Technology-based measurements for screening, monitoring and preventing frailty

Technological monitoring of motor parameters to assess multidimensional frailty of older people in the PRO-HOME project

An interconnected system employing Kinect Azure and Fitbit Sense for continuous and non-intrusive data collection was used in the PRO-HOME protected discharge program, aiming at monitoring functional and clinical parameters in hospitalized older patients at different risks of frailty. The present study shows the findings on 30 older patients included in the PRO-HOME project. The Fitbit Sense recorded the mean daily and hourly number of steps, mean daily walked distance, and time spent inactive. Moreover, Kinect infrared camera captured gait speed and daily mean latero-lateral (body sway) and antero-posterior oscillations (lean-in). Patients underwent a standard Comprehensive Geriatric Assessment (CGA) to compute the Multidimensional Prognostic Index (MPI), including basic and instrumental activities of daily living (ADL, IADL), cognition (Short Portable Mental Status Questionnaire, SPMSQ) and nutrition, risk of pressure sores (Exton-Smith Scale, ESS), comorbidity, number of drugs and cohabitation status. Significant correlations between the mean hourly number of steps and MPI (p = 0.022), IADL (p = 0.013), SPMSQ (p = 0.006), ESS (p = 0.009), and both mean and maximum automated gait speed (p = 0.046 and p = 0.048) were found. Automated gait speed was also correlated with mean walked distance per day (p = 0.007) and lean-in (p = 0.047). Domotic technological monitoring through Fitbit Sense and Kinect Azure provides information on multidimensional frailty, including mobility and cognitive and functional status, in older people.

Effects of Monitoring Frailty Through a Mobile/Web-Based Application and a Sensor Kit to Prevent Functional Decline in Frail and Prefrail Older Adults: FACET (Frailty Care and Well Function) Pilot Randomized Controlled Trial

BACKGROUND

Frailty represents a state of susceptibility to stressors and constitutes a dynamic process. Untreated, this state can progress to disability. Hence, timely detection of alterations in patients' frailty status is imperative to institute prompt clinical interventions and impede frailty progression. With this aim, the FACET (Frailty Care and Well Function) technological ecosystem was developed to provide clinically gathered data from the home to a medical team for early intervention.

OBJECTIVE

The aim of this study was to assess whether the FACET technological ecosystem prevents frailty progression and improves frailty status, according to the frailty phenotype criteria and Frailty Trait Scale-5 items (FTS-5) at 3 and 6 months of follow-up.

METHODS

This randomized clinical trial involved 90 older adults aged ≥70 years meeting 2 or more Fried frailty phenotype criteria, having 4 or more comorbidities, and having supervision at home. This study was conducted between August 2018 and June 2019 at the geriatrics outpatient clinics in Getafe University Hospital and Albacete University Hospital. Participants were randomized into a control group receiving standard treatment and the intervention group receiving standard treatment along with the FACET home monitoring system. The system monitored functional tests at home (gait speed, chair stand test, frailty status, and weight). Outcomes were assessed using multivariate linear regression models for continuous response and multivariate logistic models for dichotomous response. P values less than .05 were considered statistically significant.

RESULTS

The mean age of the participants was 82.33 years, with 28% (25/90) being males. Participants allocated to the intervention group showed a 74% reduction in the risk of deterioration in the FTS-5 score (P=.04) and 92% lower likelihood of worsening by 1 point according to Fried frailty phenotype criteria compared to the control group (P=.02) at 6 months of follow-up. Frailty status, when assessed through FTS-5, improved in the intervention group at 3 months (P=.004) and 6 months (P=.047), while when the frailty phenotype criteria were used, benefits were shown at 3 months of follow-up (P=.03) but not at 6 months.

CONCLUSIONS

The FACET technological ecosystem helps in the early identification of changes in the functional status of prefrail and frail older adults, facilitating prompt clinical interventions, thereby improving health outcomes in terms of frailty and functional status and potentially preventing disability and dependency.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03707145; https://clinicaltrials.gov/study/NCT03707145.

In-Shoe Sensor Measures of Loading Asymmetry during Gait as a Predictor of Frailty Development in Community-Dwelling Older Adults

Clinical walk tests may not predict the development of frailty in healthy older adults. With advancements in wearable technology, it may be possible to predict the development of frailty using loading asymmetry parameters during clinical walk tests. This prospective cohort study aimed to test the hypothesis that increased limb loading asymmetry predicts frailty risk in community-living older adults. Sixty-three independently ambulant community-living adults aged ≥ 65 years were recruited, and forty-seven subjects completed the ten-month follow-up after baseline. Loading asymmetry index of net and regional (forefoot, midfoot, and rearfoot) plantar forces were collected using force sensing insoles during a 10 m walk test with their maximum speed. Development of frailty was defined if the participant progressed from baseline at least one grading group of frailty at the follow-up period using the Kihon Checklist. Fourteen subjects developed frailty during the follow-up period. Increased risk of frailty was associated with each 1% increase in loading asymmetry of net impulse (Odds ratio 1.153, 95%CI 1.001 to 1.329). Net impulse asymmetry significantly correlated with asymmetry of peak force in midfoot force. These results indicate the feasibility of measuring plantar forces of gait during clinical walking tests and underscore the potential of using load asymmetry as a tool to augment frailty risk assessment in community-dwelling older adults.

Evaluation of the accuracy of a UWB tracker for in-home positioning for older adults

The population of older adults is rapidly growing. In-home monitoring systems have been used to support aging-in-place. Ambient sensors or wearable localizers can be used but may be too low resolution, while camera systems are invasive to privacy. Ultra-wideband (UWB) localization offers precise positioning by placing anchors throughout the house and wearing a tag that is tracked by the anchors. In this study, the accuracy of UWB for indoor tracking was evaluated in a motion capture gait lab and in a mock condo in the Glenrose Rehabilitation Hospital. First, the configuration of UWB was tested, changing factors related to sampling time, anchor placement and line-of-sight. Comparing these factors to the configurations recommended by the manufacturer guidelines, accuracies remained within 14 cm. We then performed static and dynamic accuracy tests, with dynamic testing comprised of rolling and walking motions. In the motion capture lab, we found localization accuracies of 7.0 ± 11.1 cm while in the mock condo, we found accuracies of 27.3 ± 12.9 cm. Dynamic testing with rolling motions had an average of 19.1 ± 1.6 cm while walking was 20.5 ± 4.2 cm. The mean accuracy of UWB is within the 30 cm target for indoor localization.

Technologies for frailty, comorbidity, and multimorbidity in older adults: a systematic review of research designs

BACKGROUND

Frailty, neurodegeneration and geriatric syndromes cause a significant impact at the clinical, social, and economic level, mainly in the context of the aging world. Recently, Information and Communication Technologies (ICTs), virtual reality tools, and machine learning models have been increasingly applied to the care of older patients to improve diagnosis, prognosis, and interventions. However, so far, the methodological limitations of studies in this field have prevented to generalize data to real-word. This review systematically overviews the research designs used by studies applying technologies for the assessment and treatment of aging-related syndromes in older people.

METHODS

Following the PRISMA guidelines, records from PubMed, EMBASE, and Web of Science were systematically screened to select original articles in which interventional or observational designs were used to study technologies' applications in samples of frail, comorbid, or multimorbid patients.

RESULTS

Thirty-four articles met the inclusion criteria. Most of the studies used diagnostic accuracy designs to test assessment procedures or retrospective cohort designs to build predictive models. A minority were randomized or non-randomized interventional studies. Quality evaluation revealed a high risk of bias for observational studies, while a low risk of bias for interventional studies.

CONCLUSIONS

The majority of the reviewed articles use an observational design mainly to study diagnostic procedures and suffer from a high risk of bias. The scarce presence of methodologically robust interventional studies may suggest that the field is in its infancy. Methodological considerations will be presented on how to standardize procedures and research quality in this field.

Benefits and Barriers of Technology for Home Function and Mobility Assessment: Perspectives of Older Patients With Blood Cancers, Caregivers, and Clinicians

PURPOSE

Advances in digital health technology can overcome barriers to measurement of function and mobility for older adults with blood cancers, but little is known about how older adults perceive such technology for use in their homes.

METHODS

To characterize potential benefits and barriers associated with using technology for home functional assessment, we conducted three semistructured focus groups (FGs) in January 2022. Eligible patients came from the Older Adult Hematologic Malignancies Program at Dana-Farber Cancer Institute (DFCI), which includes adults 73 years and older enrolled during their initial consult with their oncologist. Eligible caregivers were 18 years and older and identified by enrolled patients as their primary caregiver. Eligible clinicians were practicing DFCI hematologic oncologists, nurse practitioners, or physician assistants with ≥2 years of clinical experience. A qualitative researcher led thematic analysis of FG transcripts to identify key themes.

RESULTS

Twenty-three participants attended the three FGs: eight patients, seven caregivers, and eight oncology clinicians. All participants valued function and mobility assessments and felt that technology could overcome barriers to their measurement. We identified three themes related to potential benefits: making it easier for oncology teams to consider function and mobility; providing standardized, objective data; and facilitating longitudinal data. We also identified four themes related to barriers to home functional assessment: concerns related to privacy and confidentiality, burden of measuring additional patient data, challenges in operating new technology, and concerns related to data improving care.

CONCLUSION

These data suggest that specific concerns raised by older patients, caregivers, and oncology clinicians must be addressed to improve acceptability and uptake of technology used to measure function and mobility in the home.

Preventing falls: the use of machine learning for the prediction of future falls in individuals without history of fall

Nowadays, it becomes of paramount societal importance to support many frail-prone groups in our society (elderly, patients with neurodegenerative diseases, etc.) to remain socially and physically active, maintain their quality of life, and avoid their loss of autonomy. Once older people enter the prefrail stage, they are already likely to experience falls whose consequences may accelerate the deterioration of their quality of life (injuries, fear of falling, reduction of physical activity). In that context, detecting frailty and high risk of fall at an early stage is the first line of defense against the detrimental consequences of fall. The second line of defense would be to develop original protocols to detect future fallers before any fall occur. This paper briefly summarizes the current advancements and perspectives that may arise from the combination of affordable and easy-to-use non-wearable systems (force platforms, 3D tracking motion systems), wearable systems (accelerometers, gyroscopes, inertial measurement units-IMUs) with appropriate machine learning analytics, as well as the efforts to address these challenges.

The Problem of Monitoring the Psycho-Physical Condition of Seniors during Proposed Activities in Urban Space

The world's population is rapidly ageing, which places a heavy burden on traditional healthcare systems with increased economic and social costs. Technology can assist in the implementation of strategies that enable active and independent ageing by promoting and motivating health-related behaviours, monitoring, and collecting data on daily life for assessment and for aiding in independent living. ICT (Information and Communication Technology) tools can help prevent cognitive and physical decline and social isolation, and enable elderly people to live independently. In this paper, we introduced a comprehensive tool for guiding seniors along the designed urban health paths employing urban architecture as an impulse to perform physical and cognitive exercises. The behaviour of seniors is monitored during their activities using wearable sensors and mobile application. We distinguished three types of data recipients (seniors, path/exercise designers, and the public), for whom we proposed methods of analysing the obtained data and examples of their use. In this work, a wide range of diverse information was examined from which short- and long-term patterns can be drawn. We have also shown that by fusing sensory data and data from mobile applications, we can give context to sensory data, thanks to which we can formulate more insightful assessments of seniors' behaviour.

Health-Related Telemonitoring Parameters/Signals of Older Adults: An Umbrella Review

Aging is one of the greatest challenges in modern society. The development of wearable solutions for telemonitoring biological signals has been viewed as a strategy to enhance older adults' healthcare sustainability. This study aims to review the biological signals remotely monitored by technologies in older adults. PubMed, the Cochrane Database of Systematic Reviews, the Web of Science, and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports were systematically searched in December 2021. Only systematic reviews and meta-analyses of remote health-related biological and environmental monitoring signals in older adults were considered, with publication dates between 2016 and 2022, written in English, Portuguese, or Spanish. Studies referring to conference proceedings or articles with abstract access only were excluded. The data were extracted independently by two reviewers, using a predefined table form, consulting a third reviewer in case of doubts or concerns. Eighteen studies were included, fourteen systematic reviews and four meta-analyses. Nine of the reviews included older adults from the community, whereas the others also included institutionalized participants. Heart and respiratory rate, physical activity, electrocardiography, body temperature, blood pressure, glucose, and heart rate were the most frequently measured biological variables, with physical activity and heart rate foremost. These were obtained through wearables, with the waist, wrist, and ankle being the most mentioned body regions for the device's placement. Six of the reviews presented the psychometric properties of the systems, most of which were valid and accurate. In relation to environmental signals, only two articles presented data on this topic. Luminosity, temperature, and movement were the most mentioned variables. The need for large-scale long-term health-related telemonitoring implementation of studies with larger sample sizes was pointed out by several reviews in order to define the feasibility levels of wearable devices.

Detecting Fall Risk and Frailty in Elders with Inertial Motion Sensors: A Survey of Significant Gait Parameters

In the elderly, geriatric problems such as the risk of fall or frailty are a challenge for society. Patients with frailty present difficulties in walking and higher fall risk. The use of sensors for gait analysis allows the detection of objective parameters related to these pathologies and to make an early diagnosis. Inertial Measurement Units (IMUs) are wearables that, due to their accuracy, portability, and low price, are an excellent option to analyze human gait parameters in health-monitoring applications. Many relevant gait parameters (e.g., step time, walking speed) are used to assess motor, or even cognitive, health problems in the elderly, but we perceived that there is not a full consensus on which parameters are the most significant to estimate the risk of fall and the frailty state. In this work, we analyzed the different IMU-based gait parameters proposed in the literature to assess frailty state (robust, prefrail, or frail) or fall risk. The aim was to collect the most significant gait parameters, measured from inertial sensors, able to discriminate between patient groups and to highlight those parameters that are not relevant or for which there is controversy among the examined works. For this purpose, a literature review of the studies published in recent years was carried out; apart from 10 previous relevant reviews using inertial and other sensing technologies, a total of 22 specific studies giving statistical significance values were analyzed. The results showed that the most significant parameters are double-support time, gait speed, stride time, step time, and the number of steps/day or walking percentage/day, for frailty diagnosis. In the case of fall risk detection, parameters related to trunk stability or movements are the most relevant. Although these results are important, the total number of works found was limited and most of them performed the significance statistics on subsets of all possible gait parameters; this fact highlights the need for new frailty studies using a more complete set of gait parameters.

Wearable inertial sensors for human movement analysis: a five-year update

INTRODUCTION

The aim of the present review is to track the evolution of wearable IMUs from their use in supervised laboratory- and ambulatory-based settings to their application for long-term monitoring of human movement in unsupervised naturalistic settings.

AREAS COVERED

Four main emerging areas of application were identified and synthesized, namely, mobile health solutions (specifically, for the assessment of frailty, risk of falls, chronic neurological diseases, and for the monitoring and promotion of active living), occupational ergonomics, rehabilitation and telerehabilitation, and cognitive assessment. Findings from recent scientific literature in each of these areas was synthesized from an applied and/or clinical perspective with the purpose of providing clinical researchers and practitioners with practical guidance on contemporary uses of inertial sensors in applied clinical settings.

EXPERT OPINION

IMU-based wearable devices have undergone a rapid transition from use in laboratory-based clinical practice to unsupervised, applied settings. Successful use of wearable inertial sensing for assessing mobility, motor performance and movement disorders in applied settings will rely also on machine learning algorithms for managing the vast amounts of data generated by these sensors for extracting information that is both clinically relevant and interpretable by practitioners.

Digital Health Interventions among People Living with Frailty: A Scoping Review

OBJECTIVES

Digital health interventions (DHIs) are interesting resources to improve various health conditions. However, their use in the older and frail population is still sparse. We aimed to give an overview of DHI used in the frail older population.

DESIGN

Scoping review with PRISMA guidelines based on Population, Concept, and Context.

SETTING AND PARTICIPANTS

We included original studies in English with DHI (concept) on people described as frail (population) in the clinical or community setting (context) and no limitation on date of publication. We searched 3 online databases (PubMed, Scopus, and Web of Science).

MEASURES

We described DHI in terms of purpose, delivering, content and assessment. We also described frailty assessment and study design.

RESULTS

We included 105 studies that fulfilled our eligibility criteria. The most frequently reported DHIs were with the purpose of monitoring (45; 43%), with a delivery method of sensor-based technologies (59; 56%), with a content of feedback to users (34; 32%), and for assessment of feasibility (57; 54%). Efficacy was reported in 31 (30%) studies and usability/feasibility in 57 (55%) studies. The most common study design was descriptive exploratory for new methodology or technology (24; 23%). There were 14 (13%) randomized controlled trials, with only 4 of 14 studies (29%) showing a low or moderate risk of bias. Frailty assessment using validated scales was reported in only 47 (45%) studies.

CONCLUSIONS AND IMPLICATIONS

There was much heterogeneity among frailty assessments, study designs, and evaluations of DHIs. There is now a strong need for more standardized approaches to assess frailty, well-structured randomized controlled trials, and proper evaluation and report. This work will contribute to the development of better DHIs in this vulnerable population.

Early diagnosis of frailty: Technological and non-intrusive devices for clinical detection

This work analyses different concepts for frailty diagnosis based on affordable standard technology such as smartphones or wearable devices. The goal is to provide ideas that go beyond classical diagnostic tools such as magnetic resonance imaging or tomography, thus changing the paradigm; enabling the detection of frailty without expensive facilities, in an ecological way for both patients and medical staff and even with continuous monitoring. Fried's five-point phenotype model of frailty along with a model based on trials and several classical physical tests were used for device classification. This work provides a starting point for future researchers who will have to try to bridge the gap separating elderly people from technology and medical tests in order to provide feasible, accurate and affordable tools for frailty monitoring for a wide range of users.

Towards automated assessment of frailty status using a wrist-worn device

Wearable sensors potentially enable monitoring the users physical activity in daily life. Therefore, they are particularly appealing for the evaluation of older subjects in their environment, to capture early signs of frailty and mobility-related problems. This study explores the use of body-worn accelerometers for automated assessment of frailty during walking activity. Experiments involved 34 volunteers aged 70+, who were initially screened by geriatricians for the presence of frailty according to Frieds criteria. After screening, the volunteers were asked to walk 60 m at preferred speed, while wearing two accelerometers, one positioned on the lower back and the other on the wrist. Sensor-derived signals were analyzed independently to compare the ability of the two signals (wrist vs. lower back) in frailty status assessment. A gait detection technique was applied to identify segments made of four gait cycles. These segments were then used as input to compute 25 features in time and time-frequency domains, the latter by means of the Wavelet Transform. Finally, five machine learning models were trained and evaluated to classify subjects as robust or non-robust (i.e., pre-frail or frail). Gaussian naive Bayes applied to the features derived from the wrist sensor signal identified non-robust subjects with 91% sensitivity and 82% specificity, compared to 87% sensitivity and 64% specificity achieved with the lower back sensor. Results demonstrate that a wrist-worn accelerometer provides valuable information for the recognition of frailty in older adults, and could represent an effective tool to enable automated and unobtrusive assessment of frailty.

Feasibility and Acceptability of Home-Based Exercise Snacking and Tai Chi Snacking Delivered Remotely to Self-Isolating Older Adults During COVID-19

The purpose of this study was to examine the feasibility and acceptability of remotely delivered, home-based exercise programs on physical function and well-being in self-isolating older adults during the COVID-19 pandemic. In a four-arm randomized controlled trial, 63 participants (aged 65 years and older) were allocated to one of three home-based daily (2 × 10-min) exercise interventions (exercise snacking, tai chi snacking, and combination) or control (UK National Health Service Web pages). Functional assessments were conducted via video call at baseline and 4-week follow-up. A web-based survey assessed the acceptability of each exercise program and secondary psychological/well-being outcomes. Ecological momentary assessment data, collected in Weeks 1 and 4, explored feeling states as antecedents and consequences of exercise. All intervention groups saw increased physical function at follow-up and displayed good adherence with exercise snacking considered the most acceptable program. Multilevel models revealed reciprocal associations between feelings of energy and exercise engagement. Further studies are needed with larger, more diverse demographic samples.

Information and Communication Technologies for Managing Frailty: A Systematic Literature Review

Frailty is a prevalent condition among Canadians; over one million are diagnosed as medically frail, and in the next ten years this number will double. Information and telecommunication technologies can provide a low-cost method for managing frailty more proactively. This study aims to examine the range and extent of information and telecommunication technologies for managing frailty in older adults, their technology readiness level, the evidence, and the associated outcomes. A systematic literature review was conducted. Four databases were searched for studies: Medline, EMBASE, CINAHL, and Web of Science. In total, we included 19 studies (out of 9,930) for the data abstraction. Overall, our findings indicate that (1) the proposed frailty phenotype is the most common ground truth to be used for assessing frailty; (2) the most common uses of information and telecommunication technologies for managing frailty are detection, and monitoring and detection, while interventional studies on frailty are very rare; (3) the five main types of information and telecommunication technologies for managing frailty in older adults are information and telecommunication technology-based platforms, smartphones, telemonitoring (home monitoring), wearable sensors and devices (commercial off-the-shelf), and multimedia formats for online access; (4) the technology readiness level of information and telecommunication technologies for managing frailty in older adults is the “Technology Demonstration” level, i.e., not yet ready to be operated in an actual operating environment; and (5) the level of evidence is still low for information and telecommunication technology studies that manage frailty in older adults. In conclusion, information and telecommunication technologies for managing frailty in the older adult population are not yet ready to be full-fledged technologies for this purpose.

ICT technologies as new promising tools for the managing of frailty: a systematic review

OBJECTIVES

Frailty is a major health issue as it encompasses functional decline, physical dependence, and increased mortality risk. Recent studies explored Information and Communication Technology (ICT) interventions as alternatives to manage frailty in older persons. The aim of the present systematic review was to synthesize current evidence on ICT application within the complex models of frailty care in older people.

METHODS

Data sources included PubMed, PsycINFO, EMBASE and Web of Science, considering eligible those reviews on ICT application in samples of older persons formally assessed as frail. Records were screened by two independent researchers, who extracted data and appraised methodological quality of reviews and studies.

RESULTS

Among the 764 retrieved papers, two systematic reviews were included. Most of the studies analyzed defined frailty considering only few components of the phenotype and used ICT to stratify different levels of frailty or to support traditional screening strategies. Assessment of frailty was the context in which ICT has been mostly tested as compared to intervention. Cost effectiveness evaluations of the ICT technologies were not reported.

CONCLUSIONS

The research investigating the use of ICT in the context of frailty is still at the very beginning. Few studies strictly focused on the assessment of frailty, while intervention on frailty using ICT was rarely reported. The lack of a proper characterization of the frail condition along with the methodological limitations prevented the investigation of ICT within complex care models. Future studies are needed to effectively integrate ICT in the care of frailty in orders.

Perceptual-motor styles

Even for a stereotyped task, sensorimotor behavior is generally variable due to noise, redundancy, adaptability, learning or plasticity. The sources and significance of different kinds of behavioral variability have attracted considerable attention in recent years. However, the idea that part of this variability depends on unique individual strategies has been explored to a lesser extent. In particular, the notion of style recurs infrequently in the literature on sensorimotor behavior. In general use, style refers to a distinctive manner or custom of behaving oneself or of doing something, especially one that is typical of a person, group of people, place, context, or period. The application of the term to the domain of perceptual and motor phenomenology opens new perspectives on the nature of behavioral variability, perspectives that are complementary to those typically considered in the studies of sensorimotor variability. In particular, the concept of style may help toward the development of personalised physiology and medicine by providing markers of individual behaviour and response to different stimuli or treatments. Here, we cover some potential applications of the concept of perceptual-motor style to different areas of neuroscience, both in the healthy and the diseased. We prefer to be as general as possible in the types of applications we consider, even at the expense of running the risk of encompassing loosely related studies, given the relative novelty of the introduction of the term perceptual-motor style in neurosciences.

Unobtrusive Sensors for the Assessment of Older Adult's Frailty: A Scoping Review

Ubiquity (devices becoming part of the context) and transparency (devices not interfering with daily activities) are very significant in healthcare monitoring applications for elders. The present study undertakes a scoping review to map the literature on sensor-based unobtrusive monitoring of older adults' frailty. We aim to determine what types of devices comply with unobtrusiveness requirements, which frailty markers have been unobtrusively assessed, which unsupervised devices have been tested, the relationships between sensor outcomes and frailty markers, and which devices can assess multiple markers. SCOPUS, PUBMED, and Web of Science were used to identify papers published 2010-2020. We selected 67 documents involving non-hospitalized older adults (65+ y.o.) and assessing frailty level or some specific frailty-marker with some sensor. Among the nine types of body worn sensors, only inertial measurement units (IMUs) on the waist and wrist-worn sensors comply with ubiquity. The former can transparently assess all variables but weight loss. Wrist-worn devices have not been tested in unsupervised conditions. Unsupervised presence detectors can predict frailty, slowness, performance, and physical activity. Waist IMUs and presence detectors are the most promising candidates for unobtrusive and unsupervised monitoring of frailty. Further research is necessary to give specific predictions of frailty level with unsupervised waist IMUs.

Technology Used to Recognize Activities of Daily Living in Community-Dwelling Older Adults

The use of technology has been suggested as a means of allowing continued autonomous living for older adults, while reducing the burden on caregivers and aiding decision-making relating to healthcare. However, more clarity is needed relating to the Activities of Daily Living (ADL) recognised, and the types of technology included within current monitoring approaches. This review aims to identify these differences and highlight the current gaps in these systems. A scoping review was conducted in accordance with PRISMA-ScR, drawing on PubMed, Scopus, and Google Scholar. Articles and commercially available systems were selected if they focused on ADL recognition of older adults within their home environment. Thirty-nine ADL recognition systems were identified, nine of which were commercially available. One system incorporated environmental and wearable technology, two used only wearable technology, and 34 used only environmental technologies. Overall, 14 ADL were identified but there was variation in the specific ADL recognised by each system. Although the use of technology to monitor ADL of older adults is becoming more prevalent, there is a large variation in the ADL recognised, how ADL are defined, and the types of technology used within monitoring systems. Key stakeholders, such as older adults and healthcare workers, should be consulted in future work to ensure that future developments are functional and useable.

Wearable Sensors Technology as a Tool for Discriminating Frailty Levels During Instrumented Gait Analysis

Background and objectives: One of the greatest challenges facing the healthcare of the aging population is frailty. There is growing scientific evidence that gait assessment using wearable sensors could be used for prefrailty and frailty screening. The purpose of this study was to examine the ability of a wearable sensor-based assessment of gait to discriminate between frailty levels (robust, prefrail, and frail). Materials and methods: 133 participants (≥60 years) were recruited and frailty was assessed using the Fried criteria. Gait was assessed using wireless inertial sensors attached by straps on the thighs, shins, and feet. Between-group differences in frailty were assessed using analysis of variance. Associations between frailty and gait parameters were assessed using multinomial logistic models with frailty as the dependent variable. We used receiver operating characteristic (ROC) curves to calculate the area under the curve (AUC) to estimate the predictive validity of each parameter. The cut-off values were calculated based on the Youden index. Results: Frailty was identified in 37 (28%) participants, prefrailty in 66 (50%), and no Fried criteria were found in 30 (23%) participants. Gait speed, stance phase time, swing phase time, stride time, double support time, and cadence were able to discriminate frailty from robust, and prefrail from robust. Stride time (AUC = 0.915), stance phase (AUC = 0.923), and cadence (AUC = 0.930) were the most sensitive parameters to separate frail or prefrail from robust. Other gait parameters, such as double support, had poor sensitivity. We determined the value of stride time (1.19 s), stance phase time (0.68 s), and cadence (101 steps/min) to identify individuals with prefrailty or frailty with sufficient sensitivity and specificity. Conclusions: The results of our study show that gait analysis using wearable sensors could discriminate between frailty levels. We were able to identify several gait indicators apart from gait speed that distinguish frail or prefrail from robust with sufficient sensitivity and specificity. If improved and adapted for everyday use, gait assessment technologies could contribute to frailty screening and monitoring.

Survey on virtual coaching for older adults

Virtual coaching has emerged as a promising solution to extend independent living for older adults. A virtual coach system is an always-attentive personalized system that continuously monitors user's activity and surroundings and delivers interventions - that is, intentional messages - in the appropriate moment. This article presents a survey of different approaches in virtual coaching for older adults, from the less technically supported tools to the latest developments and future avenues for research. It focuses on the technical aspects, especially on software architectures, user interaction and coaching personalization. Nevertheless, some aspects from the fields of personality/social psychology are also presented in the context of coaching strategies. Coaching is considered holistically, including matters such as physical and cognitive training, nutrition, social interaction and mood.

Motor style at rest and during locomotion in human

Humans exhibit various motor styles that reflect their intra- and interindividual variability when implementing sensorimotor transformations. This opens important questions, such as, At what point should they be readjusted to maintain optimal motor control? Do changes in motor style reveal the onset of a pathological process and can these changes help rehabilitation and recovery? To further investigate the concept of motor style, tests were carried out to quantify posture at rest and motor control in 18 healthy subjects under four conditions: walking at three velocities (comfortable walking, walking at 4 km/h, and race walking) and running at maximum velocity. The results suggest that motor control can be conveniently decomposed into a static component (a stable configuration of the head and column with respect to the gravitational vertical) and dynamic components (head, trunk, and limb movements) in humans, as in quadrupeds, and both at rest and during locomotion. These skeletal configurations provide static markers to quantify the motor style of individuals because they exhibit large variability among subjects. Also, using four measurements (jerk, root mean square, sample entropy, and the two-thirds power law), it was shown that the dynamics were variable at both intra- and interindividual levels during locomotion. Variability increased following a head-to -toe gradient. These findings led us to select dynamic markers that could define, together with static markers, the motor style of a subject. Finally, our results support the view that postural and motor control are subserved by different neuronal networks in frontal, sagittal, and transversal planes.NEW & NOTEWORTHY During human locomotion, motor control can be conveniently decomposed into a static and dynamic components. Variable dynamics were observed at both the intra- and interindividual levels during locomotion. Variability increased following a head-to-toe gradient. Finally, our results support the view that postural and motor control are subserved by different neuronal networks in the frontal, sagittal, and transversal planes.

The Activ8 activity monitor: Validation of posture and movement classification

Introduction

To set up and guide interventions with the aim to increase physical activity and lower sedentary behavior valid monitoring of physical behavior is essential. The aim of this study was to evaluate the validity of the single-unit Activ8 activity monitor to classify several body postures and movements.

Methods

Twelve healthy adults performed a series of activities, representative for everyday life, according to a standard protocol. Activ8 was both worn in the trouser pocket (prescribed location) and fixated to the front of the thigh. Activities were video recorded and analyzed thereafter. Postures and movements that were analyzed were lying/sitting, standing, walking, cycling, and running.

Results

The agreement between Activ8 output and video analysis was 89.7% (inter-subject range: 66.0 to 96.6%) for the pocket location and 91.9% (range 85.5 to 95.1%) for the thigh location. Sensitivity and positive predictive value scores for both locations were all above 80%, except for standing (69% or higher). Differences in classified duration of separate postures and movements were within 20% for walking, sitting and running.

Conclusion

The Activ8 is a valid instrument to quantify a defined set of body postures and movements. Because of the smaller time difference, the thigh location is preferred for research purposes.

Assessment of frailty: a survey of quantitative and clinical methods

BACKGROUND

Frailty assessment is a critical approach in assessing the health status of older people. The clinical tools deployed by geriatricians to assess frailty can be grouped into two categories; using a questionnaire-based method or analyzing the physical performance of the subject. In performance analysis, the time taken by a subject to complete a physical task such as walking over a specific distance, typically three meters, is measured. The questionnaire-based method is subjective, and the time-based performance analysis does not necessarily identify the kinematic characteristics of motion and their root causes. However, kinematic characteristics are crucial in measuring the degree of frailty.

RESULTS

The studies reviewed in this paper indicate that the quantitative analysis of activity of daily living, balance and gait are significant methods for assessing frailty in older people. Kinematic parameters (such as gait speed) and sensor-derived parameters are also strong markers of frailty. Seventeen gait parameters are found to be sensitive for discriminating various frailty levels. Gait velocity is the most significant parameter. Short term monitoring of daily activities is a more significant method for frailty assessment than is long term monitoring and can be implemented easily using clinical tests such as sit to stand or stand to sit. The risk of fall can be considered an outcome of frailty.

CONCLUSION

Frailty is a multi-dimensional phenomenon that is defined by various domains; physical, social, psychological and environmental. The physical domain has proven to be essential in the objective determination of the degree of frailty in older people. The deployment of inertial sensor in clinical tests is an effective method for the objective assessment of frailty.

Instrumented gait analysis: a measure of gait improvement by a wheeled walker in hospitalized geriatric patients

Background

In an increasing aging society, reduced mobility is one of the most important factors limiting activities of daily living and overall quality of life. The ability to walk independently contributes to the mobility, but is increasingly restricted by numerous diseases that impair gait and balance. The aim of this cross-sectional observation study was to examine whether spatio-temporal gait parameters derived from mobile instrumented gait analysis can be used to measure the gait stabilizing effects of a wheeled walker (WW) and whether these gait parameters may serve as surrogate marker in hospitalized patients with multifactorial gait and balance impairment.

Methods

One hundred six patients (ages 68–95) wearing inertial sensor equipped shoes passed an instrumented walkway with and without gait support from a WW. The walkway assessed the risk of falling associated gait parameters velocity, swing time, stride length, stride time- and double support time variability. Inertial sensor-equipped shoes measured heel strike and toe off angles, and foot clearance.

Results

The use of a WW improved the risk of spatio-temporal parameters velocity, swing time, stride length and the sagittal plane associated parameters heel strike and toe off angles in all patients. First-time users (FTUs) showed similar gait parameter improvement patterns as frequent WW users (FUs). However, FUs with higher levels of gait impairment improved more in velocity, stride length and toe off angle compared to the FTUs.

Conclusion

The impact of a WW can be quantified objectively by instrumented gait assessment. Thus, objective gait parameters may serve as surrogate markers for the use of walking aids in patients with gait and balance impairments.

Electronic supplementary material

The online version of this article (doi:10.1186/s12984-017-0228-z) contains supplementary material, which is available to authorized users.