approach.
Based on this study's findings, a few more questions were raised, and another semi-structured interview is conducted with the experts.
2.2.5 PRQ2, 3.: Pilot study-II
open coding, and tentative linkages are established between categories and include multiple visits with concerned experts with additional questions to collect further data.
Findings from the Experts’ interview
The results from experts’ opinion are concise in the following points:
• At first, fall patients had to go through the screening process that includes: cause of fall, fall history, medicine use, medical history, etc., and then the experts provide the recommendation.
• For healthy elderly (those who can do the activity of daily living), recommendations for fall prevention are environmental changes, behavioral, exercise for balance, and muscle training.
• In the international market, there are many products like “Hip protectors,” “Real-time monitoring system,” “Human airbag system for fall,” “Alarm system,” “Exergame.” Though they are available in developed countries, such interventions are not popular among doctors in India, but they appreciate the possibilities.
• The experts have mentioned that due to cost factors, hip protectors, etc.
not recommend to patients. They also said that if the patient has used such products, they do not have the record.
• Walker is advised to elderly patients (those who have very little stability/ balance). However, it is difficult to use in all places and cumbersome to some elderly patients. Cane is also used by the elderly.
But it becomes troublesome for them to use with cloths (long attire like saree, lungi, etc.) or even in many cases it is not advisable to use while moving upstairs or downstairs.
• The elderly feel uncomfortable wearing hip-protectors, as it has padded areas that cause pain in prolonged use. Apart from that, they find it uneasy due to size issues.
• Balance training is considered the most efficient to increase strength in lower limbs and to avoid elderly falls.
• Although the elderly are aware of the positive benefits of exercise, most do not engage them in exercising at recommended levels.
• The elderly male is more concerned regarding the exercise than the female.
• The elderly are not motivated to perform the exercise, and they skip days without exercising. Monitoring is required to complete the training as they tend to forget to do it step-by-step. Another issue is the elderly feel is bored while exercising and visiting the chamber/ hospital multiple times.
• Stepping pace varies among the elderly while doing the exercise. So, the elderly follow their own pace, and they are not interrupted by the medical personnel. Doctors do not force their training or gait speed, and the elderly are not obliged to do the exercise daily, as in many cases, they feel irritated or disrespected if they are asked to it more than one time. In these cases, they might refuse to exercise at all.
• For fall intervention, they have suggested the fall preventive balance exercise (stepping) or aid or tool that can motivate the elderly with playful physical training. The development of assistive measures might reduce the FOF. Reducing FOF and increasing balance confidence among the elderly is considered very important for intervention.
• Stepping exercises for balance improvement: “Simple standing with open eye/ close eye,” “One leg stand,” “Stepping over,” “Sidestep over,” “Sidestepping,” “Figure eight,” “Figure eight in one direction,”
“Tandem walking,” “Back walking.”
• A few of the exercises mentioned above have been asked to exclude as a safety measure, as these might cause a little problem in the knee pain or their safety in general. Those are: “Simple standing with a Close Eye,” “One leg stand,” “Tandem walking,” “Back walking,” and 6- inch lifting of legs by the elderly in “Step over,” and “Side stepover.”
Simple walking without lifting in these two exercises is suggested by medical personnel.
• To motivate the elderly musical environment, or self-motivation are considered options by the practiced physicians.
• All the physicians are not aware of the exergame (Exercise in the form of gaming). Those who are, they mentioned, exergames are designed for kids, not for the elderly, and its effect on them is not still confirmed briefly.
Findings from the Market survey
In the market, especially global online marketing sites, products like hip- protectors, knee caps are available. Other products like the fall alarm system are not available in the Indian market. These products are not feasible to order/ get in all parts of India. In exergames, Dance Dance Revolution (DDR), Wii, etc., are available on India's online shopping sites.
But those are not available in off-line medical and retail stores in Assam, India.
Findings from the Literature survey
The interview with the elderly and experts leads to a common problem: the elderly’s lack of interest in the traditional exercise. Literature shows the digital games, Exergame (EXG), can cater as a motivator, emotional, and social level of meaningful and cherished activities [31]. EXGs are interactive video games that involve physical activity or exertion tracked as a body [32]. EXG, like Wii, DDR, may shape the fall research in the elderly population in a positive direction. Rademaker highlighted that the gaming environment of EXG, like SilverFit, highly values the motivational impact, and findings show that the intensity of movement is recorded higher when they are using SilverFit, [84]. EXG has excellent potential in the field of elderly fall research, which needs a more in-depth study, as the present EXG like, games Wii are found to be too fast or give too negative feedback and not mainly designed for the elderly [76]. The detail of the EXG research is mentioned in the next section, 2.3 of this chapter.
Discussion
This survey answers PRQ 2, 3. This study supports the literature review findings that exercise intervention is useful for improving balance and preventing the occurrence of falls [15, 85, 25]. The study revealed that experts prefer balance exercise intervention, and they believe that
“Prevention is better than cure.” Experts have recommended a different kind of stepping exercises like “Simple Stand,” “Stepping over,” and
“Sidestep over,” which are considered as balance improvement exercise that can prevent fall in the elderly. Studies also advised that stepping exercises have a significant impact on balance improvement [33]. But this survey also shows that the elderly avoid exercising, miss the follow-up sessions due to busy schedules or boredom or missed reminders, etc. This is a similar finding discussed in section 2.1.3, PRQ1. EXG is one of the potential answers to the PRQ3, along with self-awareness, maintaining routine exercise, and motivation towards training.
The use of technology, such as EXG, is a possible way of fostering the elderly’s inhibition towards exercise. Study shows online games can improve balance as well as psychological health [85]. Findings from PRQ1, 2 show that such technological measures are not accessible to the elderly in India. It is difficult to adapt these interventions directly for India's elderly, as there is a mismatch concerning their anthropometric dimensions, environmental factors, structural issues, etc. Many studies suggested that available EXGs are not designed for the elderly [86, 31], and in India, new technology is not popular as in the developed nations [22, 72]. For using any technological measure for fall first, it is needed to understand what kind
of attributes the elderly would consider before buying such products in India. Research, another pilot study, is designed with an online form.
2.2.6 PRQ4.: Pilot study-III