Developing and feasibility testing a gamified ‘app’ to prevent slips, trips and falls among the over 65s

Developing and feasibility testing a gamified app for learning to prevent slips, trips and falls among the over 65s

Dr Paul Dewick* and Dr Emma Stanmore**Alliance Manchester Business School*; School of Nursing, Midwifery & SocialWork** The University of Manchester

Games for Health Europe, Oct’ 31st – Nov’ 1st 2016 Original Thinking Applied

With acknowledgements to Dr David Hoyle, New Charter Group

Real World

Engagement

Learning

;

• Slips, trips & falls: leading cause of injury, injury related disability and death in older people (Vieira et al., 2016)

• Falls costs NHS £2.3 billion in 2013 (NICE, 2013)

Gillespie et al. (2012), 159 trials, 79193 participants

Sherrington et al. (2008) 44 trials, 9603 participants

Motivators References Barriers ReferencesMaintaininghealthandindependence

Sarkisian etal.2005;Yardleyetal. 2006

Poorhealthandpain

Rasinaho etal. 2006;Cohen-Mansfieldetal.2003

Self- efficacy Perkinsetal. 2008;McAuley etal. 2003

Environment:availableexercisefacilities,proximitytofacilities,weather

DeGroot&Fagerstom2011;CDC,1999

Prompts Castroetal. 2001 Lackofknowledge Huietal.,2001;Rhodesetal.,1999

Music Schutzer &Graves2004;Johnsonetal.2001

GP/Dr/HCPnotpromotingorgivingadvice

Balde etal. (2003)

Demographics:male,nonsmokers,fewerdiseases&lesspain, fitatbaseline

Stigglebout etal. 2006;Umstattd &Hallam,2007

LackofTransportandcost

Yardleyetal. 2006;DeGroot&Fagerstom,2011

Aim and objectives

• Aim: to reduce incidences of slips, trips and falls among over 65s, attenuating the related high economic, social & psychological costs

• Objectives, from a user perspective: – motivate behavioural change to routinely engage

correctly in appropriate exercises to build strength and balance; and

– improve awareness of preventative or therapeutic interventions, and to reduce the fear of falling.

We started with game thinking….

• abstract challenge

• rules

• interactivity

• levels

• storytelling

....combined motivational insights....

• Collapse intrinsic and extrinsic motivation

• Keller’s (1987) ARCS model

• Ryan and Deci’s (2000) self-determination theory

….added assessment….

• Objective 1 (exercise): – ‘Correct’ balance/ strength

exercises– Progress over programme

• Objective 2 (knowledge/awareness)– Declarative knowledge – Fear of falling

….and some design ideas….

• character• game

environment• game play• reward structure• game look/feel

….we procured the services of a creative agency….

….with whom we mapped and challenged our assumptions….

…and co-developed & tested a ‘skinny’ prototype app

Next steps

• Address immediate shortcomings of the prototype app

• Conduct focus groups to investigate older people’s views of the prototype app

• Apply for further funding to co-develop and test a fully functioning app

References• Balde A. Figueras J. Hawking, D.A., et al. Physician advice to the elderly about

physical activity JAPA, 11 (2003), pp. 90–97• Bullen, E., (2015), Indices of Deprivation 2015: Health Deprivation and Disability

domain, available at http://www.manchester.gov.uk/download/downloads/id/23515/f5_indices_of_deprivation_2015_-_health_deprivation_and_disability.pdf, last accessed October 2016

• Castro, C.M., King, A. C., Brassington G.S. (2001) Telephone versus mail interventions for maintenance of physical activity in older adults Health Psychol, 20, pp. 438–444

• Centers for Disease Control and Prevention Neighborhood safety and prevention of physical inactivity—selected states, 1996 MMWR, 48 (1999), pp. 143–146

• Cohen-Mansfield J. Marx M.S., Guralnik J.M. (2003) Motivators and barriers to exercise in an older community-dwelling population. JAPA, 11 (2003), pp. 242–253

• De Groot G.C.L., Fagerstom L. (2011) Older adults’ motivating factors and barriers to exercise to prevent falls. Scandinavian Journal of Occupational Therapy. 18: 153-60.

• Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E., (2012), Interventions for preventing falls in older people living in the community. The Cochrane Database of Systematic Reviews, 9, CD007146, doi:10.1002/14651858.CD007146.pub3

• Hui, S. S., Morrow J.R. (2001) Levels of participation and knowledge of physical activity in Hong Kong adults and their associations with age JAPA, 9, pp. 372–385

References• Johnson G., Otto D., Clair A. A. (2001) The effects of instrumental and vocal music

on adherence to a physical rehabilitation exercise program with persons who are elderly J. Music Therapy, 2 pp. 82–96

• Keller, J., (1987), Development and use of the ARCS model of instructional design, Journal of instructional development, 10 (3), pp.2-10

• McAuley E., Jerome G., Marquez D., Elavsky S., Blissmer B. (2003a) Exercise self-efficacy in older adults: social, affective, and behavioral influences. Annals of Behavioral Medicine. 25: 1-7

• National Institute for Health and Care Excellence (2013), Falls: assessment and prevention of falls in older people. Available at https://www.nice.org.uk/ guidance/cg161

• Perkins J.M., Multhaup K.S., Perkins H.W. Barton C. (2008) Self-efficacy and participation in physical and social activity among older adults in Spain and the United States. The Gerontologist, 48, 51-58.

• Rasinaho M., Hirvensalo M., Leinonen R., Lintunen T., Rantanen T. (2006). Motives for and barriers to physical activity among older adults with mobility limitations. Journal of Aging & Physical Activity. 15. 90-102.

• Rhodes R., Martin A., Taunton J., Rhodes E., Donnelly M., Elliot J. (1999) Factors associated with exercise adherence among older adults: an individual perspective. Sports Medicine. 28 (6) 397-411.

References• Ryan, R.M. and Deci, E.L. (2000), Self determination theory and the facilitation of

intrinsic motivation, social development and well being, American Psychologist, 55, 68-78

• Schutzer K., Graves S. (2004) Barriers and motivations to exercise in older adults. Preventive Medicine. 39. 1056-61.

• Sherrington, C. Whitney, J., Lord, S., Herbert, R., Cumming, R., Close. J., (2008), Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis, J Am Geriatric Society, DOI: 10.1111/j.1532-5415.2008.02014.x

• Stigglebout M., Hopman-Rock M., Crone M., Lecher L., Van Mechelen W. (2006) Predicting older adults' maintenance in exercise participation using an integrated social psychological model. Health Education Research. 21, 1-14.

• Umstattd R.M., Hallam J. (2007) Older adults exercise behaviour: Roles of selected constructs of Social Cognitive Theory. Journal of Aging and Physical Activity. 15. 206-19.

• Vieira, E.R., Palmer, R.C., Chaves, P.H.M., (2016), Prevention of falls in older people living in the community, BMJ, 353: i1419, doi: 10.1136/bmj.i1419

• Yardley L., Bishop F., Beyer N., Hauer K., Kempen G.I., Piot-Ziegler C., Todd C. Cuttelod T., Horne M., Lanta K., Holt A.R. (2006) Older people’s views of falls-prevention interventions in six European countries. The Gerontologist. 46: 650-60.