Prevention 101

A look at applications that go beyond the “Help, I’ve fallen…” scenario for home telehealth falls communication devices

Key to current applications of falls-related telehealth devices and programs is a focus on prevention—that is, helping to keep falls from happening in the first place. Developments of devices such as sensors placed in flooring (especially where carpeting ends and other flooring begins, and/or where falls have already occurred) greatly extend communications to elderly residents. The fairly innocuous buzzing of the sensors meets the need/desire for unobtrusive assistance. And there’s more beyond merely sensing a potentially hazardous incident. As early as the mid-1990s, researcher Dr. Kevin Doughty and his team proposed [1] that future services evolving from the PERS technologies are likely “to predict long-term deterioration in health, using activity profiles” and so provide automated sensing of emergencies before emergent situations actually occur. A change of gait, for instance, may indicate a developing health issue, and that detail can be conveyed immediately to the walker’s healthcare provider. And so, prediction and prevention (of more widespread health hazards) could go hand in hand.

No off-the-shelf programs here, though. Very individual, customized profiles of the elderly and their homes must be undertaken in the first steps of the falls prevention planning process. Close reviews of individuals’ usual routines, routes typically taken in the house, and preferences regarding timing and quantities of activities all are in order.

One such research project is currently underway at the University of Virginia’s Medical Automation Research Center, which has focused on detecting gait anomalies and falls, through its “Passive Unobtrusive Gait Monitor.” [2] This monitoring system uses a device based on an ultra sensitive optic-fiber sensor that can detect vibrations generated by a person walking tens of feet away on both carpeted and uncarpeted floors. In effect, it really gets to know a person: in this project and others similar to it, such sensors or other monitoring devices are developed for tracking targeted individuals’ usual routines, and alerts associated with each of these individual’s day-to-day routines would be able to respond by sending signals to outside observers (such as the individual’s clinicians) about the deviations demonstrated by the elderly person being observed. For instance, decreased speed in gait and stumbling, as well as actual falling, all are significant deviations to track and respond to.

But. No sooner does such individualized surveillance tracking movement get undertaken to create a customized work plan, then discomfort with too-close observing (or Big Brother watching) gets vocalized [3], with warnings of telehealth causing the elderly to sacrifice independence and privacy.

Can there be a happy medium between seniors’ accepting potentially helpful monitoring and resisting too-close-for-comfort surveillance? This remains an open question. Today’s programs to prevent falls tread lightly on this explosive issue. Simply put, they typically use the PERS device (as the single telecommunications feature of the program) and incorporate a combination of conventional preventative means (such as medication reviews, vision checks, and so on). These conventional means (and more advanced contact, too) are described in the Look Homeward segment of this installment.

Links:

1. Doughty, K., Cameron, K., Gainer, P. (1996). “Three generations of telecare of the elderly,” J Telemedicine and Telecare 2 (2): 71-80.
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2. Retrieved Feb. 10, 2010, from: http://www.aahsa.org/section_cast.aspx?id=10460
   titled: “Passive Unobtrusive Gait Monitor, an Economical Device to Detect Gait Anomalies and Falls.”
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3. See, for instance, an editorial, “Growing Old in a High-Tech World: The Promise and Perils,” in CSA [Certified Senior Advisors] Journal (2003), Vol. 21: 2-3.
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