Risk factors for falls and technologies for fall risk assessment in older adults

Abstract Falls are a serious cause of morbidity and costs to society and frequent falls are associated with impaired quality of life of older people. Screening for high fall risk persons among the older population consumes resources and public funding. Novel, low-cost methods for identifying older persons at high fall risk are thus needed to be able to target preventive actions. The aim of this study was to examine whether individual clustering of chronic diseases is associated with higher fall risk and how technical solutions and connected data, with a special focus on the use of accelerometers, can be utilized in measuring acutely or incrementally appearing risk factors for falls in older adults. The research was carried out by collecting population-based survey data on older people (age 65–98) and by utilizing existing databases. A total of 918 people filled in a questionnaire including items on health status, lifestyle and falls. In addition, 42 volunteers participated in large-scale fall risk measurements. During the measurements, accelerometers were attached to the lumbar spine and front hip of the subject. A mobile application utilizing a separate accelerometer was developed to assess the risk of falls. The feasibility of the mobile application was tested with 11 volunteers of working age. In addition, an easy-to-use application for home-based training was developed and user experiences were collected from six older test subjects in Finland and ten older subjects in Spain. In Spain, four healthcare professionals evaluated the applicability and usability of the application. The results of the study showed that chronic diseases and multiple morbidity are associated with an increased risk of falling. Several technologies have been developed to assess the risk of a fall. Preliminary results indicated that a mobile application utilizing a separate accelerometer can detect deficiencies in walking style, which, in turn, may indicate an increased risk of falling. This study also showed that a sensor attached to the front of the hip could reliably assess some of the gait features associated with fall risk. Both the older people themselves and health care professionals felt positive about the home-based exercise application.Tiivistelmä Kaatumiset aiheuttavat merkittäviä kustannuksia ja heikentävät iäkkäiden henkilöiden terveyttä ja elämänlaatua. Kaatumisriskissä olevien seulonta vaatii henkilökuntaresursseja ja aiheuttaa kustannuksia terveydenhuollolle, joten seulontaan tarvitaan uusia yksinkertaisia ja edullisia menetelmiä. Tässä tutkimuksessa haluttiin selvittää, onko kroonisilla sairauksilla ja monisairastavuudella yhteys korkeampaan kaatumisriskiin. Lisäksi tutkimuksessa haluttiin selvittää, millaisia menetelmiä ja teknologioita kaatumisriskin arviointiin on olemassa. Teknologioista haluttiin erityisesti tutkia kiihtyvyysantureiden käyttöä kaatumisriskin arvioinnissa. Tutkimus toteutettiin keräämällä väestöpohjainen ikääntyneiden kyselyaineisto sekä hyödyntämällä tietokantoja. Yhteensä 918 henkilöä täytti kyselylomakkeen, jolla kerättiin tietoa terveydentilasta, elämäntavoista ja kaatumisista. Lisäksi 42 vapaaehtoista henkilöä osallistui laajoihin kaatumisriskimittauksiin. Mittausten ajaksi koehenkilöiden ristiselkään ja lantion etuosaan kiinnitettiin kiihtyvyysanturit. Tutkimuksessa kehitettiin myös kiihtyvyysanturia hyödyntävä mobiilisovellus kaatumisriskin arviontiin. Sovelluksen käyttökelpoisuutta testattiin 11 vapaaehtoisella työikäisellä henkilöllä. Itsenäiseen kotona tapahtuvaan harjoitteluun kehitettiin helppokäyttöinen sovellus, jonka käyttökokemuksia kerättiin kuudelta iäkkäältä testihenkilöltä Suomessa ja kymmeneltä iäkkäältä testihenkilöltä Espanjassa. Lisäksi Espanjassa neljä terveydenhuollon ammattilaista arvioi sovelluksen käyttökelpoisuutta ja käytettävyyttä. Tutkimuksen tulokset osoittivat, että krooniset sairaudet ja monisairastavuus ovat yhteydessä kohonneeseen kaatumisriskiin. Kaatumisriskin arviointiin on olemassa useita teknologisia menetelmiä. Alustavien tulosten mukaan erillistä kiihtyvyysanturia hyödyntävä mobiilisovellus pystyy tunnistamaan henkilön kävelytyylin vajavuuksia, jotka puolestaan voivat viitata kohonneeseen kaatumisriskiin. Tulosten perusteella lonkan etupuolelle kiinnitetyllä anturilla voidaan arvioida joitakin kaatumisriskiin liittyviä kävelyn piirteitä luotettavasti. Sekä iäkkäät itse että terveydenhuollon ammattilaiset suhtautuivat positiivisesti kotikäyttöön kehitettyyn harjoitussovellukseen

Design challenges for social interactions at factory floor

Abstract Industry 4.0, describes the transition of labor into more digitized and automated era. This transition makes it possible to develop a plethora of solutions for factory floor spanning from purely utilitarian to gamification. In this paper we present the initial step in recognizing the design challenges for a project developing social gamified eHealth applications to the factory floor.</P

Context defined aspects of gamification for factory floor

Abstract Modern extensively digitized factories can provide workers interfaces for gamification. The current literature highlights the importance of understanding the context before implementing gamification solution, while there are currently only few such solutions provided for the factory floor. In this study we aim at closing this gap by defining the context defined aspects for gamification at factory floor. We conducted a thorough mapping of current literature proceeded by a qualitative interview study with eight workers and their supervising manager at a manufacturing facility

Empowering and integrating senior citizens with virtual coaching

With Europe’s aging population and an increasing number of older people living alone or geographically distant from kin, loneliness is turning into a prevalent issue. This might involve deleterious consequences for both the older person and society, such as depression and increased use of healthcare services. Virtual coaches that act as friend in a para-social relationship but also as mentor that helps the elderly end-user to create meaningful relationships in his actual social environment are a powerful method to overcome loneliness and increase the quality of life in the elderly population. The AAL Joint Programme projects A²E² (AAL-2008-1-071) and V2me (AAL-2009-2-107) are exploring virtual coaches and their application in AAL scenarios, including the use of user avatars, virtual self-representations that allow the user to be represented in communication scenarios. Other European research projects that focus on social integration of the elderly are e.g. ALICE (AAL-2009-2-091) or WeCare (AAL-2009-2-026). Outside the European Union the negative implications of population aging can be observed in Japan, having an even larger proportion of senior citizens, using individual-centred devices, such as robot pets [1], to improve the quality of life of lonely elderly persons. The user groups involved often are not acquainted with modern ICT systems and therefore it is a challenge to create intuitive, adaptive platforms that cater to the individual needs and allow the user to interact easily

Life-based design of digital services supporting the sense of security for home-dwelling people living with memory disorder

Abstract Memory disorder impairs people’s independent functioning in daily life and thus threatens their safe living at home. Living at home safely requires the diversification of in-home services and forms of assistance for those living with memory disorder. The aim of this paper is to describe the life-based design process of the ongoing TuTunKo-project (2016–2017) and provide ideas for a practical operational model based on the experiences gained during the project. The goal of the project is to design a platform for digital services that support the sense of security and quality of everyday life of home-dwelling people living with memory disorder. In addition, instruments will be developed to evaluate the sense of security and life management of those with the condition and their family members

Technologies for fall risk assessment and conceptual design in personal health record system

Abstract Falls among older people are a major economic and public health problem. Due to the demographic change and aging of populations, there is an urgent need for accurate screening tools to identify those at risk to target effective falls prevention strategies. Clinical fall risk assessments are costly and time-consuming and thus cannot be performed frequently. Technologies provide means for assessing fall risk during daily living, making self-evaluations and fast methods for fall risk assessment for professional use. This study collects and evaluates existing technological solutions for fall risk assessment including various different sensor technologies. The study also presents one easy to use solution for assessing fall risk and suggests a concept-design for integrating sensor-based solutions into the Finnish national Kanta Personal Health Record. The optimal solution for technological fall risk assessment is still unclear. A wide implementation still requires extensive validation studies, adoption to health care processes and novel IoT -solutions for collecting large amounts of sensor data. Thorough methods should be utilised in designing the privacy and security aspects of fall risk assessment solutions, as well as different user profiles, to allow suitable interfaces and visualisations to users. It should always be clear what kind of data are collected from users and how the data are utilised. The consent of the users should also always be collected

Association between chronic diseases and falls among a sample of older people in Finland

Abstract Background/Objectives: Falls are a major problem for older people and recurrent fallers are especially prone to severe consequences due to falls. This study investigated the association between chronic conditions and falls. Methods: Responses from 872 older persons (age 65–98) to a health questionnaire were used in the analyses. Characteristics and disease prevalence between recurrent fallers, one-time fallers and non-fallers were compared. A hierarchical clustering method was applied to find combinations of chronic conditions that were associated with recent recurrent falling. Results: The results showed that recurrent fallers had a higher number of diseases (median 4, interquartile range, IQR = 2.0–5.0) compared to non-fallers (median 2, IQR = 1.0–3.0). Eight clusters were formed based on the data. The participants in the low chronic disease cluster were younger, more physically active, not frail, and had fewer geriatric conditions. Multiple chronic disease cluster participants were older, less physically active, overweight (body mass index, BMI > 30), at risk of malnutrition, and had more geriatric conditions. Significantly increased risk of recurrent falls relative to the low chronic cluster was found for respondents in the osteoporosis cluster and multiple chronic disease cluster (OR = 5.65, 95% confidence interval CI: 1.23–25.85, p = 0.026, and OR = 13.42, 95% CI: 2.47–72.96,  = 0.002, respectively). None of the clusters were associated with increased risk of one-time falling. Conclusions: The results implicate that the number of chronic diseases is related with risk of recurrent falling. Furthermore, the results implicate the potential of identifying certain combinations of chronic diseases that increase fall risk by analyzing health record data, although further studies are needed with a larger population sample

Health information behaviour, attitudes towards health information and motivating factors for encouraging physical activity among older people:differences by sex and age

Abstract Introduction: Difficulties in understanding health information and negative attitudes may form a barrier for effective information use by older people. This study seeks to increase the understanding of health information behaviour, as well as attitudes towards health information and motivating factors for encouraging physical activity in older people. The main focus is on information about physical activity and comparing sexes and different age groups. Method: Population-based data were collected with a questionnaire survey in the GASEL study. A random sample of 1,500 adults 65 years or older was obtained from the Finnish Population Register Centre. The number of respondents was 918 with a response rate of 61.2%. Analysis: The statistical significance of the differences between the sexes and age groups were compared using non-parametric tests. Results: Women were more likely to have shared information with others related to physical activity. Men were more likely to consider that health related stories and articles were overly long and scientific and that ipsative and normative comparison motivates them. The older the respondents were the more likely they were to avoid information and to agree that health information is often too long and scientific and mostly aimed at young people. The younger the respondents were the more eagerly they preferred ipsative comparison and considered information given by different physical activity monitors as motivating. The oldest age group (80 years or older) especially had difficulties with understanding and accepting health information. Conclusion: Older adults need health information in an easily understandable and accessible form. When possible, the information provided should be tailored for the recipient

Use of information and communication technologies among older people with and without frailty:a population-based survey

Abstract Background: Use of information and communication technologies (ICT) among seniors is increasing; however, studies on the use of ICT by seniors at the highest risk of health impairment are lacking. Frail and prefrail seniors are a group that would likely benefit from preventive nutrition and exercise interventions, both of which can take advantage of ICT. Objective: The objective of the study was to quantify the differences in ICT use, attitudes, and reasons for nonuse among physically frail, prefrail, and nonfrail home-dwelling seniors. Methods: This was a population-based questionnaire study on people aged 65–98 years living in Northern Finland. A total of 794 eligible individuals responded out of a contacted random sample of 1500. Results: In this study, 29.8% (237/794) of the respondents were classified as frail or prefrail. The ICT use of frail persons was lower than that of the nonfrail ones. In multivariable logistic regression analysis, age and education level were associated with both the use of Internet and advanced mobile ICT such as smartphones or tablets. Controlling for age and education, frailty or prefrailty was independently related to the nonuse of advanced mobile ICT (odds ratio, OR=0.61, P=.01), and frailty with use of the Internet (OR=0.45, P=.03). The frail or prefrail ICT nonusers also held the most negative opinions on the usefulness or usability of mobile ICT. When opinion variables were included in the model, frailty status remained a significant predictor of ICT use. Conclusions: Physical frailty status is associated with older peoples’ ICT use independent of age, education, and opinions on ICT use. This should be taken into consideration when designing preventive and assistive technologies and interventions for older people at risk of health impairment

Feasibility of mobile mental wellness training for older adults

Abstract Mobile technology has been increasingly adopted in promotion of mental health among older people. This study assessed the feasibility of a mobile mental wellness training application for individual use and for group work from the perspectives of older adults and social care professionals. The older individuals recruited for the study were participants in a Circle of Friends group and family caregivers’ peer support group offered by the communal senior services. The qualitative and quantitative results of interviews, questionnaires, observation, and application usage were reported. Seven older adults started using the application independently at home in parallel with the group activity. This study revealed new information regarding the barriers to the older adults’ full adoption of such mobile technologies. The results indicated that there may be potential in the incorporation of mobile technologies in promotion of mental health of older people at group settings