Application of the game ZELFIE for elderly at home, in order to live longer independently

Old adults prefer to live independently as long as possible. Regular execising,
including for example balance and strength training, enhances their ability to
remain independent, and decreases the risk for adverse outcomes such as
falling. Because we now live longer than ever before, the number of old adults
aged 75 or older is expected to double in the coming years. About 1 out of 4 of
these patients can be considered frail. Because an increase in age comes hand
in hand with comorbidities such as osteoporosis, a fall often results more
often in a hip-fracture; a condition that is known to have a dramatic influence
on a patients functional abilities in terms of for example Activities of Daily
Living (ADL). To maximize the impact of rehabilitation after surgery, and to
maximize functional recovery, it is important to provide regular and varying
functional exercises, with many repetitions.

With todays' recent technological advances, there is a growing interest in the
use of exergames for older adults. Using an exergame, patient train their
functional skills by means of playing a game. Sensors register movement
patterns and movement activity, and provide feedback at a game- and personal
level. The games can be developed to train for example balance, strength, or
condition, and are based on widely acknowledged exercise principles. Such
exergames are functiuonal relevant, as balance training for example reduces
fall risk. However, exergames should be specifically tailored to the population
and meet their user requirements. The recently existing exergames are too
complex, too unsafe, and are not designed to improve (dys)functional
performance of those vulnerable geriatric patients with a mean age of 80.
Especially this population needs assistence in training functional health,
because they often present with fear of falling, and have limited social
support. The ZELFIE game, is specifically tailored to improve their functional
health.

The aim of the present study is to implement and evaluate the 'ZELFIE game' in
vulnerable geriatric patients after hip-surgery, and in patients with an
increased risk of falling. The game is specifically tailored to and co-created
with the population group, and stimulates the ability to live independently and
remain activities of daily living (ADL). To this aim, voice samples are used to
support and motivate individuals to perform the activities that are required
for their final goals. For example, to be able to walk the stairs
independently, sub-activities such as walking to the stairs, knee-raising, and
a certain level of strength and condition are required and need to be trained
according to a patients capabilities. The ultimate goals will be discussed and
set in cooperation with a specialized geriatric physiotherapist. The (sub)goals
will be monitored and scored using the 'goal attainment scaling' method.

The study will include 30 vulnerable geriatric patients. Instructions about the
game will be given at home. The patient, the geriatric physiotherapist, and
family member will formulate the ultimate goals of the ZELFIE game. 20 patients
(sub group two and three) will play the game for 4 weeks, in which the
physical therapist weekly visits the patient and closely monitors
progression/feasibility. After 4 weeks, the game will be evaluated, and any
changes in behavior and/or functional capabilities will be established. Also
will be established to what extent the goals are achieved. 10 patients ( sub
group 1) will only play the game for one week.

The intervention during this pilot study is the application of the game ZELFIE.
short description of the game
ZELFIE encourages elderly to perform self selected commands. After performing
the mission the patient scores on a small box how well it went. He/ she can
select one of five icons with smileys. After performing the command the patient
is rewarded with a self selected piece of, for him/her meaningfull, music. The
geriatric physical therapist chooses in coordination with the patient the
commands. The geriatric physical therapist programs the voice samples that
indicate when and wich command has to be performed. Also does he/she select
together with the patient what favorite music samples have to be programmed.

The risks of using the 'magic box', i.e., the ZELFIE game, are comparable to
the risk that usual activities of daily living (ADL) will exhibit. In addition,
the goals will be carefully formulated in cooperation with the physiotherapist,
and will never require over-achievement or activities beyond a patients'
capacities or comfort zone.