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Predicting falls before they happen

PRED-FALL trainees test the effectiveness of compliant flooring and wearable hip protectors with their "hip impact simulator." Photo credit: Injury Prevention and Mobility Lab, Simon Fraser University

Helping his grandmother navigate the icy sidewalks of Winnipeg as a boy and witnessing her fear of falling helped motivate Steve Robinovitch to pursue research focused on keeping vulnerable seniors safer.

“The costs of falls are enormous for both the individual and their family members,” says Dr. Robinovitch, a professor in the School of Engineering Science and the Department of Biomedical Physiology and Kinesiology at Simon Fraser University, and the co-lead of the AGE-WELL Core Research Project titled PRED-FALL-Technologies to Predict, Prevent and Detect Falls.

Injuries suffered by older adults in falls cost about $3.5 billion a year in Canada. About 25 per cent of older adults who break their hips will die within the year. Increasingly researchers are noting that traumatic brain injuries are also exacting a terrible toll—accounting for close to half of the deaths related to falls. Falls are the number-one reason for people having to enter care homes.

The PRED-FALL research team is conducting innovative research using networks of video cameras to understand the circumstances of falls in long-term care. They are also developing a wearable sensor system that can transmit sophisticated information about mobility patterns and falls. The product might rely on sensors based in a smartphone or wrist-watch. Such a device may deliver early warning signs of risk for falls, and provide real-time feedback to assist in exercise and rehabilitation.

“Wearable sensor systems are providing us with the ability to monitor both the quantity and quality of movement as people go about their daily activities. The challenge is working together with care providers, older adults and researchers to agree on the most relevant outcomes, and to address the barriers to adoption,” says Dr. Robinovitch.

The PRED-FALL team is also field-testing innovations that hold great promise. Among them: a technology called “compliant flooring.” They worked with an industry partner to modify an existing flooring sublayer called “Smart Cell” that was designed for workers who need to be on their feet for long hours. It feels like a normal floor, but beneath the surface are banks of columns that compress when an object forcefully strikes them, and then pop back up afterwards. “You can actually drop an egg on it and the egg bounces back,” says project co-lead Fabio Feldman, Manager of Seniors Fall and Injury Prevention at Fraser Health.

The PRED-FALL team is testing the concept through a clinical trial in 150 rooms in a care facility—half were randomized to get compliant flooring, and half were renovated with a control flooring. The results will not be known until autumn 2017, but research in the lab would indicate that it could make a real difference on the frequency of hip fractures and head injuries. “It’s a relatively simple but promising intervention,” says Feldman.

Compliant flooring represents a shift that Feldman promotes – especially for long-term care – from thinking not only about fall prevention, but also injury prevention. “There is a risk that, if staff focus only on fall prevention, they may discourage residents from physical activity because they’re afraid the person is going to fall. And then quality of life goes down for the residents,” says Feldman.

“An advantage of the flooring is, once it is installed, you don’t need to rely on user acceptance and adherence in adopting the technology – it’s what we refer to as a “passive” form of prevention. Of course, we need evidence on clinical and cost effectiveness to support installations. These are two outcomes of our clinical trial.”

Along with the examination of existing products, the researchers are designing their own versions of compliant flooring. They are seeking to strike a balance–to create something that will cushion falls, but not be so soft as to limit the movement of wheelchairs and other equipment, or impair balance.

In addition, PRED-FALL is developing the next generation of wearable hip protectors. Even though hip protectors have been shown to be effective, reducing the risks of fractures by as much as 80%, the challenge has been convincing people to wear them consistently. In addition to comfort and appearance, the garments require frequent laundering, and can complicate toileting.

Feldman says that their solution is to eliminate the garment and instead use pads that attach directly to the person’s skin using skin-friendly double-sided tape. It means that the pads can be worn for up to 21 days and do not need to be removed for visits to the bathroom. The product is undergoing clinical trials and could be commercially available as early as late 2016.

Story credit: AGE-WELL NCE