Rapid technological advances have prompted the development of a wide range of telemonitoring systems to enable the prevention, early diagnosis and management, of chronic conditions. Remote monitoring can reduce the amount of recurring admissions to hospital, facilitate more efficient clinical visits with objective results, and may reduce the length of a hospital stay for individuals who are living at home. Telemonitoring can also be applied on a long-term basis to elderly persons to detect gradual deterioration in their health status, which may imply a reduction in their ability to live independently. Mobility is a good indicator of health status and thus by monitoring mobility, clinicians may assess the health status of elderly persons. This article reviews the architecture of health smart home, wearable, and combination systems for the remote monitoring of the mobility of elderly persons as a mechanism of assessing the health status of elderly persons while in their own living environment.

A 21-year-old female reports an 18-month history of light-headedness on standing. This is often associated with palpitations and a feeling of intense anxiety. She has had two black-outs in the past 12 months. She is not taking any regular medications. Her supine blood pressure was 126/84 mmHg with a heart rate of 76 bpm, and her upright blood pressure was 122/80 mmHg with a heart rate of 114 bpm. A full system examination was otherwise normal. She had a 12-lead electrocardiogram performed which was unremarkable. She was referred for head-up tilt testing. She was symptomatic during the test and lost consciousness at 16 min. Figure 1 summarizes her blood pressure and heart rate response to tilting. A diagnosis of postural orthostatic tachycardia syndrome with overlapping vasovagal syncope was made.

Background: beat-to-beat technology is increasingly used for investigating orthostatic intolerance (OI) but the prevalence of orthostatic hypotension (OH) diagnosed with this technology is unclear. Objectives: (i) to use beat-to-beat technology to define the prevalence of OH, (ii) to investigate the pathological correlates of OH, (iii) to report the diversity of postural BP responses. Methods: cross-sectional study of adults ≥ 65 years. BP responses to a 3-min head-up tilt were analysed. Results: of 326 participants, 203(62.3%) were females. The median (IQR) age was 73 (70-78). One hundred and ninety-one (58.6%) met standard (20 mmHg systolic/10 mmHg diastolic) criteria for OH. The prevalence was higher in females (60.1% F versus 56.1% M); 47% were arteriolar subtype, 33% were venular, 9% were mixed and 11.0% could not be classified. Morphological analysis identified 102 subjects with 'small drop, overshoot', 131 with 'medium drop, slow recovery' and 31 with 'large drop, nonrecovery'. Those with OH had a lower BMI (P = 0.02), a higher resting heart rate (P = 0.005), were more likely to take a psychotropic (P = 0.02), have vertigo (P = 0.004) and report OI (P = 0.02). The 95th centile for the duration of systolic BP (SYSBP) decay >20 mmHg was 175 s and the slope of systolic BP decay was 4.75 mmHg/s. The 5th centile for percentage recovery of SYSBP was 81.4%. Conclusion: (i) beat-to-beat methods identify a higher prevalence of OH than sphygmomanometry, (ii) the pathological correlates of OH diagnosed in this manner are similar to those described for sphygmomanometry, (iii) there is a diverse pattern of orthostatic BP decay that could be used in future research to predict adverse outcomes in OH.

We have demonstrated that sit-stand testing for OH has very low diagnostic accuracy. We recommend that the more time-consuming reference standard method of diagnosis be used if the condition is suspected.

This is a practical classification tool and when validated physiologically, this system could be useful in directing treatment of OH.

We have confirmed, in a single population, a changing pattern in the aetiology of syncope as a person ages. The burden of disease is greatest in the elderly.

Compared to international data care at our unit appears to be associated with a lower rate of recurrent stroke and mortality but a higher institutionalisation rate after 4 years. The reasons for this are unclear.

The objective of this work was to evaluate the accuracy and viability of a mobility telemonitoring system, based on the short message service (SMS), to monitor the functional mobility of elderly subjects in an unsupervised environment. A clinical trial was conducted consisting of 6 elderly subjects; 3 male, 3 female (mean: 81.7, SD: 5.09). Mobility was monitored using an accelerometer based portable unit worn by each monitored subject for eleven hours. Every 15 minutes the mobility of the subject was summarized and transmitted as an SMS message from the portable unit to a remote server for long term analysis. The activPAL Trio Professional physical activity logger was simultaneously used for comparison with the portable unit. On conclusion of the trial each subject completed a questionnaire detailing their satisfaction with the portable unit and any recommendations for improvements. Overall a percentage difference of 2.31% was found between the activPAL Trio and the portable unit for the detection of sitting. For the combined postures of standing and walking the percentage difference was calculated as 2.9%. A bivariate correlation and regression analysis was performed on the entire data set of one subject. Strong positive correlation's were found for the detection of sitting (r = 0.996) and for the combined postures of standing and walking (r = 0.994). Subjects suggested that a lighter, smaller and wireless unit would be more effective.