Age-related effects of repeated task switching in a novel voluntary gait adaptability task.

Age-related effects of task switching have been extensively studied based on cognitive tasks and simple motor tasks, but less on complex cognitive-motor tasks involving dynamic balance control while walking. The latter tasks may especially be difficult and relevant for older adults in terms of safe mobility in daily life. The aim of the present study was, therefore, to examine age-related changes in task-switching adaptability using a novel voluntary gait adaptability test protocol. Fifteen healthy young (27.5 ± 2.9 years) and 16 healthy old (70.9 ± 7.6 years) adults carried out 2 different visual target stepping tasks (either target avoidance or stepping) twice in a block (A-B-A-B, 2 min per task; three blocks in total) without any intrablock breaks. Our results showed that old adults showed significantly more step errors both in Tasks A and B as well as more interference effects than young adults. Age-related differences in step accuracy were significant in the anterior-posterior direction both in Task A and B but not in the mediolateral direction. Both in step errors and accuracy, no interaction effects of age and trial were shown. Our results suggest that old adults could not cope with rapid and direct task changes in our voluntary gait adaptability task as young adults. Since the significant main effect of trial for Task B, but not Task A appears to be due to different task complexity, further studies may determine the effect of task complexity or task switch timing.

Circadian aspects of mobility-related behavior in patients with dementia: An exploratory analysis in acute geriatric psychiatry.

BACKGROUND: Analyzing patients' mobility-related behavior may improve the assessment of motor behavior in dementia, however, few studies addressed circadian aspects of mobility. This cross-sectional explorative study analyzed the timing of peak mobility-related behavior, the prevalence of mobility-related sundowning and nocturnal mobility-related behavior and associated clinical characteristics in acute geriatric psychiatry. METHODS: Mobility-related behavior of 73 patients (M: 81 years) was measured over 48 h using lower-back worn hybrid motion sensors. We derived the start of the 30-min period with peak gait activity (highest number of steps) for each day and the number of nocturnal steps taken from 10PM to 7AM. Professional caregiver ratings of the patients' motor behavior were conducted within the Neuropsychiatric Inventory (NPI). RESULTS: The mean start time of peak gait activity was 2:37PM, but large variations in timing were found (range: 3:25AM-9:30PM). Twenty-five patients (34%) were identified as "sundowners". Nocturnal mobility-related behavior was measured in 35 patients (53%), whereas professional caregivers assessed night-time disorders in only 19 patients (26%). Clinical characteristics of "sundowners" were not significantly different from other patients, except for lower doses of antipsychotics as compared to non-sundowners (M:1.6 mg/day; p = 0.015). The number of nocturnal steps was significantly associated to corresponding NPI ratings (Spearman's rho = 0.4; p < 0.001). CONCLUSION: Analyzing the timing of peak gait activity and nocturnal step-count seem to provide clinical applicable information on the circadian aspects of mobility-related behavior in acute geriatric psychiatry. Even though the clinical validity needs to be evaluated, objective information on the individual circadian aspects of mobility-related behavior could help to personalize treatment with benefits for patients and caregivers.

Multidimensional interventions to increase life-space mobility in older adults ranging from nursing home residents to community-dwelling: a systematic scoping review.

BACKGROUND: Life-space mobility (LSM) is an important aspect of older adults' real-life mobility. Studies have shown that restricted LSM is a risk factor for many adverse outcomes such as low quality of life and mortality. Therefore, an increasing number of interventions aim to enhance LSM. However, the intervention approaches differ in terms of their type/content, duration, targeted populations, but also in terms of their outcome measures and assessment tools. Especially the latter impairs the comparability of studies with otherwise similar interventional approaches and thus also the interpretation of their results. Therefore, this systematic scoping review aims to provide an overview of the intervention components, assessment tools, and effectiveness of studies aiming to improve LSM in older adults. METHODS: A systematic literature search was carried out in PubMed and Web of Science. We considered studies in older adults of any design that included an intervention approach and at least one outcome of LSM. RESULTS: 27 studies were included in the review. These studies analyzed healthy community-dwelling as well as frail older adults in need of care or rehabilitation and nursing home residents with a mean age between 64 and 89. The percentage of female participants ranged from 3 to 100%. The types of interventions were of the following: physical, counseling, multidimensional, miscellaneous. Multidimensional interventions consisting of physical interventions plus any of the following or a combination of counseling/education/motivation/information appear to be most effective in increasing LSM. Older adults with mobility impairments were more responsive to these multidimensional interventions compared to healthy older adults. Most of the studies used the questionnaire-based Life-Space Assessment to quantify LSM. CONCLUSIONS: This systematic scoping review provides a comprehensive overview of a heterogenous stock of literature investigating LSM-related interventions in older adults. Future meta-analyses are needed to provide a quantitative evaluation of the effectiveness of LSM interventions and recommendations.

Evaluation of a novel technology-supported fall prevention intervention - study protocol of a multi-centre randomised controlled trial in older adults at increased risk of falls.

BACKGROUND: Increasing number of falls and fall-related injuries in an aging society give rise to the need for effective fall prevention and rehabilitation strategies. Besides traditional exercise approaches, new technologies show promising options for fall prevention in older adults. As a new technology-based approach, the hunova robot can support fall prevention in older adults. The objective of this study is to implement and evaluate a novel technology-supported fall prevention intervention using the hunova robot compared to an inactive control group. The presented protocol aims at introducing a two-armed, multi-centre (four sites) randomised controlled trial, evaluating the effects of this new approach on the number of falls and number of fallers as primary outcomes. METHODS: The full clinical trial incorporates community-dwelling older adults at risk of falls with a minimum age of 65 years. Including a one-year follow-up measurement, all participants are tested four times. The training programme for the intervention group comprises 24-32 weeks in which training sessions are scheduled mostly twice a week; the first 24 training sessions use the hunova robot, these are followed by a home-based programme of 24 training sessions. Fall-related risk factors as secondary endpoints are measured using the hunova robot. For this purpose, the hunova robot measures the participants' performance in several dimensions. The test outcomes are input for the calculation of an overall score which indicates the fall risk. The hunova-based measurements are accompanied by the timed-up-and-go test as a standard test within fall prevention studies. DISCUSSION: This study is expected to lead to new insights which may help establish a new approach to fall prevention training for older adults at risk of falls. First positive results on risk factors can be expected after the first 24 training sessions using the hunova robot. As primary outcomes, the number of falls and fallers within the study (including the one-year follow-up period) are the most relevant parameters that should be positively influenced by our new approach to fall prevention. After the study completion, approaches to examine the cost-effectiveness and develop an implementation plan are relevant aspects for further steps. TRIAL REGISTRATION: German Clinical Trial Register (DRKS), ID: DRKS00025897. Prospectively registered 16 August 2021, https://drks.de/search/de/trial/DRKS00025897 .

Clinical teaching in applied health science: effects of a student-led journal club on aging and physical activity.

BACKGROUND: This project aims to investigate the effects of a student-led journal club on students' critical thinking and clinical application skills in the academic field of aging and physical activity. METHODS: A pre-post design analysis with data collected in four successive cohorts of the program M.Sc. Sport and Movement Gerontology was conducted. Each student assigned himself/herself to a study, and then led the journal club discussion and published a summary of the journal club via graphical abstract on social media. The students rated their perceived confidence in the beginning (T0) and after the semester (T1) via questionnaire and 5-point Likert scales addressing their ability to review and summarize the evidence, to present it in a journal club and to lead the discussion. RESULTS: 41 students (32 women, M = 25 years SD 1.9 years) were included. The journal club was rated as "very good" (median 2, IQR 1). Students' confidence on participating, leading the journal club and transferring the results into clinical practice improved significantly (r ≥ 0.6, p < 0.01) - e.g.: "I feel confident in leading a discussion on the literature presented", T0: "undecided" (median 3, IQR 2) to T1: "rather agree" (median 4, IQR 1, Z= -5.41, r = 0.85, p < 0.01). DISCUSSION: The student-led journal club shows to be an effective teaching approach for the field of aging and physical activity within applied health science education. Especially the students' self-assignment to the studies and involving the scientific community via social media was rated as useful and highly motivating for students and lecturers.

Mobility in community-dwelling older adults; what are its determinants?

BACKGROUND: Based on a conceptual framework, Kuspinar and colleagues analysed life-space mobility in community-dwelling older adults. However, a number of earlier mobility studies that used the same framework remained undiscussed. This correspondence article addresses similarities and differences between these studies, as well as highlight issues that need to be addressed to improve our understanding of mobility determinants in older adults. FINDINGS: Despite differences in methodological approach as well as in detailed results, the studies share one important outcome: regardless of the specific choice of potential mobility determinants, only a low to moderate proportion of mobility could be explained. CONCLUSIONS: Our present understanding of the determinants of mobility in community-dwelling older adults is limited. A consistent terminology that takes into account the different aspects of mobility; the use of objective methods to assess real-life mobility; and monitoring changes in real-life mobility in response to interventions will contribute to furthering our understanding of mobility determinants.

Quantifying Circadian Aspects of Mobility-Related Behavior in Older Adults by Body-Worn Sensors-An "Active Period Analysis".

Disruptions of circadian motor behavior cause a significant burden for older adults as well as their caregivers and often lead to institutionalization. This cross-sectional study investigates the association between mobility-related behavior and subjectively rated circadian chronotypes in healthy older adults. The physical activity of 81 community-dwelling older adults was measured over seven consecutive days and nights using lower-back-worn hybrid motion sensors (MM+) and wrist-worn actigraphs (MW8). A 30-min and 120-min active period for the highest number of steps (MM+) and activity counts (MW8) was derived for each day, respectively. Subjective chronotypes were classified by the Morningness-Eveningness Questionnaire into 40 (50%) morning types, 35 (43%) intermediate and six (7%) evening types. Analysis revealed significantly earlier starts for the 30-min active period (steps) in the morning types compared to the intermediate types (p ≤ 0.01) and the evening types (p ≤ 0.01). The 120-min active period (steps) showed significantly earlier starts in the morning types compared to the intermediate types (p ≤ 0.01) and the evening types (p = 0.02). The starting times of active periods determined from wrist-activity counts (MW8) did not reveal differences between the three chronotypes (p = 0.36 for the 30-min and p = 0.12 for the 120-min active period). The timing of mobility-related activity, i.e., periods with the highest number of steps measured by hybrid motion sensors, is associated to subjectively rated chronotypes in healthy older adults. The analysis of individual active periods may provide an innovative approach for early detecting and individually tailoring the treatment of circadian disruptions in aging and geriatric healthcare.

[Smartphone-based health promotion in old age : An explorative multi-component approach to improving health in old age]. / Smartphone-basierte Gesundheitsförderung im Alter : Ein explorativer, mehrkomponentiger Ansatz zur Verbesserung der Gesundheit im höheren Alter.

BACKGROUND: As age-related health problems are often related to a combination of physiological, psychological and social aspects, it has been proposed that multi-component interventions might be particularly effective to improve older peoples' health. The present study used a smartphone-based approach to promote health through activities including physical as well as cognitive components performed in a daily life context. METHODS: This study investigated the effects of different health-related variables (e.g. gait and cognition) as well as the individual motivation for physical activity. The study included 34 community-dwelling older adults (mean age 75.0 ± 3.7 years, 15 women) who took part either in smartphone-based activities (intervention group) or attended lectures (control group). The smartphone-based interventions were undertaken semiweekly. RESULTS: Baseline tests showed that participants in both groups already had a high motivation for physical activities. Analyses indicated that the smartphone application was considered to be user-friendly. CONCLUSION: There were no substantial health-related benefits from the activities, probably due to moderate to good health status and activity levels at baseline and too little additional activity intensity during the intervention. Hence, it is recommended that for future research the subjects included should be less active or have health restrictions.

Assessment of Functional Performance in Acute Geriatric Psychiatry - Time for New Strategies?

OBJECTIVES: The aim of this study was to investigate the feasibility and reliability of functional performance tests in people living with dementia and depression. METHOD: A cross-sectional study was conducted in a geriatric psychiatry hospital. People living with dementia, depression, and healthy older adults were included. Feasibility of the timed up and go test (TUG), the short physical performance battery (SPPB), and the multisurface obstacle test for older adults (MSOT) was assessed based on valid test executions. Test-retest reliability was evaluated by mean difference (MD), coefficient of variation (CV), standardized MD, intraclass correlation coefficient (ICC), and correlation coefficient (rs). RESULTS: A total of 53 people in acute geriatric psychiatry and 21 healthy older adults were included. In people living with dementia (n = 23), feasibility was 65.2% (MSOT), 8.7% (TUG), and 8.7% (SPPB). In people living with depression (n = 30), feasibility was 83.3% (MSOT), 80.0% (TUG), and 46.7% (SPPB). Intraclass correlation coefficients and rs for the MSOT were high (ICC > 0.70) in both groups. Coefficient of variations of the MSOT were between 10.7% and 18.0% (dementia) and 7.1% and 17.0% (depression). Reliability of the TUG and SPPB was not analyzed in people living with dementia, due to low feasibility. In people living with depression, ICCs and rs were between 0.86 and 0.87 with CVs of 7.2% (TUG) and 0.69 and 0.95 with CVs of 7.8% and 15.1% (SPPB). CONCLUSION: Feasibility and reliability of established functional performance tests in acute geriatric psychiatry are limited, especially in people living with dementia. New strategies, for example, sensor-based approaches, may allow measurement of functional performance apart from standardized instruction-based test procedures in this clinical population.

Quantifying Habitual Physical Activity and Sedentariness in Older Adults-Different Outcomes of Two Simultaneously Body-Worn Motion Sensor Approaches and a Self-Estimation.

Applicable and accurate assessment methods are required for a clinically relevant quantification of habitual physical activity (PA) levels and sedentariness in older adults. The aim of this study is to compare habitual PA and sedentariness, as assessed with 1) a wrist-worn actigraph, 2) a hybrid motion sensor attached to the lower back, and 3) a self-estimation based on a questionnaire. Over the course of one week, PA of 58 community-dwelling subjectively healthy older adults was recorded. The results indicate that actigraphy overestimates the PA levels in older adults, whereas sedentariness is underestimated when compared to the hybrid motion sensor approach. Significantly longer durations (hh:mm/day) for all PA intensities were assessed with the actigraph (light: 04:19; moderate to vigorous: 05:08) when compared to the durations (hh:mm/day) that were assessed with the hybrid motion sensor (light: 01:24; moderate to vigorous: 02:21) and the self-estimated durations (hh:mm/day) (light: 02:33; moderate to vigorous: 03:04). Actigraphy-assessed durations of sedentariness (14:32 hh:mm/day) were significantly shorter when compared to the durations assessed with the hybrid motion sensor (20:15 hh:mm/day). Self-estimated duration of light intensity was significantly shorter when compared to the results of the hybrid motion sensor. The results of the present study highlight the importance of an accurate quantification of habitual PA levels and sedentariness in older adults. The use of hybrid motion sensors can offer important insights into the PA levels and PA types (e.g., sitting, lying) and it can increase the knowledge about mobility-related PA and patterns of sedentariness, while actigraphy appears to be not recommendable for this purpose.

Prominent physical inactivity in acute dementia care: Psychopathology seems to be more important than the dose of sedative medication.

INTRODUCTION: To objectively quantify patients' physical activity and analyze the relationships between physical activity levels, psychopathology, and sedative medication in acute hospital dementia care. MATERIALS AND METHODS: In this cross-sectional study, we assessed the patients' physical activity based on data collection by hybrid motion sensors attached on their lower back. Daily doses of antipsychotics have been converted to olanzapine-equivalents and daily benzodiazepine medication is reported as diazepam-equivalents. We assessed patients' neuropsychiatric symptoms with the Neuropsychiatric Inventory and the Cohen-Mansfield Agitation Inventory. RESULTS: We analyzed motion sensor data from 64 patients (MMSE M = 18.6). On average, patients were lying for 11.5 hours, sitting/standing sedentary for 10.3 hours, sitting/standing active for 1.0 hours, and walking for 1.2 hours per day. The analysis revealed no correlations between patients' physical activity and antipsychotic or benzodiazepine medication. More severe neuropsychiatric symptoms were associated with a decrease in the patients' physical activity (r = .32, P = .01). In particular, patients with apathy symptoms were less physically active than patients without apathy symptoms. DISCUSSION: The results reveal that most of the patients in acute dementia care had very low levels of physical activity. Their physical inactivity may be due to the severity of their neuropsychiatric symptoms, especially apathy. Antipsychotic and benzodiazepine medication appeared to have less impact on patients' physical activity. Dementia care should pay more attention to prevent physical inactivity in patients.

Towards a comprehensive set of GPS-based indicators reflecting the multidimensional nature of daily mobility for applications in health and aging research.

BACKGROUND: GPS tracking is increasingly used in health and aging research to objectively and unobtrusively assess individuals' daily-life mobility. However, mobility is a complex concept and its thorough description based on GPS-derived mobility indicators remains challenging. METHODS: With the aim of reflecting the breadth of aspects incorporated in daily mobility, we propose a conceptual framework to classify GPS-derived mobility indicators based on their characteristic and analytical properties for application in health and aging research. In order to demonstrate how the classification framework can be applied, existing mobility indicators as used in existing studies are classified according to the proposed framework. Then, we propose and compute a set of selected mobility indicators based on real-life GPS data of 95 older adults that reflects diverse aspects of individuals' daily mobility. To explore latent dimensions that underlie the mobility indicators, we conduct a factor analysis. RESULTS: The proposed framework enables a conceptual classification of mobility indicators based on the characteristic and analytical aspects they reflect. Characteristic aspects inform about the content of the mobility indicator and comprise categories related to space, time, movement scope, and attribute. Analytical aspects inform how a mobility indicator is aggregated with respect to temporal scale and statistical property. The proposed categories complement existing studies that often underrepresent mobility indicators involving timing, temporal distributions, and stop-move segmentations of movements. The factor analysis uncovers the following six dimensions required to obtain a comprehensive view of an older adult's daily mobility: extent of life space, quantity of out-of-home activities, time spent in active transport modes, stability of life space, elongation of life space, and timing of mobility. CONCLUSION: This research advocates incorporating GPS-based mobility indicators that reflect the multi-dimensional nature of individuals' daily mobility in future health- and aging-related research. This will foster a better understanding of what aspects of mobility are key to healthy aging.

Assessing Older Adults' Daily Mobility: A Comparison of GPS-Derived and Self-Reported Mobility Indicators.

Interest in global positioning system (GPS)-based mobility assessment for health and aging research is growing, and with it the demand for validated GPS-based mobility indicators. Time out of home (TOH) and number of activity locations (#ALs) are two indicators that are often derived from GPS data, despite lacking consensus regarding thresholds to be used to extract those as well as limited knowledge about their validity. Using 7 days of GPS and diary data of 35 older adults, we make the following three main contributions. First, we perform a sensitivity analysis to investigate how using spatial and temporal thresholds to compute TOH and #ALs affects the agreement between self-reported and GPS-based indicators. Second, we show how daily self-reported and GPS-derived mobility indicators are compared. Third, we explore whether the type and duration of self-reported activity events are related to the degree of correspondence between reported and GPS event. Highest indicator agreement was found for temporal interpolation (Tmax) of up to 5 h for both indicators, a radius (Dmax) to delineate home between 100 and 200 m for TOH, and for #ALs a spatial extent (Dmax) between 125 and 200 m, and temporal extent (Tmin) between 5 and 6 min to define an activity location. High agreement between self-reported and GPS-based indicators is obtained for TOH and moderate agreement for #ALs. While reported event type and duration impact on whether a reported event has a matching GPS event, indoor and outdoor events are detected at equal proportions. This work will help future studies to choose optimal threshold settings and will provide knowledge about the validity of mobility indicators.

Reading from the Black Box: What Sensors Tell Us about Resting and Recovery after Real-World Falls.

BACKGROUND: Lying on the floor for a long time after falls, regardless of whether an injury results, remains an unsolved health care problem. In order to develop efficient and acceptable fall detection and reaction approaches, it is relevant to improve the understanding of the circumstances and the characteristics of post-impact responses and the return or failure to return to pre-fall activities. Falls are seldom observed by others; until now, the knowledge about movement kinematics during falls and following impact have been anecdotal. OBJECTIVE: This study aimed to analyse characteristics of the on-ground and recovery phases after real-world falls. The aim was to compare self-recovered falls (defined as returns to standing from the floor) and non-recovered falls with long lies. METHODS AND PARTICIPANTS: Data from subjects in different settings and of different populations with high fall risk were included. Real-world falls collected by inertial sensors worn on the lower back were taken from the FARSEEING database if reliable information was available from fall reports and sensor signals. Trunk pitch angle and acceleration were analysed to describe different patterns of recovery movements while standing up from the floor after the impact of a fall. RESULTS: Falls with successful recovery, where an upright posture was regained, were different from non-recovered falls in terms of resting duration (median 10.5 vs. 34.5 s, p = 0.045). A resting duration longer than 24.5 s (area under the curve = 0.796) after the fall impact was a predictor for the inability to recover to standing. Successful recovery to standing showed lower cumulative angular pitch movement than attempted recovery in fallers that did not return to a standing position (median = 76°, interquartile range 24-170° vs. median = 308°, interquartile range 30-1,209°, p = 0.06). CONCLUSION: Fall signals with and without successful returns to standing showed different patterns during the phase on the ground. Characteristics of real-world falls provided through inertial sensors are relevant to improve the classification and the sensing of falls. The findings are also important for redesigning emergency response processes after falls in order to better support individuals in case of an unrecovered fall. This is crucial for preventing long lies and other fall-related incidents that require an automated fall alarm.

Falls in hospitalized geriatric psychiatry patients: high incidence, but only a few fractures.

Fall rates from 3.2 to 17.1 falls per 1,000 hospital days in geriatric psychiatry facilities have been reported to date. Up to 5% of the falls result in severe injuries, but data concerning medical consequences are scare. This brief report presents a retrospective analysis of one year fall protocols from a geriatric psychiatry department focusing on consequences of falls. Fall-induced injuries were rated in four categories: no injuries, mild injuries (contusions, hematomas, abrasions), moderate injuries (lacerations, dislocations), and severe injuries (fractures, cerebral hemorrhages). In total, 510 falls were registered during the study period, indicating a fall rate of 17.7 falls per 1,000 hospital days. Overall, 375 falls (73.5%) resulted in no injuries, 67 (13.1%) resulted in mild injuries, 59 (11.6%) resulted in moderate injuries, and only 9 (1.8%) falls led to severe injuries (fractures and cerebral hemorrhages). These results indicate a quite high fall rate in our sample of hospitalized geriatric psychiatry patients with only a relatively small number of severe injuries resulting from the falls. These results raise the question about the use of physical restraints and the use of bedrails in geriatric patients to prevent falls as the medical implications of falls may be less problematic than previously thought.

A Home-Based Exercise Program Driven by Tablet Application and Mobility Monitoring for Frail Older Adults: Feasibility and Practical Implications.

INTRODUCTION: Stimulation of a physically active lifestyle among older adults is essential to health and well-being. The objective of this study was to evaluate the feasibility and user opinion of a home-based exercise program supported by a sensor and tablet application for frail older adults. METHODS: Community-dwelling older adults (aged ≥70 y) living in The Netherlands were recruited in 2014. Participants exercised 3 months with and 3 months without supervision from a remote coach. Feasibility was operationalized as adherence to exercise (percentage of 5 exercise bouts per week completed) and to wearing the sensor (with 70% defined as sufficient adherence) and the number of problems reported. User opinion was measured with a questionnaire addressing ease of use of the technology and opinion on the program. RESULTS: Twenty-one of 40 enrolled participants completed the trial. Adherence overall was 60.9% (average of 3 bouts per week). Adherence among completers (69.2%) was significantly higher than adherence among dropouts (49.9%). Adherence was sufficient among completers during the 3 months of supervision (75.8%). Adherence to wearing the sensor was 66.7% and was significantly higher among completers than among dropouts (75.7% vs 54.2%). The rate of incidents was significantly lower among completers than among dropouts (0.4 vs 1.2 incidents per participant per week). Connectivity-related incidents were prominent. On a scale of 1 to 5, completers gave ratings of 4.3 (after 3 months) and 4.2 (after 6 months). CONCLUSION: A home-based exercise program using novel technology seems feasible when participants are given a stable internet connection. This program shows promise for stimulating physical activity among older frail adults, especially if it offers regular coaching.

Sensor-based assessment of mobility-related behavior in dementia: feasibility and relevance in a hospital context.

BACKGROUND: The assessment of patients' motor behavior is a key challenge in dementia care. Common geriatric assessment questionnaires or actigraphy measurements often lack methodological quality and are unsuitable to individually tailor interventions. Hence, there is a need for developing objective tools to assess patterns of motor behavior. Therefore, the feasibility of a sensor-based assessment of mobility-related behavior in patients with dementia is investigated. METHODS: A cross-sectional investigation on three dementia care wards in a psychiatric hospital was conducted. Forty-five patients with stages of dementia were included. Hybrid motion sensors, recording the sequence of body-postures, were attached on the patients' lower back for 72 consecutive hours. RESULTS: Eighty-nine percent of the assessment periods were completed. On average patients spent 10.9 h/day lying (45%), 9.7 h/day sedentary while sitting or standing (41%), 1.7 h/day active while sitting or standing (7%), 1.7 h/day walking (7%), and reached on average 8,829 steps per day (SD = 7,428). Though overall activity levels were low, the results indicate a wide spectrum of activity patterns - ranging from almost inactive to highly active with general restlessness and wandering behavior. CONCLUSION: The excellent adherence to the assessment protocol compared to wrist-worn actigraphy and the consistency of the sensor-derived analyses with clinical observations are pivotal findings of this study. These results show that it is possible to acquire objective data on individual motor behavior of patients suffering from dementia. This information is essential for tailoring the therapeutic management of these patients in a hospital context.

Inertial Sensor Based Analysis of Lie-to-Stand Transfers in Younger and Older Adults.

Many older adults lack the capacity to stand up again after a fall. Therefore, to analyse falls it is relevant to understand recovery patterns, including successful and failed attempts to get up from the floor in general. This study analysed different kinematic features of standing up from the floor. We used inertial sensors to describe the kinematics of lie-to-stand transfer patterns of younger and healthy older adults. Fourteen younger (20-50 years of age, 50% men) and 10 healthy older community dwellers (≥60 years; 50% men) conducted four lie-to-stand transfers from different initial lying postures. The analysed temporal, kinematic, and elliptic fitting complexity measures of transfer performance were significantly different between younger and older subjects (i.e., transfer duration, angular velocity (RMS), maximum vertical acceleration, maximum vertical velocity, smoothness, fluency, ellipse width, angle between ellipses). These results show the feasibility and potential of analysing kinematic features to describe the lie-to-stand transfer performance, to help design interventions and detection approaches to prevent long lies after falls. It is possible to describe age-related differences in lie-to-stand transfer performance using inertial sensors. The kinematic analysis remains to be tested on patterns after real-world falls.

Adherence to and effectiveness of an individually tailored home-based exercise program for frail older adults, driven by mobility monitoring: design of a prospective cohort study.

BACKGROUND: With the number of older adults in society rising, frailty becomes an increasingly prevalent health condition. Regular physical activity can prevent functional decline and reduce frailty symptoms. In particular, home-based exercise programs can be beneficial in reducing frailty of older adults and fall risk, and in improving associated physiological parameters. However, adherence to home-based exercise programs is generally low among older adults. Current developments in technology can assist in enlarging adherence to home-based exercise programs. This paper presents the rationale and design of a study evaluating the adherence to and effectiveness of an individually tailored, home-based physical activity program for frail older adults driven by mobility monitoring through a necklace-worn physical activity sensor and remote feedback using a tablet PC. METHODS/DESIGN: Fifty transitionally frail community-dwelling older adults will join a 6-month home-based physical activity program in which exercises are provided in the form of exercise videos on a tablet PC and daily activity is monitored by means of a necklace-worn motion sensor. Participants exercise 5 times a week. Exercises are built up in levels and are individually tailored in consultation with a coach through weekly telephone contact. DISCUSSION: The physical activity program driven by mobility monitoring through a necklace-worn sensor and remote feedback using a tablet PC is an innovative method for physical activity stimulation in frail older adults. We hypothesize that, if participants are sufficiently adherent, the program will result in higher daily physical activity and higher strength and balance assessed by physical tests compared to baseline. If adherence to and effectiveness of the program is considered sufficient, the next step would be to evaluate the effectiveness with a randomised controlled trial. The knowledge gained in this study can be used to develop and fine-tune the application of innovative technology in home-based exercise programs. TRIAL REGISTRATION: Nederlands Trial Register (NTR); trial number 4265. The study was prospectively registered (registration date 14/11/2013).