Why Dual Tasking Means Better Balance & Fewer Falls
We have all heard the staggering statistics about falls for older adults, but they bear repeating. According to the Centers for Disease Control and Prevention (CDC), one in four people over the age of 65 will have a fall this year—and fewer than half will tell their doctor about it if an injury doesn’t occur. Medicare spends approximately $29 billion on fall-related injuries each year. And older adults who fall once are more likely to fall again.
All this means preventing falls is a huge concern for the homecare industry. After all, if the home is unsafe, seniors often have to go to facility-based care, forgoing a lot of independence.
And while providers can help clear obstacles and provide walking and balance aids such as canes and rollators, there is another approach: working with seniors to improve their balance.
Nymbl Science, an app-based program that gamifies balance and fall prevention, takes that approach. Its leadership says the company’s goal is to prevent 1 million falls.
“The United States is going the wrong direction,” said Nathan Estrada, clinical vice president of Nymbl Science. “A 75-year-old is twice as likely to die from a fall today as they were 10 or 15 years ago.” Meanwhile, he added, experts simply tell older adults they are at high risk, then offer them solutions that are difficult to adopt, such as bulky medical equipment, expensive home remodels or proactive in-person therapy.
A New Direction
Nymbl began in 2016, targeting seniors in the Boulder, Colorado area, a population with a high level of senior education and technological engagement. Co-founder Dr. J.P. Farcy, an orthopedic spine surgeon, had observed that roughly 80% of his failed spinal surgery patients had poor balance before surgery. He also noted that many of these patients had worked on strength training, but still struggled in their recovery.
In his research, Farcy found that simple strength training and functional exercise takes balance from a reflexive action to one controlled by the voluntary nervous system. Essentially, this means seniors must think about how and when to balance, rather than automatically catching and righting themselves in a stumble.
The Nymbl app works like this: Users are assigned simple functional movements, such as side lunges, coupled with entertaining cognitive challenges. This is known as dual tasking, and the combination helps retrain the reflexive nature of balance. Senior adults can then better recognize they are starting to fall and formulate a recovery plan, preventing injuries.
“Dual-task balance training has been the clinical gold standard in physical therapy and occupational therapy for decades,” said Estrada. “But it took doctors a little while to get on board.”
Estrada said that in clinical trials plotting results for dual tasking compared to functional exercise alone for balance, dual tasking shows greater improvement in every category except short-term memory.
Nymbl’s approach seems to work. In senior living studies, half of the participants moved out of the “high risk” category after three weeks of regular use. Postural sway area, the most used measure of balance, was reduced by 67% for participants. Perhaps most importantly, there was a 35% decrease in calls to emergency services for falls and fall-related injuries.
And these results can be achieved in only 10 minutes a day for 21 days. In contrast, another popular program in the field, Otago, takes around 50 hours to complete. Estrada said the need to devote that kind of time to other programs makes them less appealing to users.
“You have this problem to where we’ve created these international programs that are brilliant and they work—if you could get anyone to do them,” he said.
Nymbl partners with organizations that serve older adults and can sponsor the availability of the app for that population. At this time, Nymbl is available by prescription only to older adults through certain Medicare Advantage plans and government organizations. The company also has a partnerships with New Zealand’s Ministry of Health to provide the program free of charge in that country.
According to the company, the program has the potential to save insurance providers up to $30,000 per prevented fall. Estrada said it’s a no-brainer for insurers to get on board.
“Why would the older adult pay for that? Why shouldn’t their insurance pay for that?” he said.
Managing Fear & Messaging
It’s easier to maintain good balance through training at age 50 than it is to regain balance at 90, Estrada said. Right now, many insurance companies don’t want to pay for prevention, although that attitude is changing, as evidenced by Nymbl’s recent partnerships. Some payers do reimburse for a balance screen in a physician’s or therapist’s office, but Estrada said those screens can cause more problems.
“We basically steal people’s resiliency by making them fearful—increasing the injury rate—which is why [I believe] the rate’s gone up. Every time we screen someone for falls, we’re impairing their motivation,” he said.
Estrada likened fall screening to walking an older adult up to a pit of quicksand, and when they fail the fall screen, making them step forward into the pit. But if they pass, they get to walk away.
“We’re giving false hope when they pass and false fear when they fail. Neither one of those help,” he said.
While it’s important for providers to identify balance issues in their clients, working to increase balance without inducing fear is vital to healthier aging and greater independence.
Home health agencies managing fall patients can recommend Nymbl as part of a recovery or therapy routine. Working with referral partners to make them aware of the program can also help keep clients safely at home. If homecare clients can benefit from Nymbl, they should be encouraged to advocate to have the program covered.
Most older adults want to age at home and maintain their independence. Preventing falls and related injuries is the first step to ensuring these goals.
“Older adults don’t need someone to motivate them,” said Estrada. “They want better balance. They just need to know where to go.”
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