# A Virtual Reality-Based Simulation Tool for Assessing the Risk of Falls in Older Adults
###### Abstract  
Falls are considered a significant cause of disability, pain, and premature deaths in older adults, often due to sedentary lifestyles and various risk factors. Combining immersive virtual reality (IVR) with physical exercise, or exergames, enhances motivation and personalizes training, effectively preventing falls by improving strength and balance in older people. IVR technology may increase the ecological validity of the assessments. The main goal of our study was to assess the feasibility of using a KAVE-based VR platform combining simulations of Levadas and a cable car to perform a balanced assessment and profiling of the older adult population for high risk of falls and the related user experience. A VR-based platform using a Wii balance board and a CAVE was developed to assess balance and physical fitness. Validated by the Biodex Balance System (BBS), 25 older adults participated in this study. The usability and presence were measured through the System Usability Scale and ITC-SOPI questionnaires, respectively. The IVR system showed a high presence and a good usability score of 75. Significant effects were found in the maximum excursion of the centre of pressure (COP) on the anterior-posterior axis during the cable car simulation (CCS), correlating with BBS metrics. Multiple discriminative analysis models and the support vector machine classified fall risk with moderate to high accuracy, precision, and recall. The system accurately identified all high-risk participants using the leave-one-out method. This study suggests that an IVR-based platform based on simulations with high ecological validity can be used to assess physical fitness and identify individuals at a higher risk of falls. virtual reality; balance assessment; posturography; ecological validity; physical fitness; senior fitness tests +
Footnote †: journal: Medical  
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barriers, e.g., narrow stairs, socioeconomic conditions, and multiple comorbidities. Medical conditions such as neurological and cardiac ones are also part of the risk factors for falls [1]. Some other risk factors include older age [2], poor muscle strength [3,4], gait disorders [5], cognitive deficits [6], and balance disorders [7]. Older adults with difficulties in daily life activities are particularly vulnerable to falls, leading to injuries, disabilities, poor quality of life, mortality, and financial dependency. Addressing these risk factors through interventions like physical exercise, home modifications, and medical management can help reduce the incidence and impact of falls among the elderly [8]. In particular, physical exercise has been identified as one of the best solutions to reduce the risks of falls. Some exercises that can minimize the risks of falls are body stretch, strength and balance training, tai chi, and treadmill workouts [9]. Cognitive impairments, including low memory, self-control and response, are also linked with falls among older people [6,9]. Thus, cognitive-motor interference (CMI) challenges the ability of older adults to execute tasks effectively, such as walking and speaking simultaneously [10,11], putting them at higher risk of falls and experiencing difficulties executing those cognitive tasks [12,13]. Several organizations such as the Joint American and British Geriatric Society (ABGS), the British Geriatric Society (BGS) (Panel on Prevention of Falls in Older Persons, the American Geriatrics Society and British Geriatrics Society, 2011) and the National Institute of Clinical Excellence (NICE) UK have introduced a set of guidelines to assess and reduce the risk of falls [14]. It is also suggested that older adults should have moderate-to-high-intensity balance training in their multi-tier exercise program [15]. One study conducted home-based training sessions, which were successful for both men and women. It helped to reduce the risk of falls and associated injuries by about 35-45%.