Using Cell Phone While Walking Increases the Risk of Accidents in the Elderly
Gustavo Christofoletti1*, Sidney Afonso Sobrinho Junior2, Thaís Cardoso da Silva3, and Suzi Rosa Miziara Barbosa4
1Professor of the graduate programs “Movement Sciences” and “Health and Development”, Federal University of Mato Grosso do Sul, Brazil
2Graduate student of the program “Movement Sciences”, Federal University of Mato Grosso do Sul, Brazil
3Graduate student of the program “Health and Development”, Federal University of Mato Grosso do Sul, Brazil
4Professor of the program “Open University for Seniors”, Federal University of Mato Grosso do Sul, Brazil
Submission: August 01, 2022; Published: August 29, 2022
*Corresponding author: Gustavo Christofoletti, Institute of Health, UFMS/INISA Cidade Universitária, Campo Grande, 79060-300, Brazil
How to cite this article: Gustavo C, Sidney A S J, Thaís C d S, Suzi R M B. Using Cell Phone While Walking Increases the Risk of Accidents in the Elderly. OAJ Gerontol & Geriatric Med. 2022; 7(1): 555702. DOI: 10.19080/OAJGGM.2022.07.555702
Abstract
Aim: To analyze the risks of accidents in older adults caused by the use of cell phone while walking.
Design: A systematic review was performed with manuscripts published between the years 2000 and 2021. The search was conducted in which the terms “cell phone”, “walking”, “balance”, and “risks of falls” were confronted by the boolean operators “and”, “or”, and “not”, in articles published in the National Library of Medicine citation database (MEDLINE/NLM®). Two researchers screened the articles independently and included manuscripts that addressed the impact of cell phone use on gait, balance and risk of falls in older adults. Studies were compared in terms of sample size, clinical profile of the participants, assessments, inferential analyses, and outcome.
Results: Primary analysis with the term “cell phone” identified 23,060 articles published in journals linked to MEDLINE/NLM®. The eligibility criteria reduced the number of articles to 95, 16 of them involving older adults. The sample size of the studies varied between 16 to 408 participants. The studies assessed mainly subjects’ balance and gait. The comparisons involved tasks with and without the use of cell phone. Most of the statistical analyses used paired tests (Student t-tests or repeated measure ANOVAs), correlations and regressions. The main outcomes showed that performing dual tasks decrease gait speed and increase imbalance in older adults.
Conclusion: This systematic review confirm the risks of older adults in using cell phones while walking. The number of manuscripts addressing this topic is still low, highlighting the need of further studies assessing the impact of cell phone use simultaneous to a walking task.
Keywords: Pain; Parkinson’s disease; Neurodegeneration; Management; Non motor symptoms; Dystonia; Musculoskeletal pain; Carpal tunnel syndrome
Introduction
Life expectancy has increased in recent years. This happened due to scientific and technological advances, and to changes in habits. Access to health care services, active lifestyle and healthy eating are some of the factors associated with a greater longevity [1]. As consequence, the number of subjects over 65 years will increase substantially, surpassing 1.4 billion inhabitants in the next 15 years [2]. In addition to the growing number of older adults, there has been a change in the routine of the subjects. In the past, it was common to identify the elderly by their restriction to the family environment, fragile locomotion, presence of “common to aging diseases” and by stigmas such as urinary incontinence, memory loss and reduced level of attention. Nowadays, the elderly are more active, with a healthier diet, many still employed and with a leisure routine different from the one present in the past [3-4].
Change of habits of the elderly is going through digital inclusion. Older adults have access to internet on computers, laptops and tablets [5]. However, it was with cell phones that digital technology was incorporated into the routine of the elderly [6]. The use of cell phones by older adults is becoming more and more frequent. Sending messages, chatting, video calling, leisure and health apps justify the growing use of cell phones by this population. It is noticeable that the use of cell phones is beneficiating the elderly [7]. However, a new challenge began when people started using their cell phones simultaneously with a secondary task. It is common to see people using their cell phones while walking, at the gym, when shopping and even while driving [8].
The performance of two tasks at the same time is called dual task [9]. When the focus of a person’s attention is divided between more than one task, a decrease stimulus for each of the task is estimated [10]. Previous studies highlight risks of older adults in performing dual tasks [11-13]. Lower cadence, higher number of steps, imbalance, and lower gait speed are signs of an indirect protective response of the organism when submitted to simultaneous tasks. When associated to neurological diseases, such as stroke, Parkinson’s disease or Alzheimer’s disease, the impact of dual tasks is even more dangerous [14-16].
Most of the studies that assessed dual tasks in older adults used non-routine activities, such as counting numbers or spelling letters while walking. Studies focusing on the effect of using cell phone while walking have been developed only in recent years. This happened because the use of cell phones by older adults occurred mainly in the last decade, with all the attractions of the smartphones [17].
The aim of this study was to perform a systematic review assessing the effects of cell phone use by older adults simultaneous to a walking task. The researchers believe that this study will be of interest to readers of the OAJ Gerontology & Geriatric Medicine, given that the results are discussed and confronted from the perspective of aging and its functional changes.
Materials and Methods
This systematic review was based on the checklist recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) [18]. The search for articles was carried out in the National Library of Medicine citation database (MEDLINE/NLM®).
The articles were screened according to the following keywords: cell phone, dual task, gait, balance, and risk of falls. The boolean operators “and”, “or” and “not” were included to adjust the search for articles. Additional studies were identified by manually searching the references obtained in the articles. The search was limited to articles written in English, Spanish or Portuguese, published between 2000 and 2021. Cross-sectional, prospective and retrospective longitudinal studies that used data collected from the elderly were included. Letters to the editor, abstracts, dissertations, theses, reviews, and pre-print articles were excluded. Studies that cited the use of cell phone in older adults without performing dual-tasks were also excluded.
The manuscripts identified in the search strategy had their title, abstract and text evaluated by two researchers. Only studies that used cell phone associated to a secondary walking task were included in the analysis. Studies were compared in terms of clinical profile of the participants, sample size, evaluation mechanisms, inferential analyses, and outcome.
Results
The researchers identified initially 23,060 manuscripts. By adding the term “dual task”, the number of articles was reduced to 338. The eligibility criteria reduced the number of studies to 95. Of these, 16 assessed the impact of using cell phone while walking in older adults. (Figure 1) details the searching criteria of this systematic review.
(Table 1) details the studies included in this systematic review. The sample size of the studies varied between 16 to 408 participants. The studies assessed mainly subjects’ balance and gait parameters. The comparisons involved tasks with and without the use of smartphone. Most of the statistical analyses used paired tests (Student t-tests or repeated measure ANOVAs), correlation and regression tests. The outcomes showed that performing dual tasks decrease gait speed and increase imbalance in older adults.
Most of the studies assessing the impact of cell phone use in older adults was published in the last decade. (Figure 2) shows the evolution of the studies addressing this thematic according to year of publication.
Discussion
The aim of this study was to investigate articles published in MEDLINE/NLM® that have addressed the impact of cell phone use while walking in older adults. The results point to a lack of research addressing this topic in the elderly population. Only sixteen articles were included in this review. All of the studies identified risks of the elderly when the cell phone is used in a dual task condition.
The literature has already addressed the risks of cell phone use simultaneous to a secondary daily task [35-36]. Most of the studies focused young adults, since this audience represents the largest niche market of cell phone users worldwide [37-38]. With the increasing use of cell phones by older adults, this systematic review becomes important by alerting about the risks of using the cell phone while walking. The studies included in this systematic review were published between 2011 and 2020. This shows how recent and current the topic of this discussion is. The sample size of the manuscripts varied between 16 to 408 subjects. Readers should be aware that small sample sizes, if not controlled by alfa (α) and beta (β) statistical errors, could bias the findings.
No study in this thematic was published in 2021. This can be associated to the COVID-19 pandemic, which required social isolation and had catastrophic events particularly for the elderly population [39]. Authors believe that the studies published in 2020 were developed before the COVID-19 pandemic. There are several databases that publish scientific research. The authors opted to include only articles published in MEDLINE/NLM® because this is one of the most important database to assess medical journals and articles.
An important aspect identified in this study was a slower gait speed of older adults during the dual task activity. This pattern may represent a protective mechanism for the elderly when realizing dual tasks [20-24]. The current literature suggests that gait performance is decreased by an increasing task demand and that specific brain areas are activated according to attentional and energy-optimization challenges [16]. Most of the studies included in this review was carried out in a controlled environment (laboratory), without external factors. Dual task with cell phone in an external environment (public street with noises, lights, pedestrians, whether changes and vehicles) should increase the vulnerability of the elderly. This aspect should be further addressed by new research.
As a limitation of this systematic review, it was not possible to perform meta-analysis test. The meta-analysis is highly relevant because it provide clinical guidelines. Meta-analysis is usually applied in randomized clinical trials. Since most of the studies included did not configure clinical trials (but cross-sectional studies with different groups, eg, older versus young adults), the researchers chose not to perform meta-analysis in this review.
Conclusion
This systematic review identified a lack of studies discussing the impacts of cell phone use while walking in older adults. Most of the studies was published in the last five years, demonstrating how recent and current the topic of this discussion is. The results showed that using cell phone while walking can be very risky for older adults. More studies should explores this thematic.
Acknowledgments
We thank the Office of Graduate Studies of the Federal University of Mato Grosso do Sul (UFMS process n. SCGKZ.161121), the Scientific Foundation of the State of Mato Grosso do Sul (Fundect process n. 43141.653.9297.22022022 and scholarship for Sidney Afonso Sobrinho Junior) and the Coordination for the Improvement of Higher Education Personnel (FC001 and scholarship for Thaís Cardoso da Silva).
Conflict of interest
The authors declare no conflict of interest.
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