Technology for falls prevention in dementia: Still more virtual than reality

Charlotte Eost-Telling is a research fellow in the Healthy Ageing Group at the University of Manchester, previously working in the NIHR Policy Research Unit in Older People and Frailty/Healthy Ageing and currently in the Applied Research Collaboration Greater Manchester Healthy Ageing Team. She has a background in healthy ageing research, digital health technology and human factors. Her paper Digital technologies to prevent falls in people living with dementia or mild cognitive impairment: A rapid systematic overview of systematic reviews has been published in Age and Ageing.

Falls are an increasing issue as we age and are one of the top causes of injury, disability and death in older people. As our population ages, falls will be an even more important problem for society and health services and a cause of harm to more people.

We increasingly use technology to support us in every aspect and at every stage of our lives, and falls prevention in older age is no exception. Exergaming (technology-based exercise), virtual reality training, wearable technology and apps may all help older people avoid falling.

People living with dementia are more than twice as likely to fall as other older people, and their risk of being injured when they fall is also higher. Since they are more likely to fall they could gain more benefit from anything that reduces their chance of falling. Despite this, they are often excluded from studies of new technology, perhaps because of the extra challenges they face in using some of it, and the extra challenges faced by researchers when working with people living with dementia.

We looked at the existing research, reported in systematic reviews, to give an overview of what is known about any technology for reducing falls in people living with dementia or a milder type of impaired cognition, whether they lived in the community or in residential or nursing homes. We expected to find studies of many different types of technology – our scope was broad and included sensors, mobile health (including apps), wearable devices, telehealth and telemedicine, as well as types of computing platforms, connectivity, and software.

There was very limited evidence for the effectiveness of technology. Most of the primary studies included a small number of people living with dementia, and there were problems with their methods and reporting. There were also issues with the systematic reviews that included these studies.

There were no studies at all looking at apps, and a lot of the other technology was used to distinguish people who fell from people who did not – it was not being used to try to prevent them from falling. Environmental sensors were tested for preventing falls but the results were unclear. In one case, carers found technology intrusive and disabled it during the study.

Our findings suggest a gap in understanding and an opportunity to develop more and better research into the use of technology to reduce falls in people living with dementia. We highlight the need to develop technology in collaboration with people living with dementia and those who care for them, whether they are family carers or professionals. We also spotlight the need for developers, health and care leaders and practitioners to consider the whole system of care in which the technology will be used - we must be clearer about how technology fits into the health and social care system if we are to realise its potential to reduce falls amongst people living with dementia!