MobileMe

Improving Mobility for the Elderly Using Artificial Intelligence

Photo by Gabe Pierce on Unsplash

Mobility is a privilege.

A privilege that 1 in 5 seniors (and that’s only in the US & Canada) do not get to enjoy. And yours will begin to deteriorate too… in time.

Problem

“If you’re unable to get out then you can’t go shopping, you can’t go out with your friends to eat dinner or go to the movies, and you become dependent on other people to get you places. So you become a recluse, you stay home, you get depressed. With immobilization comes incontinence, because you can’t get to the bathroom, you can develop urinary infections, skin infections. The list goes on,” says geriatrician Dr. Suzanne Salamon, an instructor at Harvard Medical School.

Who does this affect?

Older people have the highest risk of death or serious injury arising from a fall and the risk increases with age.

Global

  • Falls are the second leading cause of accidental or unintentional injury deaths worldwide.
  • Each year an estimated 646 000 individuals die from falls globally of which over 80% are in low- and middle-income countries.
  • Adults older than 65 years of age suffer the greatest number of fatal falls.
  • 37.3 million falls that are severe enough to require medical attention occur each year.

United States

According to the U.S. Centers for Disease Control and Prevention: One in four Americans aged 65+ falls each year. Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.

  • Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults
  • Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths
  • In 2015, the total cost of fall injuries was $50 billion. Medicare and Medicaid shouldered 75% of these costs
  • The financial toll for older adult falls is expected to increase as the population ages and is expected to reach $67.7 billion by 2020
  • Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture
  • Each year at least 300,000 older people are hospitalized for hip fractures. More than 95% of hip fractures are caused by falling.
  • Falls are the most common cause of traumatic brain injuries (TBI)

Physical Impacts of Falling on Seniors

  • Falls can cause hip and thigh injuries: the most common reason for hip fracture hospital admissions (9 in 10 cases). Other injuries that result from falls include head injuries, wrist fractures, and other injuries.
  • Hip fractures also impose a heavy long-term burden as older people become less independent, more reliant on family members and carers, and have an increased chance of moving into an aged care facility.

Psychological Impacts of Falling on Seniors

  • After a fall, many older people become fearful of falling again and lose confidence in walking. You may start to do less physical activity. However, over time this reduced movement makes it more likely that you’ll have another fall because of poorer balance, weaker muscles, and stiffer joints.

Effects of Falls in the Elderly

The factors associated with aging result in decreased ease of mobility, such as…

  1. The decline in physical fitness: Reduced muscle strength, decreased bone mass, loss of balance and coordination, and reduced flexibility.
  2. Impaired Vision: age-related eye diseases make it difficult to detect fall hazards, such as steps, puddles, and thresholds. While these environmental factors can be limited in elderly areas, they are inevitable and pose definite
  3. Increased reliance on medications: Side-effects, such as drowsiness, dizziness, and low blood pressure, can all contribute to an accident. Sedatives, antidepressants, anti-psychotics, opioids, and some cardiovascular drugs are the most common culprits. The impact that first-generation antihistamines pose on the poses on the central nervous system indicates symptoms such as “anxiety, confusion, sedation, blurred vision, reduced mental alertness, urinary retention, and constipation.” According to the Merck Manual, just over 40 percent of seniors take at least five drugs per week.
  4. Chronic Diseases: Health conditions such as Parkinson’s disease, Alzheimer’s disease, and arthritis cause weakness in the extremities, poor grip strength, balance disorders, and cognitive impairment.
    Peripheral neuropathy, or nerve damage, can cause numbness in the feet, making it very difficult for a senior to sense environmental hazards and get around safely.
  5. ⬆ Chances of prior surgical procedures: Hip replacements and other surgeries can leave an elderly person weak, in pain and discomfort, and less mobile. This can be temporary while a patient heals or a new and lasting problem.
  6. ⬆ Susceptibility to environmental hazards: The majority of falls in the elderly population occur in or around seniors’ homes. Environmental factors such as poor lighting, clutter, areas of disrepair, loose carpets, slick floors, and lack of safety equipment can jeopardize a senior’s safety in their home.
  • old age
  • low physical activity
  • obesity
  • impaired strength and balance
  • chronic diseases (e.g. diabetes & arthritis)

How do we test an elder’s mobility today?

The consequences of falls are being suppressed once they occur. That is a reactive approach to addressing this problem.

Timed Up and Go Test

  • The person is sitting on the chair, and when the stopwatch starts, they have to walk 3 meters and turn around and walk back to the chair and sit down. Assistive footwear and a walker is also needed, but the observer must generally observe three variables.
  • Postural stability — is the individual centered well?
  • Gait (including speed, stride length).
  • With age, gait speed increases while stride length decreases.
  • Sway — with more sway, there is less balance around the center of mass.
  • An elder adult which takes longer than 12 seconds is at a high risk of falling.

Functional Reach Test

  • Identifies fall risk based on the balance of an individual try to reach a surface -> if they are greater than 10 inches (25cm) then they have a lower chance of falling, but if they reach 6–10 inches, then they have a high risk of falling.
  • You must maintain a center of balance while doing this -> meant to assess dynamic balance
  • Has a high re-test ability (gets similar levels upon retesting) but low accuracy and positive predictive value (cannot predict fall risk too well, but predicts negative predictive value — not having fall risk — extremely well). This is not effective for predicting fall risk, though.

POMA (Tinetti Performance Oriented Mobility Assessment

  • Similarly to the Timed Up and Go Test, this utilizes a chair. The person has to stand up, turn 360 degrees, and sit down on the armless chair and the professional identifies the balance of the individual. After this, they are tested to walk over a distance: first at original gait velocity, and then at a faster speed. Professionals identify, and scale, their stride length, step height, and the symmetry and velocity of the steps, among other gait-related factors.
  • Creates a quantitative index based on the observational data based on gait and balance.
  • Makes them perform specific actions (walking, rising, sitting, turning around, step symmetry + stride length, etc.)
  • Pros: about 20 minutes to perform and good inter-rater reliability (observers tend to generally agree), 93 percent of the fallers were identified (thus, a high specificity)
  • Cons: poor identification of non-fallers (low sensitivity), quantification to specific rating scales do not account for small differences, test re-test error is high, and they cannot identify what specifically in gait/balance impacted the fall risk.

Existing Solutions For Quantification of Fall Risk

Sensor-Based Analysis Of TUG Test

  • Used inertial sensor-equipped shoes and passed an instrumental walkway with and without gait support (so with and without a walker).
  • Walker improved their gait velocity, stride length, and swing time significantly. However, without, there was a lower walking rate for the people involved.
  • This utilized 106 participants and multiple variables.
  • Was classification based and analyzed how effective a walker was -> not effective in predicting fall risk.
  • This follows the outline of the POMA test, and if the data is inputted into the algorithm correctly, we can utilize the POMA test quantitatively rather than qualitatively.

Machine Learning Analysis Using SVM, ANN, and Random Forests

This method uses a sensor to detect the specific data required for gait based analysis (including accelerometer) and typically use a principal component analysis to extract significant information, and implement either an SVM or an ANN on the data for gait analysis.

Gait Dynamics to Optimize Fall Risk Assessment

There was another study that utilized PCA for feature extraction (like the previous one) and was able to build a fall classification model using PLS-DA (Partial Least Squares Discriminant Analysis).

What’s the solution?

The MobileMe microprocessor-based device, built by Neha Shukla
On the backend of the app, an LSTM RNN runs to analyze the data
The MobileMe device displays its data on a smartphone, and sends it to doctors

Possibilities for the future

This is a predictive model — since causation does NOT = correlation, it may not be 100 percent effective all the time. Newer technologies like causal neural networks can definitely locate the cause of such gait problems — as it becomes more widespread, a shift to modeling based on this increases the confidence interval and increase the likeliness of the fall. We will be able to trace the fall risk to more specific reasons — and personalize the treatment even more.

About the Author:

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17-year old student and innovator leveraging science and emerging technologies as a catalyst for social change. Read more at www.neha-shukla.com

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Neha Shukla

17-year old student and innovator leveraging science and emerging technologies as a catalyst for social change. Read more at www.neha-shukla.com