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Monday, 13 November 2017 17:10

FallSkip: Assessment of the risk of falling in elderly people Featured

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Enrique Medina Ripoll; José Francisco Pedrero Sánchez; J.David Garrido Jaén; Juan López Pascual; Ignacio Bermejo Bosch; Salvador Pitarch Corresa; María Isabel Sinovas Alonso; Carlos Chirivella Moreno; José Montero Vilela; Javier Andrade Celdrán

Instituto de Biomecánica (IBV). Universitat Politècnica de València. Edificio 9C. Camino de Vera s/n (46022) Valencia. Spain.

The aging of the world population is an obvious reality nowadays. The increase in the population over 65 implies an increase in the number of falls.
According to the WHO, prevention strategies to be adopted by healthcare systems should address the identification of risk factors. In this respect, the Instituto de Biomecánica (IBV), within its line of research on older people, has defined a clinical protocol based on a modification of the Time Up & Go (TUG) test in order to obtain a simple and reliable risk of falling index.
This index is obtained from biomechanical records that make it possible to define a model to classify fall risk. This model is based on gait pattern, balance, muscular power, as well as temporal variables.
Finally, new technological solutions have been developed to apply it in primary care and specialized assistance.

INTRODUCTION

One out of three older adults falls at least once a year, which is one of the major geriatric syndromes and the second world cause of accidental or unintentional death (WHO, 2016; Samantha Turner, Rupert Kisser, & Wim Rogmans, 2015).

A fall usually implies a deterioration in the autonomy of elderly people, which reduces their quality of life and that of their social environment. The consequences range from clinical problems such as fractures or sprains to the fear of falling syndrome, which involves an increase in the fragility of the older person and the onset of functional disability (Olmos Zapata, 2012).

According to da Silva Gama, Conesa, & Ferreira, (2008),  falls affect approximately 16.5% of elderly people in Spain. The psychosocial and assistance consequences, as well as the fear of falling syndrome, affect between 64% and 44.7%; in addition, between 9.7% and 19% of the falls result in hospital admission of the elderly person.

There are several methods to assess the functional capacity and the risk of falling; however, these methods show some limitations because not all of them are repeatable and they are usually based on subjective criteria.

One of the methods with more scientific evidence is the Physiological Profile Assessment, (Lord, Menz, & Tiedemann, 2003); however, it has the disadvantage of being too expensive in terms of time for daily use clinical practice. In order to provide a more versatile solution adapted to the needs of healthcare professionals, the IBV has developed a new biomechanical application, FallSkip: assessment of the risk of falling, which has been possible thanks to more than 40 years of experience that the IBV has in the field of research and innovation in health technology and elderly people.

FallSkip allows the user to measure in less than one minute the risk of falling of a person based on his or her functional state. To do this, the system analyzes the biomechanical response of the patient when performing a modified protocol of the "Time Up & Go" (TUG) test, which makes it especially appropriate to cover the needs of primary, specialized and social care professionals.

DESCRIPTION

The FallSkip assessment system consists of an Android based recording system and a measuring protocol specially designed to assess the risk of falling.

The test develops in four consecutive phases, Figure 1:

♦ Phase 1 – The measurement begins with the patient standing, facing forward, arms at both sides, for 30 seconds.

♦ Phase 2 – When the device emits a sound, the patient starts walking along a corridor of three meters in a straight line, towards a chair.

♦ Phase 3 Sitting and rising. At the end of the corridor, the patient has to sit and then rise from a chair.

♦ Phase 4 Gait. The patient walks in the opposite direction until he reaches the test starting position.

Figure 1: Diagram of the FallSkip test

The measuring device, located in the patient's lower back (Figure 2), records the accelerations generated by the patient's movement throughout the test. From the acceleration measured, the system segments the phases of the test and sets the parameters to calculate the biomechanical variables associated with the risk of falling:

♦ Balance assessment by analyzing the displacements of the center of mass during the standing phase.

♦ Gait assessment by analyzing the displacement of the center of mass and the duration of the gait phase.

♦ Assessment of the ability to sit and stand up by analyzing the power to perform the movement.

♦ Evaluation of the reaction time to an auditory stimulus, in the transition between the first and second phase of the test.

Figure 2: Preparation of the FallSkip test

The FallSkip application assesses the overall risk of falling by combining the result of the biomechanical test with the main risk factors: age, gender and patient history of falls. The fall risk result is available immediately after the test, the color coding provides an accurate, fast and intuitive assessment on a single screen (Figure 3).

Figure 3: Results screen of the FallSkip application

The assessment lasts, including the instrumentation of the patient and the performance of the test, approximately one minute. This device has been designed to be used by healthcare personnel in the clinical setting, where objectivity and time-saving provide a great added value to the clinical protocols.

CONCLUSIONS

The FallSkip device allows healthcare professionals to objectively measure patient s’ risk of falling, in a totally reliable way, which allows them to define customized preventive and clinical interventions . At the same time, the assessment of the functional patterns makes it possible to develop the so-called precision medicine, which optimizes the healthcare resources available throughout the process.

Thus, FallSkip aims to help save both the personal and economic costs linked to the social and medical interventions that the falls of the elderly involve.

ACKNOWLEDGMENTS

We thank the following entities for their support and interest in the IBV research line on the assessment of the risk of falling in the elderly:

Business Association of Retirement Homes and Services for Dependent People of the Valencian Community (AERTE), Physical Medicine and Rehabilitation Service of La Fe University and Polytechnic Hospital in Valencia, Valencian Society of Physical Medicine and Rehabilitation.

Other entities: La Ribera Hospital, Elderly Department of Mislata Town Hall, Valencian Society of Family and Community Medicine, Gestión Sanitaria del Mediterraneo S.L.

REFERENCES

Cruz, E., González, M., López, M., Godoy, I. D., & Pérez, M. U. (2014). Caídas: revisión de nuevos conceptos. Journal of Pedro Ernesto University Hospital (Rio de Janeiro), 13(2), 86–95.

da Silva Gama, Z. A., Conesa, A. G., & Ferreira, M. S. (2008). Epidemología de caídas de ancianos en España. Una revisión sistemática. Revista Española de Salud Pública Journal, 82(1), 43–56.

Lord, S. R., Menz, H. B., & Tiedemann, A. (2003). A Physiological Profile Approach to Falls Risk Assessment and Prevention. Physical Therapy, 83(3), 237–252.

Olmos Zapata, P. (2012). Estudio del síndrome de temor a caerse en personas mayores de 65 años.

WHO. (2016). WHO | Falls Descriptive Note.

Samantha Turner, Rupert Kisser, & Wim Rogmans. (2015). Falls among older adults in the EU-28: Key facts from the available statistics.

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Read 5167 times Last modified on Thursday, 31 May 2018 15:40



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