Feasibility study by a single-blind randomized controlled trial of self-management of mobility with a gait-speed feedback device by older persons at risk for falling

Abstract

This single-blind randomized pilot study explored feasibility and safety of a self-management fall prevention program, hypothesizing that older persons can comply with this program, while it does not result in more (injurious) falls, or a decrease in mental wellbeing as an adverse effect of being focused on falls prevention. Eighty-six persons, community-dwelling or home for the aged (mean age 80.3 years [SD: 6.3], 56 women (65.1%)) participated. The intervention group measured their gait speed by using the Mobility Feedback Device (MFD) weekly for 6 months. The control group was monitored for the outcomes without an intervention. Change scores involving health perception and mental wellbeing (Medical Outcomes Study 20-item short form (MOS-20)) were compared between groups. Feasibility was assessed by drop-out rate and compliance to measure gait speed. Safety was assessed by fall incidence during follow-up. MOS-20 decreased significantly in the control group (p = 0.024) but remained stable in the intervention group. Drop-out rate was low (9.3%), and compliance was good. Fall incidence was the same for both groups (p = 0.155). The self-management fall prevention program is feasible and safe in a community-dwelling and home for the aged population, making it worthwhile to further explore selfmanagement fall-prevention studies.

The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials

“…Having a mean age ≥65 years as an inclusion criterion for our search, there were still large differences in the inclusion criteria at the study level: ≥18 years in three studies [ 13 , 14 , 24 ], 45-90 years in one study [ 17 ], 55-79 years in one study [ 49 ], ≥60 years in one study [ 11 ], and ≥65 years in six studies [ 7 , 23 , 50 - 53 ]. The other seven trials did not have age as an inclusion criterion but targeted conditions present specifically in older adults, such as cardiovascular conditions, dementia, or being a senior housing resident [ 6 , 8 , 12 , 22 , 27 , 48 , 54 ].…”

“…The mean ages of study populations ranged from 68.9 years to 87.8 years. Only one study assessed frailty at baseline based on the Fried Frailty Score [ 53 ]. Frailty could be estimated retrospectively for six other studies [ 7 , 14 , 22 , 23 , 50 , 54 ].…”

“… a Categorized according to a method proposed by Brefka et al [ 41 ], except for Schoon et al [ 53 ]. b ADL: activities of daily living.…”

“…The 19 selected trials evaluated devices representing the following six domains: (1) mobility (n=5 [ 6 , 7 , 14 , 52 , 53 ]), (2) personal disease management (n=5 [ 13 , 22 , 48 , 51 , 54 ]), (3) medication (n=4 [ 12 , 17 , 27 , 50 ]), (4) mental support (n=2 [ 8 , 11 ]), (5) hearing (n=2 [ 23 , 49 ]), and (6) vision (n=1 [ 24 ]). All devices addressed at least one of the areas of autonomy, safety, or communication.…”

“…Significant effectiveness was only reported in a pilot study for a nightlight path, which reduced falls among older people classified as slightly impaired/prefrail who had mild and moderate Alzheimer disease (odds ratio 0.73, 95% CI 0.15-0.88) [ 7 ]. Home automatization for people with dementia living in group homes [ 6 ], a mobile safety alarm with a drop sensor for community-dwelling older persons [ 52 ], and a gait-speed monitoring and feedback device for older people at risk for falling [ 53 ] were not effective. In a crossover study on the use of a metronome to improve QoL in individuals classified as slightly impaired/prefrail who were suffering from Parkinson disease, no evidence of effectiveness could be shown.…”