Wearables for independent living in older adults: Gait and falls

Solutions are needed to satisfy care demands of older adults to live independently. Wearable technology (wearables) is one approach that offers a viable means for ubiquitous, sustainable and scalable monitoring of the health of older adults in habitual free-living environments. Gait has been presented as a relevant (bio)marker in ageing and pathological studies, with objective assessment achievable by inertial-based wearables. Commercial wearables have struggled to provide accurate analytics and have been limited by non-clinically oriented gait outcomes. Moreover, some research-grade wearables also fail to provide transparent functionality due to limitations in proprietary software. Innovation within this field is often sporadic, with large heterogeneity of wearable types and algorithms for gait outcomes leading to a lack of pragmatic use. This review provides a summary of the recent literature on gait assessment through the use of wearables, focusing on the need for an algorithm fusion approach to measurement, culminating in the ability to better detect and classify falls. A brief presentation of wearables in one pathological group is presented, identifying appropriate work for researchers in other cohorts to utilise. Suggestions for how this domain needs to progress are also summarised

INSURANCE Insurance Generally: Requires Coverage for Colorectal Cancer Screening in Health Benefit Policies

The Act adds new Code section 33-2456.3. The Act requires most health benefit insurance policies to provide coverage for colorectal cancer screening. The Act further provides definitions to specify the health benefit policies affected and to identify the guidelines for the types of treatment to be covered by those health benefit policies

INSURANCE Insurance Generally: Requires Coverage for Colorectal Cancer Screening in Health Benefit Policies

The Act adds new Code section 33-2456.3. The Act requires most health benefit insurance policies to provide coverage for colorectal cancer screening. The Act further provides definitions to specify the health benefit policies affected and to identify the guidelines for the types of treatment to be covered by those health benefit policies

SOCIAL SERVICES Programs and Protection for Children: Allows Certain Child-Placing Agencies to Access Child Abuse Records

The Act allows licensed child placement agencies and child-caring institutions that are assisting the Department of Human Resources in providing foster homes or adoptive homes for children to have access to records of child abuse. Court appointed investigators of adoption petitions are also allowed access to child abuse records

Instrumenting gait with an accelerometer: A system and algorithm examination

Gait is an important clinical assessment tool since changes in gait may reflect changes in general health. Measurement of gait is a complex process which has been restricted to the laboratory until relatively recently. The application of an inexpensive body worn sensor with appropriate gait algorithms (BWM) is an attractive alternative and offers the potential to assess gait in any setting. In this study we investigated the use of a low-cost BWM, compared to laboratory reference using a robust testing protocol in both younger and older adults. We observed that the BWM is a valid tool for estimating total step count and mean spatio-temporal gait characteristics however agreement for variability and asymmetry results was poor. We conducted a detailed investigation to explain the poor agreement between systems and determined it was due to inherent differences between the systems rather than inability of the sensor to measure the gait characteristics. The results highlight caution in the choice of reference system for validation studies. The BWM used in this study has the potential to gather longitudinal (real-world) spatio-temporal gait data that could be readily used in large lifestyle-based intervention studies, but further refinement of the algorithm(s) is required

First-person Vision-based Assessment of Fall Risks in The Wild, Towards Fall Prevention in Older Adults

Falls in older adults is one of the most important public health problems world-wide. In our previous works, we showed that first-personvision (FPV) data acquired by chest- and waist-mounted camerashave the potential to be utilized to (A) develop novel markerlessdeep models to estimate spatiotemporal gait parameters over time(e.g., step width) by localizing feet in 2D coordinate system of RGBframes (using optical flow and RGB streams) and (B) automaticallyidentify environmental hazards (e.g., curbs, stairs, different terrains)that may lead to falling. In this paper, a summary of our recent FPV-based approaches for fall risk assessment in the wild are being discussed. These approaches aimed to eventually inform clinical decisions on the most appropriate prevention interventions to reducefall incidence in older populations

First-person Vision-based Assessment of Fall Risks in The Wild, Towards Fall Prevention in Older Adults

Falls in older adults is one of the most important public health problems world-wide. In our previous works, we showed that first-personvision (FPV) data acquired by chest- and waist-mounted camerashave the potential to be utilized to (A) develop novel markerlessdeep models to estimate spatiotemporal gait parameters over time(e.g., step width) by localizing feet in 2D coordinate system of RGBframes (using optical flow and RGB streams) and (B) automaticallyidentify environmental hazards (e.g., curbs, stairs, different terrains)that may lead to falling. In this paper, a summary of our recent FPV-based approaches for fall risk assessment in the wild are being discussed. These approaches aimed to eventually inform clinical decisions on the most appropriate prevention interventions to reducefall incidence in older populations

A Scoping Review of Technological Approaches to Environmental Monitoring

Indoor environment quality (IEQ) can negatively affect occupant health and wellbeing. Air quality, as well as thermal, visual and auditory conditions, can determine how comfortable occupants feel within buildings. Some can be measured objectively, but many are assessed by interpreting qualitative responses. Continuous monitoring by passive sensors may be useful to identify links between environmental and physiological changes. Few studies localise measurements to an occupant level perhaps due to many environmental monitoring solutions being large and expensive. Traditional models for occupant comfort analysis often exacerbate this by not differentiating between individual building occupants. This scoping review aims to understand IEQ and explore approaches as to how it is measured with various sensing technologies, identifying trends for monitoring occupant health and wellbeing. Twenty-seven studies were reviewed, and more than 60 state-of-the-art and low-cost IEQ sensors identified. Studies were found to focus on the home or workplace, but not both. This review also found how wearable technology could be used to augment IEQ measurements, creating personalised approaches to health and wellbeing. Opportunities exist to make individuals the primary unit of analysis. Future research should explore holistic personalised approaches to health monitoring in buildings that analyse the individual as they move between environments

BioMeT and algorithm challenges: A proposed digital standardized evaluation framework

Technology is advancing at an extraordinary rate. Continuous flows of novel data are being generated with the potential to revolutionize how we better identify, treat, manage, and prevent disease across therapeutic areas. However, lack of security of confidence in digital health technologies is hampering adoption, particularly for biometric monitoring technologies (BioMeTs) where frontline healthcare professionals are struggling to determine which BioMeTs are fit-for-purpose and in which context. Here, we discuss the challenges to adoption and offer pragmatic guidance regarding BioMeTs, cumulating in a proposed framework to advance their development and deployment in healthcare, health research, and health promotion. Furthermore, the framework proposes a process to establish an audit trail of BioMeTs (hardware and algorithms), to instill trust amongst multidisciplinary users

Movements of older adults during exergaming interventions that are associated with the Systems Framework for Postural Control: A systematic review

One in three older adults fall annually, in part due to impairments in the physiological systems that make up the postural control (PC) system. Exercise, particularly balance training, helps to prevent deterioration and even to improve outcomes in the PC system. Exergaming (exercise-gaming) is interactive computer gaming whereby an individual moves the body in response to onscreen cues in a playful format. Exergaming is an alternative method to standard practice for improving PC outcomes, which has been shown to reduce the risk of falling. Exergaming has received research attention, yet the intervention is still in its infancy. There could be benefit in exploring the movements trained with respect to a framework known for identifying underlying deficits in the PC system, the Systems Framework for Postural Control (SFPC). This may help target areas for improvement in balance training using exergames and shed light on the impact for fall prevention. A literature search was therefore conducted across six databases (CINAHL, EMBASE, PubMed, ISI, SPORTdiscus and Science Direct) using a range of search terms and combinations relating to exergaming, balance, exercise, falls and elderly. Quality assessment was conducted using the PEDro Scale and a custom-made quality assessment tool. Movements were rated by two reviewers based on the 9 operational definitions of the SFPC. Eighteen publications were included in the analysis, with a mean PEDro score of 5.6 (1.5). Overall, 4.99 (1.27) of the 9 operational definitions of the SFPC are trained in exergaming interventions. Exergaming does encourage individuals to stand up (3), lean while standing (4), move upper limbs and turn heads (6) and dual-task while standing (9), to some extent move the body forwards, backwards and sideways (1), and coordinate movements (2) but hardly at all to kick, hop, jump or walk (7), or to force a postural reaction from a physical force to the individual (5) and it does not mimic actual changes in sensory context (8). This is the first review, to our knowledge, that synthesises the literature on movements trained in exergaming interventions with respect to an established theoretical framework for PC. This review could provide useful information for designing exergames with PC outcomes in mind, which could help target specific exergames for multi-factorial training to overcome balance deficits. Some elements of PC are too unsafe to be trained using exergames, such as restricting sensory inputs or applying physical perturbations to an individual to elicit postural responses