Free-living gait cadence measured by wearable accelerometer: a promising alternative to traditional measures of mobility for assessing fall risk

Background Wearable devices have become widespread in research applications, yet evidence on whether they are superior to structured clinic-based assessments is sparse. In this manuscript, we compare traditional, lab-based metrics of mobility with a novel accelerometry-based measure of free-living gait cadence for predicting fall rates. Methods Using negative binomial regression, we compared traditional in-clinic measures of mobility (6-minute gait cadence, speed, and distance, and 4-meter gait speed) with free-living gait cadence from wearable accelerometers in predicting fall rates. Accelerometry data were collected with wrist-worn Actigraphs (GT9X) over 7 days in 432 community-dwelling older adults (aged 77.29±5.46 yrs, 59.1% men, 80.2% White) participating in the Study to Understand Fall Reduction and Vitamin D in You (STURDY). Falls were ascertained using monthly calendars, quarterly contacts, and ad-hoc telephone reports. Accelerometry-based free-living gait cadence was estimated with the Adaptive Empirical Pattern Transformation algorithm. Results Across all participants, free-living cadence was significantly related to fall rates; every 10 steps/min. higher cadence was associated with a 13.2% lower fall rate (p=0.036). Clinic-based measures of mobility were not related to falls (p>0.05). Among higher-functioning participants (cadence ≥100 steps/min.), every 10 steps/min higher free-living cadence was associated with a 27.7% lower fall rate (p=0.01). In participants with slow baseline gait (gait speed <0.8 m/s), all metrics were significantly associated with fall rates. Conclusion Data collected from biosensors in the free-living environment may provide a more sensitive indicator of fall risk than in-clinic tests, especially among higher functioning older adults who may be more responsive to intervention.

Free-Living Gait Cadence Measured by Wearable Accelerometers for Assessing Fall Risk

Accelerometers are widespread in research applications, yet whether they are superior to structured clinic-based assessments is unknown. Using negative binomial regression, we compared traditional in-clinic measures of mobility (6-minute gait cadence, speed, and distance, and 4-meter gait speed) with free-living gait cadence from wrist accelerometers (Actigraph GT9X) in predicting fall rates in 432 older adults (age 77.29±5.46 yrs, 59.1% men, 80.2% White) participating in the Study to Understand Fall Reduction and Vitamin D in You (STURDY). Accelerometry-based gait cadence was estimated with the Adaptive Empirical Pattern Transformation algorithm. Across all participants, every 10 steps/min higher cadence was associated with a 13.2% lower fall rate (p=0.036). Mobility measures were not related to falls (p>0.05). Among higher-functioning participants (cadence ≥100 steps/min), every 10 steps/min higher free-living cadence (p=0.01) was associated with a 27.7% lower fall rate. Data collected from accelerometers may provide a more sensitive indicator of fall risk than in-clinic tests.

Effect of rapid thermal shock cycle on the thermomechanical reliability of 20Sn-80Pb solder bumps

The influence of rapid thermal shock(RTS) cycles on 20Sn-80Pb solder bumps was studied. In the study, 20Sn-80Pb solder bumps were prepared by desktop nitrogen lead-free reflow soldering machine. The prepared 20Sn-80Pb solder bumps were used for RTS test in the temperature rang of 0°C ~ 150°C. One cycle of RTS is 24 seconds, and the temperature rise and fall rate of RTS is 12.5 C/s. The result indicated that when the cycle of RTS reached 1500T (here T is cycle, the same below), the shear strength of Sn-80Pb solder bump dropped by drastically 48.6%. Whereas, when the cycle of RTS reached 5500T, 20Sn-80Pb solder bumps’ shear strength decreased to 18.35 MPa, which increased by 7.5% compared with that of l6.97 MPa at 4500T. With the increase of RTS cycles, 20Sn-80Pb solder bumps’ shear strength was a decreasing trend and the fracture mechanism changed from ductile fracture to ductile-brittle mixed fracture, which could be subject to the thickening of the interfaical IMCs and the stress concentration caused by the growth of interfacial IMCs. To understand the changes of the mechanical properties of 20Sn-80Pb solder bumps, the influences of RTS on the crack and interfacial IMC of 20Sn-80Pb solder bumps were studied in details.

Cholinesterase inhibitor to prevent falls in Parkinson’s disease (CHIEF-PD) trial: a phase 3 randomised, double-blind placebo-controlled trial of rivastigmine to prevent falls in Parkinson’s disease

Background Falls are a common complication of Parkinson’s disease. There is a need for new therapeutic options to target this debilitating aspect of the disease. Cholinergic deficit has been shown to contribute to both gait and cognitive dysfunction seen in the condition. Potential benefits of using cholinesterase inhibitors were shown during a single centre phase 2 trial. The aim of this trial is to evaluate the effectiveness of a cholinesterase inhibitor on fall rate in people with idiopathic Parkinson’s disease. Methods This is a multi-centre, double-blind, randomised placebo-controlled trial in 600 people with idiopathic Parkinson’s disease (Hoehn and Yahr stages 1 to 4) with a history of a fall in the past year. Participants will be randomised to two groups, receiving either transdermal rivastigmine or identical placebo for 12 months. The primary outcome is the fall rate over 12 months follow-up. Secondary outcome measures, collected at baseline and 12 months either face-to-face or via remote video/telephone assessments, include gait and balance measures, neuropsychiatric indices, Parkinson’s motor and non-motor symptoms, quality of life and cost-effectiveness. Discussion This trial will establish whether cholinesterase inhibitor therapy is effective in preventing falls in Parkinson’s disease. If cost-effective, it will alter current management guidelines by offering a new therapeutic option in this high-risk population. Trial registration REC reference: 19/SW/0043. EudraCT: 2018–003219-23. ISCRTN: 41639809 (registered 16/04/2019). ClinicalTrials.gov Identifier: NCT04226248 Protocol at time of publication Version 7.0, 20th January 2021.

Reducing falls in the outpatient oncology clinics.

262 Background: Patients with cancer are at particularly high risk for falls and unfortunately may suffer worse outcomes with falls. Patients with cancer are at increased risk for fractures due to bony metastases, and worse subsequent bleeding due to thrombocytopenia from disease or from prophylaxis or treatment for deep vein thromboses. In 2020, there were 10 falls among patients with cancer in NewYork Presbyterian/Weill Cornell Medicine outpatient oncology clinics, with a fall rate of 0.31 falls per 1000 patient visit. In 2019, there were 14 falls (0.39 falls per 1000 patient visits).The aim of this project is to reduce the total number of falls and overall fall rate by 50% in NewYork Presbyterian/Weill Cornell Medicine outpatient oncology clinic areas by December 30, 2021. Methods: In Plan-Do-Study-Act (PDSA) cycle in February 2021, we identified key stakeholders (nurses, medical assistants, nurse navigators, and clinic managers) in NYP/Weill Cornell oncology outpatient areas. We engaged key stakeholders in a series of interactive conferences to introduce and implement quality improvement tools (root cause analysis and process mapping) with outpatient teams to identify risk factors for patients who fell in NYP/Weill Cornell oncology outpatient areas from 01/2020-12/2021. A standardized post-fall huddle process was implemented, and prior falls were reviewed using this process. Interventions were based on these identified risk factors to prevent falls in the outpatient clinic areas. In the second PDSA cycle which began April 1, 2021, a new handoff process was initiated in the outpatient clinic setting. Prior to the end of the shift, the charge nurse cross references the “G Drive list” with patient list for the following day and identifies patients with previous falls or those identified by nurses as being high risk for falls. This list is located in a commonly used, HIPAA compliant file location, which was already part of the normal scheduling workflow. These patients are then discussed in the daily huddle to create awareness by all staff and provide “handoff” between visits which by design cannot happen nurse to nurse with each visit. The team has been reviewing the list monthly to develop a sustainability plan. Results: Since the completion of the interactive QI conferences in PDSA cycle 1, there have zero additional falls in the oncology outpatient clinic areas. Continuing on into PDSA cycle 2 with the new handoff process, there have not been any additional falls. Conclusions: This project demonstrates an effective QI intervention to reduce falls in the outpatient oncology areas and prevent injuries in this vulnerable population. This multidisciplinary approach to identifying root causes for falls and reviewing our processes for monitoring patients in our infusion areas ultimately has led to significant reduction in falls. It has also empowered key stakeholders in our oncology clinics with QI tools to address other areas for improvement.

Reduction of Inpatient Fall Rate in an Adult Acute Care Setting

Practice Problem: Falls are among the most reported hospital-acquired conditions and can lead to severe injuries, increased length of hospital stays, pain, distress, and emotional trauma in the elderly. The Centers for Medicare and Medicaid Services (CMS) identifies falls as preventable and no longer authorizes reimbursement to healthcare systems for treating inpatient fall-related injuries. PICOT: The PICOT question that guided this project was: In adult, acute care patients admitted to the telemetry unit (P), how does implementing evidence-based multimodal fall prevention strategies (I) compared to routine fall prevention strategies (C) affect inpatient fall rate (O) over a period of 6-8 weeks (T)? Evidence: The literature review revealed that using multimodal risk prevention strategies effectively reduces fall risk and fall-related injuries and thus improves patient safety and outcomes. Intervention: A multimodal fall prevention strategy was developed, according to the Morse Fall Risk Assessment score, utilizing tools such as bed alarm on, lights on, a urinal within reach, purposeful hourly rounding, and bedside reporting during shift change. The oncoming shift nurse checked with the off-going shift nurse at the patient’s bedside to ensure that the fall risk patients’ fall precaution strategies had been initiated and maintained throughout the shift. Outcome: The EBP project did not result in an overall reduction in the fall rates; however, the fall rate with injury was low in the telemetry unit. The project resulted in an increase in the staff’s knowledge and awareness of multimodal fall prevention strategies. Conclusion: The reduction in the incidence of falls after the implementation of the EBP project in the telemetry unit was not statistically significant. However, the result indicated a clinically meaningful improvement in fall-related injury outcomes and increased staff knowledge and awareness of the fall prevention strategies.

Reduction of Inpatient Fall Rate in an Adult Acute Care Setting

Practice Problem: Falls are among the most reported hospital-acquired conditions and can lead to severe injuries, increased length of hospital stays, pain, distress, and emotional trauma in the elderly. The Centers for Medicare and Medicaid Services (CMS) identifies falls as preventable and no longer authorizes reimbursement to healthcare systems for treating inpatient fall-related injuries. PICOT: The PICOT question that guided this project was: In adult, acute care patients admitted to the telemetry unit (P), how does implementing evidence-based multimodal fall prevention strategies (I) compared to routine fall prevention strategies (C) affect inpatient fall rate (O) over a period of 6-8 weeks (T)? Evidence: The literature review revealed that using multimodal risk prevention strategies effectively reduces fall risk and fall-related injuries and thus improves patient safety and outcomes. Intervention: A multimodal fall prevention strategy was developed, according to the Morse Fall Risk Assessment score, utilizing tools such as bed alarm on, lights on, a urinal within reach, purposeful hourly rounding, and bedside reporting during shift change. The oncoming shift nurse checked with the off-going shift nurse at the patient’s bedside to ensure that the fall risk patients’ fall precaution strategies had been initiated and maintained throughout the shift. Outcome: The EBP project did not result in an overall reduction in the fall rates; however, the fall rate with injury was low in the telemetry unit. The project resulted in an increase in the staff’s knowledge and awareness of multimodal fall prevention strategies. Conclusion: The reduction in the incidence of falls after the implementation of the EBP project in the telemetry unit was not statistically significant. However, the result indicated a clinically meaningful improvement in fall-related injury outcomes and increased staff knowledge and awareness of the fall prevention strategies.

Development of a multivariable prognostic PREdiction model for 1-year risk of FALLing in a cohort of community-dwelling older adults aged 75 years and above (PREFALL)

Background Falls are the leading cause of fatal and non-fatal injuries in older adults, and attention to falls prevention is imperative. Prognostic models identifying high-risk individuals could guide fall-preventive interventions in the rapidly growing older population. We aimed to develop a prognostic prediction model on falls rate in community-dwelling older adults. Methods Design: prospective cohort study with 12 months follow-up and participants recruited from June 14, 2018, to July 18, 2019. Setting: general population. Subjects: community-dwelling older adults aged 75+ years, without dementia or acute illness, and able to stand unsupported for one minute. Outcome: fall rate for 12 months. Statistical methods: candidate predictors were physical and cognitive tests along with self-report questionnaires. We developed a Poisson model using least absolute shrinkage and selection operator penalization, leave-one-out cross-validation, and bootstrap resampling with 1000 iterations. Results Sample size at study start and end was 241 and 198 (82%), respectively. The number of fallers was 87 (36%), and the fall rate was 0.94 falls per person-year. Predictors included in the final model were educational level, dizziness, alcohol consumption, prior falls, self-perceived falls risk, disability, and depressive symptoms. Mean absolute error (95% CI) was 0.88 falls (0.71–1.16). Conclusion We developed a falls prediction model for community-dwelling older adults in a general population setting. The model was developed by selecting predictors from among physical and cognitive tests along with self-report questionnaires. The final model included only the questionnaire-based predictors, and its predictions had an average imprecision of less than one fall, thereby making it appropriate for clinical practice. Future external validation is needed. Trial registration Clinicaltrials.gov (NCT03608709).

On the quality of RS41 radiosonde descent data

Radiosonde descent profiles have been available from tens of stations for several years now – mainly from Vaisala RS41 radiosondes. They have been compared with the ascent profiles, with ECMWF short-range forecasts and with co-located radio-occultation retrievals. Over this time our understanding of the data has grown, and the comparison also shed some light on radiosonde ascent data. It has become clear that the fall rate is very variable and that it is an important factor, with high fall rates being associated with temperature biases, especially at higher altitudes. Ascent winds are affected by pendulum motion, on average descent winds are less affected by pendulum motion and are smoother. It is plausible that the true wind variability in the vertical lies between that shown by ascent and descent profiles. The discrepancy indicates the need for reference wind measurements.

A Digital Health Fall Prevention Program for Older Adults: Feasibility Study (Preprint)

BACKGROUND About 1 in 3 adults aged 65 and older falls annually. Exercise interventions are effective in reducing the fall risk and fall rate among older adults. In 2020, startup company Age Bold Inc. disseminated the Bold Fall Prevention Program, aiming to reduce falls among older adults through a remotely delivered, digital exercise program. OBJECTIVE We conducted a feasibility study to assess the delivery of the Bold Fall Prevention Program remotely and evaluate the program's impact on 2 primary outcomes—annualized fall rate and weekly minutes of physical activity (PA)—over 6 months of follow-up. METHODS Older adults at high risk of falling were screened and recruited for the feasibility study via nationwide digital advertising strategies. Self-reported outcomes were collected via surveys administered at the time of enrollment and after 3 and 6 months. Responses were used to calculate changes in the annualized fall rate and minutes of PA per week. RESULTS The remote delivery of a progressive digital fall prevention program and associated research study, including remote recruitment, enrollment, and data collection, was deemed feasible. Participants successfully engaged at home with on-demand video exercise classes, self-assessments, and online surveys. We enrolled 65 participants, of whom 48 (74%) were women, and the average participant age was 72.6 years. Of the 65 participants, 54 (83%) took at least 1 exercise class, 40 (62%) responded to at least 1 follow-up survey at either 3 or 6 months, 20 (31%) responded to both follow-up surveys, and 25 (39%) were lost to follow-up. Among all participants who completed at least 1 follow-up survey, weekly minutes of PA increased by 182% (ratio change=2.82, 95% CI 1.26-6.37, n=35) from baseline and annualized falls per year decreased by 46% (incidence rate ratio [IRR]=0.54, 95% CI 0.32-0.90, n=40). Among only 6-month survey responders (n=31, 48%), weekly minutes of PA increased by 206% (ratio change=3.06, 95% CI 1.43-6.55) from baseline to 6 months (n=30, 46%) and the annualized fall rate decreased by 28% (IRR=0.72, 95% CI 0.42-1.23) from baseline to 6 months. CONCLUSIONS The Bold Fall Prevention Program provides a feasible strategy to increase PA and reduce the burden of falls among older adults.