Author: Eng. Alessandro Vagnini and Eng. Luca Minesso
Introduction to the clinical problem
Every year 684,000 people die from the consequences of falls worldwide, representing the second leading cause of involuntary death in the world. These numbers are destined to dramatically worsen in the coming years due to the increase in life expectancy and the consequent aging of the population; just think that in 2019, the number of people over the age of 70, the age in which the greatest risk of falling occurs, was 1 billion. This number will increase to 2.1 billion by 2050 [1].
Aging, in fact, is characterized by a progressive loss of motor skills due to the deterioration of the musculoskeletal functions that cause the loss of fluidity of movement [2], [3]. After the age of 70 in particular, there is a significant decrease in the reaction time for maintaining balance, resulting in poor independence and a significant lowering of the quality of life.
Therefore, in the coming years, medicine will have to face a new important challenge: drastically reducing the risk of falling in people over 70 and the possible adverse events related to it (such as fractures and loss of autonomy). In this context, the objective assessment of the risk that a person could fall is fundamental. In fact, it is possible to define adequate rehabilitation programs, therapeutic programs and preventive measures aimed at reducing the risk itself, such as adapting the home environment or adequately informing and training caregivers.
Importance of evaluation in clinical problems
How can we assess the risk of falling? It is certainly not a simple issue as it is a complex event, determined by a plurality of factors [2]:
– Previous falls
– Visual impairment
– Medicines
– Cognitive impairment
– Engines
In this context, motor risk factors (related to walking and balance) demonstrate a very good ability to predict future falls compared to other factors, suggesting that the assessment of gait and balance should remain a pillar of screening [4]. National and international guidelines suggest to evaluate the risk of falling through two main methods ad clinical scales and clinical tests.
Importance of objective technological assessment
In recent years, the development of easy-to-use wearable technologies have allowed the instrumental objectification of clinical tests [5] [6] as the Timed up and Go test which reproduces activities normally carried out in daily life. It measures the total time it takes a subject to get up from a chair, walk 10 feet, rotate 180 degrees, and return to the starting position [7].
The quantitative assessment provided by the TUG allows both to estimate the degree of motor independence of a subject and to quantify the risk thanks to the objective evaluation of the time taken to perform these gestures.
Conclusion
Due to the aging of the population, this situation is going to get worse. For this reason, an easy and reliable tool to objectively assess people’s mobility is essential. By periodically monitoring the risk of falls in an accurate manner, it is possible to intervene preventively by implementing the necessary measures to reduce falls.
References
[1] W. H. Organization, «Falls,» 26 April 2021. [Online]. [2] Ganz, David A., et al. Will my patient fall?. Jama, 2007, 297.1: 77-86. [3] TALBOT, Laura A., et al. Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury. BMC public health, 2005, 5.1: 1-9. [4] VERGHESE, Joe, et al. Quantitative gait markers and incident fall risk in older adults. The Journals of Gerontology: Series A, 2009, 64.8: 896-901. [5] KLEINER, Ana Francisca Rozin, et al. Timed up and go evaluation with wearable devices: validation in Parkinson’s disease. Journal of bodywork and movement therapies, 2018, 22.2: 390-395. [6] DIBILIO, Valeria, et al. Dopaminergic and non-dopaminergic gait components assessed by instrumented timed up and go test in Parkinson’s disease. Journal of Neural Transmission, 2017, 124.12: 1539-1546. [7] NORDIN, Ellinor, et al. Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff’s global judgement and fall history in evaluating fall risk in residential care facilities. Age and ageing, 2008, 37.4: 442-448.