Improving Fall Detection Devices for Older Adults Using Quality Function Deployment (QFD) Approach.

Engineering invention must be in tandem with public demands. Often it is difficult to identify the priorities of consumers where technological advancement is needed. In line with the global challenge of increasing fall prevalence among older adults, providing prevention solutions is the key. This study aims at developing an improved fall detection device using an approach called Quality Function Deployment (QFD). The goal is to investigate features to incorporate in existing device from consumer's perspectives. A three-phases design process is constructed; (1) Questionnaire, (2) Ishikawa Method, and (3) QFD. The proposed method begins with identifying customer needs as the requirement analysis, followed by a method to convert them to design specifications to be added in a fall detection device using QFD tool. As the top feature is monitoring balance, the new improved fall detection devices incorporating balance features will help older adults to monitor their level of risk of falling.

Prevalence, Circumstances, and Risk Factors of Falls Among Community Dwelling Members of University of the Third Age.

Objective: Study aimed to identify the prevalence of falls and associated contributory factors among older Malaysians. Methods: A cross sectional study among community dwelling older adults aged 50 years and above. Self-administered questionnaires on history of falls in the previous 12 months, physical assessment and computerized and clinical measures of balance were assessed on a single occasion. Results: Forty nine (31.0%) participants fell, with 4.4% reported having multiple falls within the previous 12 months. Slips were the most prevalent cause of falls, accounting for 49% of falls. More than half (54.5%) of falls occurred in the afternoon while participants walked inside the home (32.7%), outside home (30.6%), and 36.7% were in community areas. More than half of respondents were identified as having turning instability. Step Test, turn sway, depression, physical activity level and edge contrast sensitivity were significantly worse for fallers (p < 0.05). Multiple logistic regression analysis showed that turning performance, visual acuity and back pain were significantly associated with falls risk, accounting for 72% of the variance of risk factors for falls among studied population. Conclusion: Falls are common among community dwelling older Malaysians. The findings provide information of falls and falls risk factors among community dwelling older adults in Malaysia. Future intervention studies should target locally identified falls risk factors. This study has highlighted the importance of instability during turning as an important fall risk factor.

Effectiveness of a Community-Based Muscle Strengthening Exercise Program to Increase Muscle Strength Among Pre-frail Older Persons in Malaysia: A Pilot Study.

Deterioration in muscle mass and muscle strength is common among the frail older persons, cause functional dependence and decrease in the quality of life. Therefore, the identification of cost-effective interventions to prevent or ameliorate frailty is crucially needed. The aim of this study is to determine the effectiveness of a Community-based Muscle Strengthening Exercise (COME) program to increase muscle strength among pre-frail older persons. This study was a quasi-experimental study. A total of 32 older persons aged 60 years and older with pre-frail symptoms were recruited from the community center. The COME was developed based on the Growing Stronger program and the Otago Home Exercise Program. COME was designed to strengthen all of the major muscle groups in the upper and lower extremities. The exercise program was conducted for 12 weeks and divided into 3 parts; (1) to strengthen the body slowly and gently, using only body weight, (2) to introduce dumbbells and ankle weights to increase strength and (3) to add various new ways to boost strength even more. Functional tests were measured before and after the intervention. The results revealed non-significant p-value for pre- and post-intervention comparison for all study outcomes. Observing the values of mean difference, the study intervention was shown to have slightly improved the time up and go (Mean difference = -0.25), and sit-to-stand duration (Mean difference = -0.41) as well as the handgrip strength (Mean difference = 0.68) among the participants. On the assessment of Cohen ES, all three improvements exhibited small effect sizes. Sit-to-stand duration was shown to have most benefited from the intervention with highest ES among the outcome variables (ES = 0.20). COME intervention program among pre-frail older persons showed favorable trend toward improvement of upper and lower extremities muscle strength. This study should be further tested in randomized control trial to confirm its effectiveness.

The Association of Falls with Instability: An Analysis of Perceptions and Expectations toward the Use of Fall Detection Devices Among Older Adults in Malaysia.

Background: Falls are a significant incident among older adults affecting one in every three individuals aged 65 and over. Fall risk increases with age and other factors, namely instability. Recent studies on the use of fall detection devices in the Malaysian community are scarce, despite the necessity to use them. Therefore, this study aimed to investigate the association between the prevalence of falls with instability. This study also presents a survey that explores older adults' perceptions and expectations toward fall detection devices. Methods: A cross-sectional survey was conducted involving 336 community-dwelling older adults aged 50 years and older; based on randomly selected participants. Data were analyzed using quantitative descriptive analysis. Chi-square test was conducted to investigate the associations between self-reported falls with instability, demographic and walking characteristics. Additionally, older adults' perceptions and expectations concerning the use of fall detection devices in their daily lives were explored. Results: The prevalence of falls was 28.9%, where one-quarter of older adults fell at least once in the past 6 months. Participants aged 70 years and older have a higher fall percentage than other groups. The prevalence of falls was significantly associated with instability, age, and walking characteristics. Around 70% of the participants reported having instability issues, of which over half of them fell at least once within 6 months. Almost 65% of the participants have a definite interest in using a fall detection device. Survey results revealed that the most expected features for a fall detection device include: user-friendly, followed by affordably priced, and accurate. Conclusions: The prevalence of falls in community-dwelling older adults is significantly associated with instability. Positive perceptions and informative expectations will be used to develop an enhanced fall detection incorporating balance monitoring system. Our findings demonstrate the need to extend the fall detection device features aiming for fall prevention intervention.

Can healthy life style predict successful aging among Iranian older adults?

Background: Successful aging is a prominent and worldwide theme in gerontology. However, until recently, only few studies were conducted about successful aging in Iran. This study examined whether a healthy lifestyle could predict successful aging among older Iranians. Methods: This cross sectional and descriptive study included 975 older Iranians who were selected through a multistage cluster-quota method from the health centers of Shiraz, Iran. A 5-part questionnaire, including demographic characteristics, the Seniors' Healthy Lifestyle, Barthel Index, the Diner Life Satisfaction and Quality of Life, was used to collect the data. A logistic regression analysis was used in data analysis; data were analyzed using SPSS 21; and significance level was set at α = 0.05. Results: The prevalence of successful aging among older Iranians was calculated at 24.0%. Results of multiple logistic regression analysis revealed that age (95% CI = 1.129- 1.702 and OR = 1.352), gender (95% CI = 0.412-0.764 and OR = 0.687), education level (95% CI = 1.443 - 1.699 and OR = 1.454), job (95% CI = 1.063-1.413 and OR = 1.185), monthly income (95% CI = 1.355-4.055 and OR = 2.272), insurance (95% CI = 0.344-0.842 and OR = 0.540), source of income (95% CI = 1.014-1.298 and OR = 1.145), and healthy lifestyle (95% CI = 0.772 - 0.858 and OR = 0.814) were predictors for successful aging. Conclusion: Findings indicated that successful agers were mostly younger men, with higher education level and monthly income, who had insurance and a job and a healthy lifestyle. Thus, to age successfully, one must maintain and improve healthy lifestyle to prolong one's health.

What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: There is strong research evidence for falls prevention among older people in the community setting, although most is from Western countries. Differences between countries (eg sunlight exposure, diet, environment, exercise preferences) may influence the success of implementing falls prevention approaches in Asian countries that have been shown to be effective elsewhere in the world. The aim of this review is to evaluate the scope and effectiveness of falls prevention randomized controlled trials (RCTs) from the Asian region. METHOD: RCTs investigating falls prevention interventions conducted in Asian countries from (i) the most recent (2012) Cochrane community setting falls prevention review, and (ii) subsequent published RCTs meeting the same criteria were identified, classified and grouped according to the ProFANE intervention classification. Characteristics of included trials were extracted from both the Cochrane review and original publications. Where ≥2 studies investigated an intervention type in the Asian region, a meta-analysis was performed. RESULTS: Fifteen of 159 RCTs in the Cochrane review were conducted in the Asian region (9%), and a further 11 recent RCTs conducted in Asia were identified (total 26 Asian studies: median 160 participants, mean age:75.1, female:71.9%). Exercise (15 RCTs) and home assessment/modification (n = 2) were the only single interventions with ≥2 RCTs. Intervention types with ≥1 effective RCT in reducing fall outcomes were exercise (6 effective), home modification (1 effective), and medication (vitamin D) (1 effective). One multiple and one multifactorial intervention also had positive falls outcomes. Meta-analysis of exercise interventions identified significant benefit (number of fallers: Odds Ratio 0.43 [0.34,0.53]; number of falls: 0.35 [0.21,0.57]; and number of fallers injured: 0.50 [0.35,0.71]); but multifactorial interventions did not reach significance (number of fallers OR = 0.57 [0.23,1.44]). CONCLUSION: There is a small but growing research base of falls prevention RCTs from Asian countries, with exercise approaches being most researched and effective. For other interventions shown to be effective elsewhere, consideration of local issues is required to ensure that research and programs implemented in these countries are effective, and relevant to the local context, people, and health system. There is also a need for further high quality, appropriately powered falls prevention trials in Asian countries.

Effectiveness of Individualized Home-Based Exercise on Turning and Balance Performance Among Adults Older than 50 yrs: A Randomized Controlled Trial.

OBJECTIVE: This study evaluated the effectiveness of an individualized home-based exercise program that included specific turning exercises in improving turning performance in adults identified as having unsteadiness during turning. DESIGN: A single-blind (assessors) randomized controlled trial was conducted with 68 community-dwelling Malaysians aged 50 yrs and older, who had abnormal turning performance (outside of age and sex, normal limits on the Step/Quick Turn Test [180-degree turn task on the NeuroCom Balance Master with long plate]). The intervention group received a 16-wk home exercise program that included two turning exercises, whereas the control group maintained their usual activities. RESULTS: Significant group × time effects were found using two-way repeated-measures analysis of variance for turning and balance/mobility measures. The intervention group significantly improved relative to the control group for (1) sway when turning 180 degrees Step/Quick Turn, F1,65 = 8.070, P = 0.006; (2) time to perform 180-degree turn Step/Quick Turn, F1,65 = 8.216, P = 0.006; (3) Timed Up and Go (single task), F1,65 = 6.647, P = 0.012; (4) Timed Up and Go (dual task), F1,65 = 8.301, P = 0.005; and (5) static stance sway, F1,65 = 10.491, P = 0.002. CONCLUSIONS: An individualized home exercise program that included specific exercises to improve turning ability was effective in improving turning performance in adults older than 50 yrs.