A Fall Risk Evaluation and Feedback System for Older Adults

2021 ◽  
Vol 13 (2) ◽  
pp. 105-118
Author(s):  
Isa Jahnke ◽  
Lorraine J. Phillips ◽  
Fatih Demir ◽  
Carmen Abbott ◽  
Marjorie Skubic
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Risk Evaluation ◽  
Feedback System ◽  
Clinical Test ◽  
Validity And Reliability ◽  
Timed Up And Go ◽  
Sociotechnical System ◽  
System Usability Scale ◽  
System Solution

Falls are widespread among older adults causing serious injuries and threatening their quality of life. An approach to estimate fall risk, and to prevent falls, is the Timed-Up-and-Go (TUG) test. The TUG test has established validity and reliability. However, as a clinical test, it is not accessible for personal use. To enhance its reach, the authors developed a prototype called Fall Risk Evaluation and Feedback System (FREFS). The prototype is a Kinect-based depth sensor system with interfaces that support older adults in completing the TUG test and receiving personalized test results. The personalized feedback feature is novel that existing prototypes do not include. This study's goal was to gain knowledge of the user experience of FREFS. This research applied methods of observation, interviews, and collected responses on the System Usability Scale (SUS). Results show participants perceived the system as usable, with SUS score of 84.3, but also revealed issues. First, users were unsure how to deal with the TUG tests results when the results showed high fall risk. Second, clearer instructions and reduction of information overload specifically for these age groups were needed. Third, a communication approach embedded into the system would be required (i.e., a link to a chatbot feature or a button to connect to a real person). Overall, the study demonstrated that such a prototype cannot be fully automated; it needs a sociotechnical system solution that includes human communication.

scholarly journals Multisensory integration involved in the body perception of community-dwelling older adults

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. Hide ◽  
Y. Ito ◽  
N. Kuroda ◽  
M. Kanda ◽  
W. Teramoto
Keyword(s):  
Older Adults ◽  
Multisensory Integration ◽  
Fall Risk ◽  
Community Dwelling ◽  
The Body ◽  
Risk Of Falling ◽  
Body Perception ◽  
Rubber Hand ◽  
Timed Up And Go ◽  
Community Dwelling Older Adults

AbstractThis study investigates how the multisensory integration in body perception changes with increasing age, and whether it is associated with older adults’ risk of falling. For this, the rubber hand illusion (RHI) and rubber foot illusion (RFI) were used. Twenty-eight community-dwelling older adults and 25 university students were recruited. They viewed a rubber hand or foot that was stimulated in synchrony or asynchrony with their own hidden hand or foot. The illusion was assessed by using a questionnaire, and measuring the proprioceptive drift and latency. The Timed Up and Go Test was used to classify the older adults into lower and higher fall-risk groups. No difference was observed in the RHI between the younger and older adults. However, several differences were observed in the RFI. Specifically, the older adults with a lower fall-risk hardly experienced the illusion, whereas those with a higher fall-risk experienced it with a shorter latency and no weaker than the younger adults. These results suggest that in older adults, the mechanism of multisensory integration for constructing body perception can change depending on the stimulated body parts, and that the risk of falling is associated with multisensory integration.

scholarly journals Towards Using the Instrumented Timed Up-and-Go Test for Screening of Sensory System Performance for Balance Control in Older Adults

Sensors ◽  
2019 ◽  
Vol 19 (3) ◽  
pp. 622 ◽  
Author(s):  
Thomas Gerhardy ◽  
Katharina Gordt ◽  
Carl-Philipp Jansen ◽  
Michael Schwenk
Keyword(s):  
Older Adults ◽  
System Performance ◽  
Fall Risk ◽  
Balance Control ◽  
Sensory System ◽  
Sensory Systems ◽  
Community Dwelling ◽  
Functional Mobility ◽  
Timed Up And Go ◽  
Community Dwelling Older Adults

Background: Decreasing performance of the sensory systems’ for balance control, including the visual, somatosensory and vestibular system, is associated with increased fall risk in older adults. A smartphone-based version of the Timed Up-and-Go (mTUG) may allow screening sensory balance impairments through mTUG subphases. The association between mTUG subphases and sensory system performance is examined. Methods: Functional mobility of forty-one community-dwelling older adults (>55 years) was measured using a validated mTUG. Duration of mTUG and its subphases ‘sit-to-walk’, ‘walking’, ‘turning’, ‘turn-to-sit’ and ‘sit-down’ were extracted. Sensory systems’ performance was quantified by validated posturography during standing (30 s) under different conditions. Visual, somatosensory and vestibular control ratios (CR) were calculated from posturography and correlated with mTUG subphases. Results: Vestibular CR correlated with mTUG total time (r = 0.54; p < 0.01), subphases ‘walking’ (r = 0.56; p < 0.01), and ‘turning’ (r = 0.43; p = 0.01). Somatosensory CR correlated with mTUG total time (r = 0.52; p = 0.01), subphases ‘walking’ (r = 0.52; p < 0.01) and ‘turning’ (r = 0.44; p < 0.01). Conclusions: Supporting the proposed approach, results indicate an association between specific mTUG subphases and sensory system performance. mTUG subphases ‘walking’ and ‘turning’ may allow screening for sensory system deterioration. This is a first step towards an objective, detailed and expeditious balance control assessment, however needing validation in a larger study.

scholarly journals Beneficial Effects of Interactive Physical-Cognitive Game-Based Training on Fall Risk and Cognitive Performance of Older Adults

2020 ◽  
Vol 17 (17) ◽  
pp. 6079
Author(s):  
Kochaphan Phirom ◽  
Teerawat Kamnardsiri ◽  
Somporn Sungkarat
Keyword(s):  
Older Adults ◽  
Cognitive Performance ◽  
Fall Risk ◽  
Intervention Group ◽  
Significant Risk ◽  
Community Dwelling ◽  
Cognitive Outcome ◽  
Timed Up And Go ◽  
Cognitive Improvement ◽  
Risk Factors For Falls

Physical and cognitive declines are significant risk factors for falls. Promising evidence suggests that combined physical-cognitive training would be an effective fall risk reduction and cognitive improvement intervention. However, a limited number of studies have been conducted and findings have been inconclusive. This study investigated the effects of interactive physical-cognitive game-based training on the fall risk and cognitive performance of older adults. Forty participants were randomly allocated to the intervention (n = 20) and control (n = 20) groups. Participants in the intervention group performed a 1 h session, 3 times a week for 12 weeks of the interactive physical-cognitive game-based training program. Fall risk (Physiological Profile Assessment, PPA; and Timed Up and Go, TUG) and cognitive outcome (Montreal Cognitive Assessment, MoCA) were assessed at pre- and post-intervention. Thirty-nine participants (mean age = 69.81 ± 3.78 years) completed the study (97.5%). At the end of the trial, participants in the intervention group demonstrated significant improvement in the PPA fall risk score (p = 0.015), postural sway (p = 0.005), MoCA score (p = 0.001), and TUG-dual task (p = 0.045) compared to controls. In conclusion, the interactive physical-cognitive, game-based training was effective in reducing physiological fall risk and improving cognitive function in community-dwelling older adults.

Bend Don’t Break: Stretching Improves Scores on a Battery of Fall Assessment Tools in Older Adults

2021 ◽  
Vol 30 (1) ◽  
pp. 78-84
Author(s):  
Nathan F. Johnson ◽  
Chloe Hutchinson ◽  
Kaitlyn Hargett ◽  
Kyle Kosik ◽  
Phillip Gribble
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Community Dwelling ◽  
Assessment Tools ◽  
Static Stretching ◽  
Timed Up And Go ◽  
Sit To Stand ◽  
Age Related ◽  
Flexibility Training ◽  
Community Dwelling Older Adults

Context: Falls and loss of autonomy are often attributed in large part to musculoskeletal impairments in later adulthood. Age-related declines in flexibility contribute to late adulthood musculoskeletal impairment. The novel sitting-rising test has been proposed to be a quick, effective screening of musculoskeletal fitness, fall risk, and all-cause mortality in older adults. The timed up and go and 5 times sit-to-stand tests are two of the 3 most evidence-supported performance measures to assess fall risk. Objective: This study aimed to determine if 5 weeks of flexibility training could increase sitting-rising test, timed up and go, and 5 times sit-to-stand scores in community-dwelling older adults. Participants: Forty-seven adults aged 60 years and older (mean age = 66.7 y, SD = 4.1) participated in this study. Participants completed a static stretching protocol consisting of 3 weekly 1-hour stretching sessions. Results: The protocol improved flexibility as seen in sit-and-reach scores and improved scores on all outcome variables. Specifically, there was a significant increase in sitting-rising test scores from preintervention (M = 7.45, SD = 1.45) to postintervention (M = 8.04, SD = 1.36), t(42) = −5.21, P < .001. Timed up and go scores demonstrated a significant decrease from preintervention (M = 8.85, SD = 1.32) to postintervention (M = 8.20, SD = 1.35), t(46) = 5.10, P < .001. Five times sit-to-stand scores demonstrated a significant decrease from preintervention (M = 12.57, SD = 2.68) to postintervention (M = 10.46, SD = 2.06), t(46) = 6.62, P < .001. Finally, significant increases in sit-and-reach scores were associated with improved functional performance (r = −.308, P = .03). Conclusion: Findings suggest that flexibility training can be an effective mode of low-level exercise to improve functional outcomes. Static stretching may help to improve musculoskeletal health, promote autonomy, and decrease mortality in community-dwelling older adults.

scholarly journals Pilot Outcomes of a Multicomponent Fall Risk Program Integrated Into Daily Lives of Community-Dwelling Older Adults

2020 ◽  
pp. 073346482091266
Author(s):  
Sarah L. Szanton ◽  
Lindy Clemson ◽  
Minhui Liu ◽  
Laura N. Gitlin ◽  
Melissa D. Hladek ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Fall Risk ◽  
Pilot Trial ◽  
Balance Training ◽  
Community Dwelling ◽  
Control Group ◽  
Timed Up And Go ◽  
Daily Lives ◽  
Fall Risk Factors

Objectives: To evaluate whether a fall prevention intervention reduces fall risk in older adults who have previously fallen. Design: Randomized controlled pilot trial. Setting: Participants’ homes. Intervention: LIVE-LiFE, adapted from Lifestyle-Intervention Functional Exercise (LiFE) integrates strength and balance training into daily habits in eight visits over 12 weeks. The adaptations to LiFE were to also provide (a) US$500 in home safety changes, (b) vision contrast screening and referral, and (c) medication recommendations. Control condition consisted of fall prevention materials and individualized fall risk summary. Measurement: Timed Up and Go (TUG) and Tandem stand. Falls efficacy, feasibility, and acceptability of the intervention. Results: Sample ( N = 37) was 65% female, 65% White, and average 77 years. Compared with the control group, each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect (1.1) for tandem stand, moderate (0.5) in falls efficacy, and small (0.1) in the TUG. Conclusion: Simultaneously addressing preventable fall risk factors is feasible.

scholarly journals Fall risk among older adults residing in Bharatpur, Chitwan, Nepal

2020 ◽  
Vol 10 (3) ◽  
pp. 12-15
Author(s):  
Jogmaya Limbu ◽  
Sunita Poudyal
Keyword(s):  
Older Adults ◽  
Older People ◽  
Fall Risk ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
Structured Interview ◽  
Cross Sectional Study ◽  
Timed Up And Go ◽  
Cross Sectional ◽  
Risk Of Falls

Background: Falls in older people is a common serious health problem that has profound im­pact on overall health and quality of life of older people. The aim of this study was to assess the fall risk among older adults. Methods: The descriptive cross-sectional study was carried out among older adults residing in Bharatpur, Chitwan. A total of 98 older adults were selected by using simple random sampling technique. The data were collected by using structured interview schedule and fall risk was as­sessed by Timed Up and Go (TUG) test. Data were collected from 23rd June, 2019 to 7th July, 2019. Obtained data were analyzed using descriptive and inferential statistics. Results: The study findings revealed that more than half (60.2%) of the older adults were from the age group of ≤79 years, male (63.3%) and almost half (50%) were illiterate. Nearly all (96.9%) older adults were living with their family however, 50% were undernourished (BMI- <22.9). Ma­jorities (66.3%) were suffering from chronic diseases and had been taking medicine. Majority of older adults reported vision problem (64.3%) and hearing problem (60.2%). However, only 8.2% reported history of fall within last 6-12 months. More than half (59.2%) of the older adults had high risk of fall and found significant association with age (p=0.039) and vision problem (p=0.043). Conclusions: More than half of the older adults are in risk of falls. Therefore, more emphasis should be given in screening the older people for fall risk factors as preventive measures.

scholarly journals Effects of a Supervised versus an Unsupervised Combined Balance and Strength Training Program on Balance and Muscle Power in Healthy Older Adults: A Randomized Controlled Trial

Gerontology ◽  
2015 ◽  
Vol 62 (3) ◽  
pp. 275-288 ◽  
Author(s):  
André Lacroix ◽  
Reto W. Kressig ◽  
Thomas Muehlbauer ◽  
Yves J. Gschwind ◽  
Barbara Pfenninger ◽  
...  
Keyword(s):  
Older Adults ◽  
Lower Extremity ◽  
Fall Risk ◽  
Muscle Power ◽  
Timed Up And Go ◽  
Healthy Older Adults ◽  
Chair Stand ◽  
Lower Extremity Muscle ◽  
Unsupervised Training ◽  
Romberg Test

Background: Losses in lower extremity muscle strength/power, muscle mass and deficits in static and particularly dynamic balance due to aging are associated with impaired functional performance and an increased fall risk. It has been shown that the combination of balance and strength training (BST) mitigates these age-related deficits. However, it is unresolved whether supervised versus unsupervised BST is equally effective in improving muscle power and balance in older adults. Objective: This study examined the impact of a 12-week BST program followed by 12 weeks of detraining on measures of balance and muscle power in healthy older adults enrolled in supervised (SUP) or unsupervised (UNSUP) training. Methods: Sixty-six older adults (men: 25, women: 41; age 73 ± 4 years) were randomly assigned to a SUP group (2/week supervised training, 1/week unsupervised training; n = 22), an UNSUP group (3/week unsupervised training; n = 22) or a passive control group (CON; n = 22). Static (i.e., Romberg Test) and dynamic (i.e., 10-meter walk test) steady-state, proactive (i.e., Timed Up and Go Test, Functional Reach Test), and reactive balance (e.g., Push and Release Test), as well as lower extremity muscle power (i.e., Chair Stand Test; Stair Ascent and Descent Test) were tested before and after the active training phase as well as after detraining. Results: Adherence rates to training were 92% for SUP and 97% for UNSUP. BST resulted in significant group × time interactions. Post hoc analyses showed, among others, significant training-related improvements for the Romberg Test, stride velocity, Timed Up and Go Test, and Chair Stand Test in favor of the SUP group. Following detraining, significantly enhanced performances (compared to baseline) were still present in 13 variables for the SUP group and in 10 variables for the UNSUP group. Conclusion: Twelve weeks of BST proved to be safe (no training-related injuries) and feasible (high attendance rates of >90%). Deficits of balance and lower extremity muscle power can be mitigated by BST in healthy older adults. Additionally, supervised as compared to unsupervised BST was more effective. Thus, it is recommended to counteract intrinsic fall risk factors by applying supervised BST programs for older adults.

scholarly journals The BAND Test: Improving Reliability and Balance Testing for People with Neurocognitive Impairments: A Pilot Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 898-898
Author(s):  
Evelyn Hahn ◽  
Melissa Moore ◽  
Lindsay Neirman ◽  
Stephanie Arcadia ◽  
Stacy-Jo Krasa ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Intraclass Correlation ◽  
Berg Balance Scale ◽  
Minimal Detectable Change ◽  
Neurocognitive Deficits ◽  
Validity And Reliability ◽  
Balance Testing ◽  
Neurocognitive Impairments ◽  
Improve Measurement

Abstract People with neurocognitive impairments have a higher risk of falls compared to other older adults and require specific cues for evaluation. Additional options for balance testing is necessary to improve reliability and assessment of fall risk. This study established the efficacy of the novel Balance Assessment for Neurocognitive Deficits (BAND) in order to improve measurement of fall risk for people with neurocognitive impairments. The BAND was analyzed for construct validity and reliability through comparison with the Berg Balance Scale (BBS). Older adults with neurocognitive impairments (n=15) in subacute and long-term settings performed BAND and BBS assessments during therapy. Clinicians determined ambulation assistance, fall risk, and time. Calculation of intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC95) values was completed. Corresponding ICC values were 0.985 (95% confidence interval (95% CI), 0.956-0.995) for test-retest reliability and 0.995 (95% CI, 0.985-0.998) for inter-rater reliability. Other values included SEM=0.79 and MDC95=2.18. A linear-regression graph including Pearson’s coefficient (r) demonstrated validity through comparing BAND and BBS and showed a strong correlation (r=0.94, 95% CI, 0.825-0.98). A Bland-Altman plot was created to assess agreement between clinicians, and the mean difference was 0.2667 with 95% limits of agreement (-0.897 to 1.430). The BAND demonstrated excellent reliability and agreement for clinicians providing the test. Further research is necessary to compare the BAND with additional assessments and to demonstrate the utility in expanded populations including the community.

scholarly journals Effect of Three Months Pilates Training on Balance and Fall Risk in Older Women

2021 ◽  
Vol 18 (7) ◽  
pp. 3663
Author(s):  
Małgorzata Długosz-Boś ◽  
Katarzyna Filar-Mierzwa ◽  
Robert Stawarz ◽  
Anna Ścisłowska-Czarnecka ◽  
Agnieszka Jankowicz-Szymańska ◽  
...  
Keyword(s):  
Older Women ◽  
Fall Risk ◽  
Control Group ◽  
Clinical Test ◽  
Timed Up And Go ◽  
Mean Values ◽  
Eyes Closed ◽  
Before And After ◽  
The Right ◽  
Experimental Group

This study assessed the effect of Pilates exercises on balance and fall risk in older women. Participants comprised 50 older women aged over 60 years, divided randomly into two groups: the experimental group (n = 30), which took part in Pilates sessions two times per week for three months, and the control group (n = 20). The control group did not participate in such sessions but also did not participate in any other rehabilitation programs or additional physical activity except everyday activities. Before and after the training cycle, all women underwent an assessment using Timed Up and Go (TUG), the One Leg Stance Test (OLST), a test performed on a Freestep baropodometric platform, and the tests performed on a Biosway platform. After the training, significantly decreased values of the surface of the ellipse (p = 0.0037) and mean values of velocity (p = 0.0262) for the right foot in the experimental group were observed. The Limits of Stability (LoS) test (p = 0.005) and the Modified Clinical Test of Sensory Interaction on Balance (m-CTSIB) performed on an unstable surface with eyes closed (p = 0.0409) indicated statistically significant changes in the experimental group. None of the above changes were statistically significant in relation to the control group. Pilates training affected the participants’ balance by improving LOS and reducing fall risk.

scholarly journals Mobility Screening for Fall Risk Assessment in a Population-Based Sample of Older Adults: An Analysis From the CLSA

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 269-269
Author(s):  
Marla Beauchamp ◽  
Ayse Kuspinar ◽  
Nazmul Sohel ◽  
Alexandra Mayhew ◽  
Lauren Griffith ◽  
...  
Keyword(s):  
Older Adults ◽  
Risk Assessment ◽  
Fall Risk ◽  
Population Based ◽  
Community Dwelling ◽  
Receiver Operating Curve ◽  
Inclusion Criteria ◽  
Timed Up And Go ◽  
Fall Risk Assessment ◽  
Acceptable Accuracy

Abstract Existing guidelines for fall prevention in older adults recommend mobility screening for fall risk assessment; however, there is no consensus on which test to use and at what cut-off. This study aimed to determine the accuracy and optimal cut-off values of commonly used mobility tests for predicting falls in the Canadian Longitudinal Study on Aging (CLSA). Mobility tests at baseline included the Timed Up and Go (TUG), Single Leg Stance (SLS), chair-rise, and gait speed test. Inclusion criteria were: age ≥ 65 years and history of a fall or mobility problem at baseline. Accuracy of fall prediction at 18-months for each mobility test was measured by the area under the receiver operating curve (AUC). Of 1,121 participants that met inclusion criteria (mean age 75.2 ± 5.9 years; 66.6% women), 218 (19.4%) participants reported ≥1 fall at 18-months. None of the mobility tests achieved acceptable accuracy for identifying individuals with ≥1 fall at follow-up. Among women 65-74 and 75-85 years, the TUG identified recurrent fallers (≥2 falls) with optimal cut-off scores of 14.1 and 12.9 seconds (both AUCs 0.70), respectively. Among men 65-74 years, only the SLS showed acceptable accuracy (AUC 0.85) for identifying recurrent fallers with an optimal cut-off of 3.6 seconds. Our findings indicate that for a population-based sample of community-dwelling older adults, commonly used mobility tests do not have sufficient accuracy for identifying fallers. The TUG and SLS can identify older adults at risk for recurrent falls, however their accuracy and cut-off values vary by age and sex.

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