Scientific Research

One in four seniors fall annually, leading to unnecessary hospitalizations and decreased independence, with existing in-person fall prevention programs limited by access, scheduling, and cost. KINIMA Seniors is a newly developed automated interactive exercise and movement app providing real-time visual and audio feedback to assess and reduce risk of falls in seniors, using our proprietary augmented reality motion capture system. KINIMA Seniors introduces an innovative, scalable solution through a mobile app, assessing and reducing fall risks without the need for on-body sensors. It allows seniors to engage in exercises that enhance strength, balance, and gait, displayed alongside a virtual trainer with visual and audio cues for improving physical performance.

Methods:

20 sessions lasting 45 minutes were conducted over 10 weeks in 4 US Senior Centers using the KINIMA Seniors interactive movement platform. During the 1st and last sessions, the KINIMA system's computer vision data capture technology was employed to assess our 4 measures related to the risk of falls, and these measurements were compared with human observer-derived data in both the initial and final assessments. 26 participants completed the sessions with 4 dropouts. Assessment measures were: 1) One-Legged Stance test (left and right), 2) # of Leg Lifts in 30 seconds (left and right), 3) # of Sit to Stand repetitions in 30 seconds, 4) Timed Up and Go.

Results:

This study demonstrated improved fall risk outcomes were achieved in pre/post measures, technical feasibility, likeability of our automated exercise features, and accuracy of automated fall risk measures.

Conclusion:

KINIMA Seniors can deliver a cost-effective and scalable offering for fall prevention targeting enterprises that cater to seniors, such as senior day centers, senior living, and physical therapy. This technology facilitates independent aging in place and also offers a personalized exercise regimen with performance tracking to significantly enhance quality of life. 

INTRODUCTION

People with Parkinson’s disease (PwPD) often report low levels of physical activity and poor health and 90% of PwPD will fall at least once[1]. Interventions to reduce falls in PwPD often involve physical therapy and exercise, however the environment is an independent risk factor for falls[2]. Exploring whether fall circumstances differ in PwPD due to health status and physical activity level will inform occupational health services and the design and development of environmental modifications.

METHODS

An online survey was developed to evaluate falls in adults ≥60y. Of 358 respondents, 117 were diagnosed with PD. The survey covered basic descriptors, fall history and contextual information about falls. Health (good/ average/ poor) and physical activity (active/ inactive) status were self-reported and used to stratify respondents.

RESULTS

68% of respondents with PD had fallen and of these 90% had poor health or were physically inactive. The 3 most problematic environments (steps/stairs, uneven/sloped surfaces and objects on the floor) and 4 most common pre fall activities (turning, walking, moving too quickly and transferring) were the same regardless of health or physical activity status, although more frequently reported by those with poor health or physically inactive.

Misjudging objects and falling over trip hazards was more common in PwPD of poor health than those of average/good health. Falls on steps and stairs were more common in physically inactive PwPD than those who were physically active.

CONCLUSION

This survey has highlighted several problematic aspects of the home environment contributing to falls in PwPD. Routine person-environment risk assessments are required to identify home hazards early. Research through co-design with PwPD and relevant stakeholders is required to develop novel home modifications targeting problematic environments so interventions may be prescribed effectively.

[1] Allen 2013 PMID:23533953 [2] van der Marck 2014 PMID:24484618

Introduction

Stair falls cause approximately 230,000 injuries and 500 fatalities each year (Roys, 2001). Falls cost the NHS £4.6 million every day (AgeUK, 2010), and approximately £2 billion each year (GOV.UK, 2022), with falls on stairs accounting for the majority of these costs. However, the evidence about how to reduce stair falls is unclear. The aim of this systematic review was to establish which interventions are effective or show greatest potential to improve safety on stairs and reduce falls.

Methods

Five databases were searched: Medline, Scopus, Web of Science, PubMed and CINAHL. Papers were included if they were interventions or provided proof-of-principle to inform an intervention design. Papers were excluded if participants were under the age of 18, or were diagnosed with any clinical condition (disease outside that which we can expect from healthy ageing).

Results

No study reported fall occurrence as an outcome measure. Step-edge highlighters were the only intervention tested in real-world environments, as well as laboratories, and showed good proof of principle, feasibility and acceptability. Five intervention types were found that reduced fall risk in laboratory trials: lighting, horizontal-vertical illusions in ascent, stair dimensions (riser, going and pitch), avoiding multi-tasking and handrail use. These were successful in reducing mechanical demand (reducing or redistributing joint moments) and improving stepping behaviours associated with fall risk (reductions in magnitude and variability of foot clearances and overhang on the step).

Conclusion

This review has established there is no definitive evidence that any intervention reduced fall rates, but that some interventions show good proof-of-principle and feasibility: step-edge highlighters flush to the step edge, increased lighting levels, horizontal-vertical illusions in ascent, use of handrails, avoiding multi-tasking, riser heights 10.2-19cm, going lengths 22.5-32.5cm and reduced pitch angles. Future research must translate these interventions into real world settings and evaluate effectiveness to reduce fall rates.

Introduction: Approximately a third of community dwelling adults over the age of 65 fall each year, with around half experiencing more than one fall per year. Currently within North Tyneside older adults who have had a fall, or are at risk of falling, may be invited to attend a specialist falls clinic; if appropriate they may be referred to Age UK North Tyneside’s Strength and Balance Class. Improving strength and balance in those at risk is an established intervention, yet adherence to programmes, and the subsequent adoption of exercise post-intervention varies. This work aims to explore why participants attended (or did not attend) the classes, whether they felt benefit from the classes and if they had adopted any new behaviours into their day to day routines. Method: 18 users of the Age UK Strength and Balance users were recruited from the quantitative arm of our mixed methods project, having been attenders of both the North Tyneside Community Falls Prevention Service (NTCFPS) and Age UK classes. Participants were interviewed in the NTCFPS over a 9 month period in 2023. Interviews were audio-recorded and transcribed verbatim, with an inductive thematic analysis approach selected for analysis. Results: Findings revealed a broadly positive experience of the classes, with participants particularly engaging with the shared background that the classes’ social support offered. Participants that were previously active were more likely to engage with further strength and balance training or resources, often wishing to continue with classes provided by Age UK. Conclusions: Users of the classes enjoyed the programme, regardless of if they felt they received benefit from them. Addressing common barriers requires better communication of logistical aids available to them. Further work is required to understand preferences of facilitators and barriers of completing further classes or training, either independently or in a group environment.

 Introduction:

Maintaining good postural stability is considered important to prevent falls in the elderly. We evaluated factors associated with good postural stability.

Methods:

We evaluated 33 patients (6 males and 27 females) over 65 years old. The average age was 76.1 years old ranging 65 to 85. We measured Index of Postural Stability(IPS) using gravicoder GW-5000 manufactured by ANIMA. The IPS was advocated by Mochizuki in 2000. It was defined following this equation; IPS=log[(area of stability limit + area of postural sway)/area of postural sway). Larger IPS means better postural stability. The average IPS in each age was already known. IPS was calculated automatically through gravicoda. We divided these patients into two groups by the results of IPS. Group A with the patients whose IPS was larger, Group B with the patients whose IPS was smaller than the average in their age. We compared the following items between the two groups. Functional performance (gait speed, two-step test, one-leg standing test, five-repetition sit-to-stand test, grip strength), body composition (height, weight, BMI, limb circumference, skeletal muscle mass ), spino-pelvic parameters (Pelvic Incidence(PI), Lumbar Lordosis(LL), Pelvic Tilt(PT), Sagittal Vertical Axis (SVA)) using whole spine x-ray photograph.

Results:

Thirteen patients were classified into Group A and 20 patients were into Group B. Gait speed, two-step test, five-repetition sit-to-stand test, one-leg standing test, SVA were significantly different between the two groups. SVA was 6.39±31.0mm in Group A and 50.6±27.5 mm in Group B. SVA of less than 50 mm is known to be an important indicator of good posture.

Conclusion:

The results showed that SVA is related to postural stability as well as gait and balance ability. This suggests that good posture is likely one of the keys to fall prevention.

Introduction: Inpatient falls are a common problem, and it is important that newly qualified doctors feel confident in conducting competent assessments of patients after they fall. This project seeks to assess the confidence levels of final year Manchester Medical School (MMS) students surrounding the topic of inpatient falls assessments, as well as to determine whether another resource from MMS regarding this topic would be beneficial.

Method: A survey was conducted and disseminated amongst final year students at MMS through email and social media, with questions designed to address the objectives set, as well as gain an understanding of students’ prior experience and knowledge of inpatient falls assessments.

Results: A total of 70 out of 545 students answered the survey, equivalent to a 13% response rate. The results demonstrated that 70% had observed and 27.1% of students had performed an inpatient post-fall assessment. The results showed students generally were not confident in conducting inpatient falls assessments, with 17% and 39% of students self-assessing as ‘Extremely not confident’ and ‘Somewhat not confident’ respectively. 100% of students believed an additional resource on the topic would be a beneficial addition to the MMS curriculum; with the majority (60%) opting for a simulation session as an appropriate option, followed by an informative summary document (21%), an interactive online case (9%), and a lecture (6%).

Conclusions: Despite certain limitations of the project, it can be said that students generally lack confidence and experience when performing inpatient falls assessments and believe that an additional resource from MMS would be beneficial.

Introduction

Geriatric medicine is inherently complex and requires multi-disciplinary integration. Simulation-based training has been recognised by the Joint Royal Colleges of Physicians’ Training Board and the Royal College of Nursing as a method to enhance learning and improve patient outcomes. This project aimed to develop a multi-professional simulation programme within care of the elderly to mimic the multi-professional clinical practice that takes place on geriatric hospital wards.

Methods

A total of ten half-day simulation sessions have been run across two sites in two years. The scenarios cover frailty, orthogeriatric post-operative complications, acute delirium, Parkinson’s disease, thrombolysis and end of life care. The sessions were attended by 57 participants, including 24 doctors, 20 nurses, 7 nursing students, 4 healthcare assistants and 2 physician associates. Quantitative and qualitative questionnaires conducted pre- and post- simulation were used to assess confidence levels and attitudes towards simulation as a learning tool.

Results

Both pre- and post- simulation, candidates had the most confidence in managing end of life situations, and least confidence in managing acutely unwell patients with Parkinson’s disease. Confidence levels for managing common geriatric scenarios increased by an average of 21% after candidates participated in the simulation session. Thematic analysis highlighted the importance of collaboration within a team to enhance a sense of belonging, and pro-activeness of staff to highlight deteriorating patients to colleagues and family members.

Conclusions

Simulation that mimics the ward environment is an effective tool in increasing the confidence of the multi-disciplinary team looking after geriatric patients through exposing candidates to complex situations and increasing awareness of the roles within the team. The simulation sessions have highlighted clinical areas that require further education within the Trust, such as thrombolysis. Future development of the simulation will aim to adapt the scenarios for use of the wider multidisciplinary team, incorporating therapists and pharmacists.

The introduction of an additional meal in nursing homes may be associated with a positive impact on the BMI of residents with dementia.

Abstract

Background

Since 2010, many nursing homes in Norway have introduced an extra meal daily, with a hot lunch, and pushing dinner to later in the day. This initiative aims to reduce the long time interval between breakfast and supper.

Aim

This study examines how an extra meal affects the residents' body mass index (BMI) at nursing homes in Norway. Research questions include how an extra meal affects BMI among residents in the dementia unit.

Methods

We used a cross-sectional design to analyze data from residents over 65 years old in dementia care units. Both parametric and non-parametric statistical tests were used to evaluate changes in BMI.

Results

Our study identified a modest increase in BMI among residents in the dementia care unit after introducing an additional meal. The results imply that incorporating an extra meal to meet residents' needs could support the maintenance of a healthy BMI.

Discussion

Our study reveals that the introduction of an extra meal resulted in a slight increase in BMI among the residents with dementia, which does not correspond with previous studies indicating malnutrition among these residents. The dementia disease reduces functional abilities, and challenges related to mealtime behavior, restlessness, and depression can lead to weight loss. The fact that our results show a slight increase in BMI at the dementia units may be related to these residents often being troubled with restlessness and not finding the peace to consume a full meal. By introducing an extra meal, the total food intake increases since residents still eat a little at each meal, and focusing more on accommodating each resident might have influenced the increase in BMI values.

Conclusion

The study indicates that the introduction of an extra meal has a positive effect on the BMI value of residents with dementia in nursing homes.

Introduction:

Polypharmacy is common amongst older adults and could result in adverse outcomes if not reviewed and optimised regularly (Davies et al, 2020). The aim of this survey is to assess and report on the variation in doctors’ understanding of medication reviews at Maidstone and Tunbridge Wells hospitals (MTW).    

Method:

A short, anonymised, online questionnaire was circulated to all current doctors at MTW via email and WhatsApp groups.

Results:

38 doctors of different grades (Foundation Year One-Consultant) from a variety of medical and surgical specialties responded. Of these, 41% could correctly define appropriate polypharmacy, but only 6% could define problematic polypharmacy.  Most respondents (59.5%) had not received any training on structured medication reviews (SMR). 51.4% were not aware of any tools used in medication optimisation. 43% said they “always carry out” medication reviews in clinical practice and 8.3% said that they never do. Less than half (38%) felt confident in completing SMR. The main barriers to routine implementation of SMR identified by the respondents were: lack of confidence (27%), time pressures (26%), senior clinicians not giving importance to SMR (16%), 3% felt it was not the doctor’s responsibility. Most respondents (91.7%) said that they would benefit from further training in SMR.  

Conclusions:

The results show that there is a wide variation in the respondents’ understanding and practice of medication reviews. Also that there is a clear and well founded demand for training. Once training has been formulated and delivered a follow up survey of those attending should be used to help gauge its effectiveness. The small sample size is a limitation of this study affecting its generalisability as is the fact that it was a self-selected group completing the survey.

Introduction

Physical and cognitive decline at an older age is preceded by changes that accumulate over time until they become clinically evident difficulties. These changes, frequently overlooked by patients and health professionals, may respond better than fully established conditions to strategies designed to prevent disabilities and dependence in later life. The objective of this study was twofold: to provide further support for the need to screen for early functional changes in older adults and to look for an early association between decline in mobility and cognition.

Methods

A cross-sectional cohort study was conducted on 95 active functionally independent community-dwelling older adults in Havana, Cuba. We measured their gait speed at the usual pace and their cognitive status using the MMSE. A value of 0.8 m/s was used as the cut-off point to decide whether they presented a decline in gait speed. A quantitative analysis of their EEG at rest was also performed to look for an associated subclinical decline in brain function.

Results

Results show that 70% of the sample had a gait speed deterioration (i.e., lower than 0.8 m/s), of which 80% also had an abnormal EEG frequency composition for their age. While there was no statistically significant difference in the MMSE score between participants with a gait speed above and below the selected cut-off, individuals with MMSE scores below 25 also had a gait speed < 0.8 m/s and an abnormal EEG frequency composition.

Conclusions

Our results provide further evidence of early decline in older adults – even if still independent and active - and point to the need for clinical pathways that incorporate screening and early intervention targeted at early deterioration to prolong the years of functional life in older age.