Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions.

Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT) and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems

Falls prevention advice and visual feedback to those at risk of falling : study protocol for a pilot randomized controlled trial

Studies have shown that functional strength and balance exercises can reduce the risk of falling in older people if they are done on a regular basis. However, the repetitive nature of these exercises; combined with the inherent lack of feedback of progress may discourage seniors from exercising in the home, thereby rendering such an intervention ineffective. This study hypothesizes that the use of visual feedback and multimodal games will be more effective in encouraging adherence to home rehabilitation than standard care; thereby promoting independence and improving the quality of life in older adults at risk of falling

Fall prevention intervention technologies: A conceptual framework and survey of the state of the art

In recent years, an ever increasing range of technology-based applications have been developed with the goal of assisting in the delivery of more effective and efficient fall prevention interventions. Whilst there have been a number of studies that have surveyed technologies for a particular sub-domain of fall prevention, there is no existing research which surveys the full spectrum of falls prevention interventions and characterises the range of technologies that have augmented this landscape. This study presents a conceptual framework and survey of the state of the art of technology-based fall prevention systems which is derived from a systematic template analysis of studies presented in contemporary research literature. The framework proposes four broad categories of fall prevention intervention system: Pre-fall prevention; Post-fall prevention; Fall injury prevention; Cross-fall prevention. Other categories include, Application type, Technology deployment platform, Information sources, Deployment environment, User interface type, and Collaborative function. After presenting the conceptual framework, a detailed survey of the state of the art is presented as a function of the proposed framework. A number of research challenges emerge as a result of surveying the research literature, which include a need for: new systems that focus on overcoming extrinsic falls risk factors; systems that support the environmental risk assessment process; systems that enable patients and practitioners to develop more collaborative relationships and engage in shared decision making during falls risk assessment and prevention activities. In response to these challenges, recommendations and future research directions are proposed to overcome each respective challenge.The Royal Society, grant Ref: RG13082

A Wii Bit of Fun: A Novel Platform to Deliver Effective Balance Training to Older Adults

BACKGROUND: Falls and fall-related injuries are symptomatic of an aging population. This study aimed to design, develop, and deliver a novel method of balance training, using an interactive game-based system to promote engagement, with the inclusion of older adults at both high and low risk of experiencing a fall.STUDY DESIGN: Eighty-two older adults (65 years of age and older) were recruited from sheltered accommodation and local activity groups. Forty volunteers were randomly selected and received 5 weeks of balance game training (5 males, 35 females; mean, 77.18 ± 6.59 years), whereas the remaining control participants recorded levels of physical activity (20 males, 22 females; mean, 76.62 ± 7.28 years). The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments.RESULTS: Balance game training had a significant effect on levels of functional balance and balance confidence (P Peer reviewedFinal Published versio

Information technology for active ageing: A review of theory and practice

Active Ageing aims to foster a physically, mentally and socially active lifestyle as a person ages. It is a complex, multi-faceted problem that involves a variety of different actors, such as policy makers, doctors, care givers, family members, friends and, of course, older adults. This review aims to understand the role of a new actor, which increasingly plays the role of enabler and facilitator, i.e., that of the technology provider. The review specifically focuses on Information Technology (IT), with a particular emphasis on software applications, and on how IT can prevent decline, compensate for lost capabilities, aid care, and enhance existing capabilities. The analysis confirms the crucial role of IT in Active Ageing, shows that Active Ageing requires a multidisciplinary approach, and identifies the need for better integration of hardware, software, the environment and the involved actors

Efficacy of a Mobile Application for Improving Gait Performance in Community-Dwelling Older Adults

The United States is a rapidly aging nation. Older adults have higher rates of falls than any other age group. One in four older adults fall each year. Many of these falls are associated with sedentary lifestyles and decreased muscular strength effecting balance and gait performance. Physical activity (exercise) can reduce the risk of falls among older adults, yet adherence remains low. Exergames can increase adherence to interventions that promote health and physical activity. Social engagement can increase self-efficacy and motivation to exercise. By design, the Bingocize® health promotion mobile application (app) increases social engagement, while providing a multi-factorial fall prevention intervention. The purpose of this investigation was to evaluate the efficacy of the app to improve gait in community-dwelling older adults (N=38; mean age 72.42 years +12.58). Participants were clustered and randomly assigned to (a) experimental (n=20; using app with bingo game, health education and exercise) or (b) control (n=18; using app with bingo game, health education without exercise) condition. Each group completed a tenweek intervention that consisted of two- 45-60 minute sessions per week. Pre and post gait analysis, at self-selected (SS) and fast-walking speeds, measured using the GAITRite® Electronic Walkway (GWS). Gait analysis included parameters of velocity, cadence, step time, step length and width, and single and double support time. A mixedmodel ANOVA (p \u3c .05) was used for statistical analysis. There were no main effects observed. Significant interactions (group x time) were observed at fast speed and SS speed compared to the control group. Significant interactions were observed at fast speed included velocity (λ = .886, F (1, 36) = 4.61, p = .039, = .114); and step length (λ = .864, F (1, 36) = 5.64, p = .023, = .136); and were observed at SS speed for single support time (λ = .887, F (1, 36) = 4.59, p = .039, = .113). Post hoc analyses using paired and independent samples t-tests were conducted on gait variables with observed significant interactions. The independent samples t-test for Single Support Time (SS) post was significant (t (36) = 2.454, p = .019, two-tailed). None of the remaining post hoc analyses were significant. There was a meaningful detectable change (MDC) in mean velocity (\u3e5 cm/s) over time, for both SS and fast walking speeds, within the experimental condition. MDC in gait speed ranges from 5 cm/s (small) to 10 cm/s (large). As for clinical significance, this should be considered a small, yet meaningful detectable change. It is the conclusion of the investigators, that the app, with the exercise intervention, can effectively produce a meaningful change in gait speed (5 cm/s), which has the potential for reducing the risk of falls in older adults. This investigation was funded by The Retirement Research Foundation

Dance movement therapy and falls prevention

Falls are a leading cause of morbidity, healthcare use and mortality. Dance is a popular form of physical activity among older people and previous research has suggested that it may improve various health outcomes in this population, including balance, gait and muscle performance. A systematic review of the potential benefits of dance on falls and fear of falling is lacking. Thus, we conducted a systematic review considering all randomized controls trials (RCTs) investigating if dance can reduce falls and improve fear of falling in older adults. Major databases were searched from inception until 1 March 2017 and a total of 10 RCTs were identified, which included a total of 680 people (n = 356 dance, n = 324 control). Overall, the mean age of the samples was 69.4 years, and 75.2% were female. Across four RCTs, dance therapy reduced falls versus usual care in only one study. Dance therapy improved fear of falling in two out of three included RCTs. There were no serious adverse events reported in the RCTs. In summary, we found a paucity of studies investigating the effect of dance on falls and fear of falling and the evidence base is preliminary and equivocal. Given the heterogeneity of the included samples and interventions, in addition to the short-term follow-up, no firm conclusions can be drawn. However, dance appears to be safe and, given its popularity and demonstrated benefits on other health/wellbeing outcomes in older adults, it is important that future research considers its potential benefits on falls/fear of falling in older age

Developing a Standardized Process for an Effective, Evidence-Based Fall Management Program to Reduce Falls in a Nursing Home Setting

Background: Falls among the elderly population, aged 65 years and older, are a significantly growing public health problem. For elderly people residing in residential care facilities and facility administrators, falls are of great concern due to the post-fall associated consequences. Preventing resident falls in long-term care is a priority to reduce injuries and associated costs. Project Design: This evidence-based quality improvement (EBQI) pilot project focused on fall prevention and was conducted on 1 unit (3 long-term care hallways) at a facility that provides both long-term care (LTC) and short-term rehabilitation services in Utah County, Utah. Interventions chosen for the Falls Management Program Bundle (FMPB) included (a) providing staff educational and training sessions, (b) providing resident educational and training sessions, (c) instituting a Falling Star program, and (d) creating a Fall TIPS poster program. Results: The post-test results following the education sessions on fall risk factors and fall prevention strategies showed an overall increase in knowledge in a minimum of 47% of resident and nurse participants. After the trainings, 94.4% (n = 17) of the nurses were able to determine the correct level of risk for a resident case-study scenario, and 55.5% (n = 10) were able to identify 3 out of 4 tailored interventions. Due to contextual factors, findings were inconclusive of whether the three-month evidence-based Falls Management Program Bundle resulted in a reduction of resident falls in the target hallways. Recommendations: Implementation of a standardized, evidence-based Fall Management Program (FMP) that includes multiple fall-prevention strategies has the potential to prevent and/or reduce falls. Continuation of interventions included in the Falls Management Program Bundle would assist in keeping staff and residents educated on fall prevention measures, as well as communicating risk level and needed interventions in fall prevention. More accurate data 8 collection on the number of falls for the specific unit is needed to confirm effectiveness of the standardized fall prevention program. Continuation and monitoring of the Fall Management Program Bundle would be beneficial to assist the facility in its decision to add this project to other units. Conclusion: The implementation of a standardized, evidence-based Fall Management Program to reduce falls at this facility increased nurses’ and residents’ knowledge regarding fall risk factors and fall prevention strategies. Training regarding risk assessment was beneficial in identifying risk levels and tailored interventions. Nursing staff was able to utilize the Fall TIPS poster program to communicate a fall intervention plan to residents and other staff members

Improving health outcomes for the elderly an analytic framework

The authors present an analytic framework for investigating interactive gaming technologies and integrating a number of such technologies into a remote healthcare monioring system (ReMoteCare) to help improve the quality of life of the elderly, the chronically unwell and infirm whether they are living in their own homes or in aged care facilities. The framework covers population characteristics of the cohort, the interactive technologies as well as economic and environmental factors. It is anticipated that a series of interactive exercises, developed in conjunction with a Feldenkrais movement therapist who specializes in exercises for the elderly, will help to improve the physical and mental health outcomes of this cohort

The Role of "Non-Traditional" Physical Activities in Improving Balance in Older Adults: A Review

Recent research indicates that the number of people aged over 60 years is rising faster than any other age group which will put increased financial and social strains on all countries. One major focus of various health and social care agencies is not only to keep these older individuals healthy but also physically active and independent. Many older people lead inactive lives which together with the ageing process lead to physiological changes which have potentially damaging effects on balance control and are risk factors for falls. Research shows that physical activity improves mental health, often stimulates social contacts and can help older people remain as independent as possible. This paper has attempted to review existing research on physical activities and exercise intervention used to improve balance in older adults. Using relevant databases and keywords, 68 studies that met the inclusion criteria were reviewed. Results indicate that many traditional activities can help to improve balance in older adults. However, further investigations need to be conducted into activities that are not generally considered appropriate for older people but may be enjoyable and have health benefits and may help to improve balance in this population