Watch the Walk and Prevent a Fall

FALLS are so harmful to the elderly and so costly to society that if falling were a disease, it would be deemed an epidemic.

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Julie Keefe for The New York Times

Philip and Dorothy Martin are participating in research intended to help prevent falls.

More than one-third of people ages 65 or older fall each year. About one fall in 10 results in a serious injury, like a hip fracture. Roughly 20 percent of older people who suffer a hip fracture die within a year.

The estimated economic cost of falls ranges widely, up to $75 billion a year in the United States, if fall-related home care and assisted-living costs are added to medical expenses.

For years, a small group of geriatric experts has studied falls and suggested preventive programs. Most of the work has relied on visits to doctors and self-reported surveys of volunteers.

But now, researchers are beginning to apply the digital tools of low-cost wireless sensors in carpets, clothing and rooms to monitor an older person’s walking and activity. The continuous measurement and greater precision afforded by simple computing devices, researchers say, promise to deliver new insights on risk factors and tailored prevention measures.

For an older person, a fall is often a byproduct of some other health problem: cardiovascular weakness, changes in medication, the beginnings of dementia, gradual muscle degeneration. Motion analysis aided by inexpensive sensors and computing, researchers say, may well become a new “vital sign,” like ablood pressure reading, that can yield all sorts of clues about health.

“For the last 100 years, clinical research and medical practice have been based on appointments, examinations and asking patients questions — tiny biopsies of time in a person’s life,” said Dr. Jeffrey Kaye, a professor of neurology and biomedical engineering at the Oregon Health and Science University. “But technology now gives us the ability to get behavioral activity data all the time for a much more fine-grained, real-world picture of what is happening with a person’s health.”
The National Institute on Aging is intrigued, and sponsoring some initial research. Richard M. Suzman, the institute’s director of behavioral and social research, said studies of older people’s activity patterns, including early detection of risks, would “increasingly use sensors to deliver this higher fidelity of data.”

“It’s extremely promising,” he added.
Fall prevention also promises to be part of an emerging — and potentially large — worldwide industry of helping older people live independently in their homes longer. The European Union, for example, has committed 1 billion euros, or nearly $1.5 billion, to study and finance technologies and services for the aged. Big corporations, including Intel and General Electric, are investing in the field.
“The independent-living industry could have a huge payoff in innovation, jobs and competitiveness,” said Eric Dishman, an Intel research fellow and director of strategy for the company’s digital health group.

In clinical settings, wearable sensors and wireless sensors embedded in carpets are used to measure precisely a person’s walking speed, stride length, step width and body sway — all variables in assessing the risk of falling.

In Ireland, a research group, Technology Research for Independent Living, recently completed a two-year study of 600 people, ages 60 to 94. The subjects came in for detailed walking assessments, using the sensor technology. The exact measurements, said Dr. Chie Wei Fan, a medical gerontologist at Trinity College Dublin, help in devising more customized exercise programs for specific muscles or changes in medication to eliminate dizziness.

The technology-aided “targeted interventions,” Dr. Fan said, reduced falls by 30 percent in the study group, compared with a similarly aged sampling of the population. But she thinks it should be possible to reach 50 or 60 percent.
“We’re still catching the fallers too late,” Dr. Fan said.
Earlier detection is the goal of an at-home sensor and data study being conducted by the Oregon Center for Aging and Technology, whose sponsors include the Oregon Health and Science University and Intel.

The initial five-year study, begun in 2006 and financed by the National Institute on Aging, involves 230 volunteers, whose mean age is 84. In each home, wireless sensors are placed in rooms and hallways linked to a personal computer connected to the Internet, allowing a person’s activity to be monitored steadily. The cost of the sensors is $200 or less.

Activity patterns from the data, said Dr. Kaye, director of the aging and technology center, can help identify ways to prevent falls. The motion sensors may show that a person with congestive heart failure, for example, is getting up from bed often at night to go to the bathroom. If the heart problem is under control, Dr. Kaye said, it may well be a good idea to reduce the dose of the person’s diuretic, trading a little bit of ankle swelling for a good night’s sleep — and far less risk of falling.

Dorothy Martin, 81, and her husband Philip, 83, joined the study two years ago. They live in a two-bedroom apartment in a retirement community in Lake Oswego, Ore., and as part of the study they fill out weekly self-assessments of their activities and health. Once a year, they undergo detailed, in-person physical and cognitive evaluations. They say the sensor monitoring is unobtrusive because the sensors track only motion, not what they are doing.

Both of the Martins are in good health. Still, they have watched friends grow increasingly frail over the years.

“We did this to participate in research that would be helpful to other people, and possibly to us,” Mr. Martin said. Read the complete orginal article here http://www.nytimes.com/2009/11/08/business/08unboxed.html?hpw=&pagewanted=print