Fall Risk: Early Warning Light + Intervention

Tools for Independent Living: Explorations

This is the second in our series of deep-dive explorations of topics relating to “Tools for Independent Living”.

In this exploration we are exploring the idea of being able (at home) to Measure & Improve your Fall Risk — and get an early warning when it is time to “take action”. See below for an explanation.

Our hypothesis is that for many of us, we would “like” some sort of early warning or check engine light concept, that helps us know whether our fall risk is changing, and whether it is starting to show signs of problems in our future. And ideally this would be accompanied by some type of targeted intervention that we could do, and then observe the fall risk metric move back into the green zone.

NOTE: This is very different to the typical content on the Internet about falls, which usually boils down to (a) visit the physical therapist if you want to know your risk for falling and (b) take up one of several specific exercise programs (eg Tai Chi) if you want to improve balance and reduce fall risk.

While there is nothing wrong with the advice above, we notice that many older adults ignore it while they are physically robust, only starting to think about it after they have a fall or exhibit some other sign of frailty.

In that way, it’s a bit like the typical medical advice of “eat better and exercise more”. Everyone has heard it but many don’t act.

This exploration is the first of a series about our search for a good “Fall Risk Early Warning Light” and an accompanying Intervention Program.

What We Want: Fall Risk Early Warning

Richard Caro described this idea a few years ago (here), in an article about “Gerontech Products we Wish Existed”.

The core concept has two parts:

1. there is some type of ongoing monitoring you can do that gives you a “score”, that relates in some way to “risk” of the thing you are monitoring (in this case fall risk for example); and

2. there is some type of ongoing intervention you can do that can impact your score, so you can be proactive about maintaining “wellness”.

Over the last few years we have seen a handful of product concepts that seem relevant to this idea, although we are still waiting for the “perfect product”. This year we started to think it might be possible to create a sort of Do-it-Yourself (“DIY”) version of the Fall Risk Early Warning Concept by combining some existing products.

Whether or not that is possible is what we will be exploring in this series of posts over the next few months.

Here is the idea (reprinted from our earlier article).

Gait or Balance Monitor + Predictive Score + Intervention

It's a truism to talk of falls being a big problem for people as they age. And there are many, many initiatives designed to address the "problem of falls". (See our "Topic Hub": Avoid the Perils of Falling for an overview of the issues and current solutions).

There are various "alerts" that "call for help" after you have fallen. And lots of fall risk reduction interventions (like exercise classes) designed to help reduce fall risk. And we think these are all useful and important.

BUT, alerting after you fall is less good than avoiding the fall in the first place. And balance exercises are only good if people do them — and human nature being what it is, they tend not to do things that are "good for them" (like eating broccoli) unless there is something that triggers them to focus on the issue.

We think a very powerful approach would combine several pieces that would together monitor fall risk over time, and offer appropriate interventions as needed.

The ideal time for using this would be long before a person becomes at high risk for a fall. Think of it as a prophylactic.

Piece 1: Fall Risk Score

The first thing we want is a way to measure fall risk.

It does not need to be perfect, or absolute, although those would be good attributes. But it needs to measure and track a proxy for fall risk over time. And tell you something about where you stand compared to some metric of "goodness or badness".

And when we say "fall risk" it can be some type of proxy for that, such as a metric derived from gait, or from balance.

And here are some critical features.

• The fall risk score needs to be given to you, as the older adult (ie you are in charge, not "the system") — with educational tools so you know what it means.

• And ideally this would all happen at home, and not require a trip to see some type of healthcare person.

• And it would be up to the older adult to decide who was allowed to see the risk score, and what they would do about it.

• And it would track changes over time. Because often it would be changes over time that would trigger a desire to "do something" rather than an absolute number.

• And the risk score would need some peer-reviewed validation.

• In an actual product, maybe "fall risk" is the wrong terminology, and we would choose a more aspirational and positive term.

While clinicians have metrics of fall risk today, to our knowledge none of them has yet been turned into a service that meets all the criteria above and is widely commercially available. But we think they could be, relatively easily.

Also, the clinical fall risk metrics (e.g. Timed Up and Go, Chair Stand Test, Four Stage Balance Test (see here for details)) are designed as sort of “threshold” indicators that a person is moving into the medium or high fall risk zone. In this respect they are a bit like the clinical measures of cognition we looked at in our series on cognition early warning indicators.

These clinical metrics are less useful for someone who is “healthy”, but wants to get an early warning that trends are deteriorating, even if not yet close to the clinical “high risk” zone.

Piece 2: Intervention

There needs to be something you can do to improve your "fall risk" score, once you start to get worried about it.

The good news is that physiotherapists have some defined approaches to exercises for reducing fall risk, and so these interventions already exist. What is missing is connecting the fall risk score, with the features above, to the intervention. 

We think there needs to be some out-of-the-box thinking that connects the fall risk to some defined coaching and or exercise services. This should go beyond "see your physiotherapist", or “take up Tai Chi”.

There are good examples in the emerging digital health space of this type of coupling of monitoring and intervention (look for examples in the areas of diabetes management and weight loss).

This Exploration: Next Steps

We are exploring the extent to which the product concept above either already exists or can be assembled from various existing products that do some of the above.

Over the next few months we will be sharing what we learned.

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Please Share Your Opinions and Ideas

Some of you may well have opinions on this topic. We welcome your comments and suggestions in the comments (button below).

We are especially interested if you know of a product or service that does some or all of what we describe above. We would like to learn more about it, especially if you have personal experience with it.

To short circuit some of the likely comments:

• we will definitely be including the opinions of experts (such as physiotherapists and geriatricians) in our exploration. If you are such a person and would like to help, please send us an email (or reply to this email);

• please don’t post comments that are infomercials or affiliate links or other marketing material. They will be blocked.

• If possible, please use the comments rather than sending us an email, so others can benefit from your opinions too.

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