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

A study on the falls factors among the older adult with cognitive impairment based on large-sample data

Introduction

This study explored the correlative factors of falls among the older adult with cognitive impairment, to provide distinct evidence for preventing falls in the older adult with cognitive impairment compared with the general older adult population.

Methods

This study was based on a cross-sectional survey, with an older adult population of 124,124 was included. The data was sourced from the Elderly Care Unified Needs Assessment for Long-Term Care Insurance in Shanghai. Binary and multivariable logistic regression analyses were conducted sequentially on the correlative factors of falls. Multivariable logistic regression was performed on variables that were significant, stratified by cognitive function levels.

Results

The incidence of fall in the past 90 days was 17.67% in this study. Specific variables such as gender (male), advanced age (≥80), residence with a elevator (or lift), mild or moderate disability, quality of sleep (acceptable/poor) were negatively correlated with falls, while higher education level, living alone, residence with indoor steps, unclean and untidy living environment, MCI or dementia, chronic diseases, restricted joints, impaired vision, and the use of diaper were positively correlative factors of falls. Comparing with older adult with normal cognitive functions, older adult with dementia faced a higher risk of falling due to accessibility barrier in the residence. For general older adults, less frequency of going outside and poor social interactions were positively correlated with falls, while for older adult with cognitive impairments, going outside moderately (sometimes) was found positively correlated with falls. Older adults with cognitive impairments have increased fall risks associated with chronic diseases, restricted joints, and the use of diaper. The risk of falling escalated with the greater number of chronic diseases.

Discussion

For older adult with cognitive impairments, it is advisable to live with others. Additionally, creating an accessible living environment and maintaining the cleanness and tidiness can effectively reduce the risk of falls, particularly for those with MCI or dementia. Optimal outdoor activity plans should be developed separately based on the cognitive function of older adults. Older adult with dementia who have comorbidities should be paid special attention in fall prevention compared to the general older adult population.

Gerontechnology for better elderly care and life quality: a systematic literature review

Gerontechnology as multidisciplinary research has expanded in recent years due to its significant role in ensuring better care and improved quality of life for older adults and their caregivers. With a substantial increase in studies on reasons behind less inclination of older individuals to accept gerontechnology, barriers to its non-acceptance appear to be persistent. In addition, there is a dearth of research on the adoption of gerontechnology from the perspectives of social caregivers, given that caregivers bear a substantial burden in the form of chronic stress, which adversely affects their health and that of older people. Therefore, the aim of this study is to present a holistic perspective of older adults and their caregivers by systematically reviewing literature on gerontechnology acceptance. Adopting the preferred reported items for systematic and meta-analysis (PRISMA) framework, publications specifically on gerontechnology from 2002 to 2022 in Scopus, Web of Science and PubMed, that focused on older people (50 years and above) and caregivers (informal and formal) were reviewed. We critically evaluated 25 publications and synthesised them thematically. The results highlight that gerontechnology acceptance by older adults and their social caregivers is highly contingent on certain personal, physical, socio-cultural and technological indicators. However, this paper concludes that a generalised policy approach for gerontechnology and a better quality of life may be ineffective, considering that older adults and social caregivers constitute two heterogeneous groups.

Colombian Stakeholder Perceptions and Recommendations Regarding Fall Detection Systems for Older Adults

This study aimed to analyze perceptions and recommendations from stakeholders on the effectiveness of fall detection systems for older adults, aside from any additional technological solutions they may use within their activities of daily living (ADLs). This study performed a mixed-method approach to explore the views and recommendations of stakeholders concerning the implementation of wearable fall detection systems. Semi-structured online interviews and surveys were conducted on 25 Colombian adults classified into four stakeholder groups: older adults, informal caregivers, healthcare professionals, and researchers. A total of 25 individuals were interviewed or surveyed, comprising 12 females (48%) and 13 males (52%). The four groups cited the importance of wearable fall detection systems in ADLs monitoring of older adults. They did not consider them stigmatizing nor discriminatory but some raised potential privacy issues. The groups also communicated that the apparatus could be small, lightweight, and easy to handle with a help message sent to a relative or caregiver. All stakeholders interviewed perceived assistive technology as potentially useful for opportune healthcare, as well as for promoting independent living for the end user and their family members. For this reason, this study assessed the perceptions and recommendations received concerning fall detectors depending on the needs of stakeholders and the settings in which they are used.

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.

Association Between Fatigue and Falls Risk Among the Elderly Aged Over 75 Years in China: The Chain Mediating Role of Falls Efficacy and Lower Limb Function

Background

Although fatigue has been shown to be strongly associated with falls risk, very few studies have focused on its mechanism involved in community-dwelling older subjects. The purpose of this study was to explore the relationship between fatigue and falls risk and its internal mechanism by constructing a chain mediation model.

Methods

A cross-sectional study design was adopted. A convenience sample of 270 older adults was recruited from July to October 2021 in an urban community, in Beijing, China. The participants completed the 14-item Fatigue Scale (FS-14), Falls Efficacy Scale International (FES-I), the Short Physical Performance Battery (SPPB) and Fall-Risk Self-Assessment Questionnaire (FRQ) to measure fatigue, falls efficacy, lower limb function and falls risk. The theory of unpleasant symptoms was used as a conceptual framework. Structural equation modeling (SEM) was utilized to test the hypothetical model.

Results

The overall fit of final model was found to be satisfactory: χ2/df = 1.61, CFI = 0.971, TLI = 0.962, RMSEA = 0.049 (95% CI 0.030/0.066) and SRMR = 0.023. Fatigue had a direct effect on falls risk (β = 0.559, S.E. = 0.089, 95% CI 0.380/0.731), and it also had indirect effects on falls risk (β = 0.303, S.E. = 0.072, 95% CI 0.173/0.460) through mediating factors. Falls efficacy and lower limb function were the main mediating variables, and there was a chain mediating effect (β = 0.015, S.E. = 0.010, 95% CI 0.003/0.046).

Conclusions

Our study suggests that fatigue can influence falls risk among the elderly in China. There are many mediating paths between fatigue and falls risk. These results may help healthcare professionals to better understand the inherent relationship between fatigue and fall risk that may benefit older adults.