Fall risk assessment in the wild: A critical examination of wearable sensor use in free-living conditions

Mina Nouredanesh*, Alan Godfrey, Jennifer Howcroft, Edward Lemaire, James Tung

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)
1 Downloads (Pure)

Abstract

Background
Despite advances in laboratory-based supervised fall risk assessment methods (FRAs), falls still remain a major public health problem. This can be due to the alteration of behavior in laboratory due to the awareness of being observed (i.e., Hawthorne effect), the multifactorial complex etiology of falls, and our limited understanding of human behaviour in natural environments, or in the’ wild’. To address these imitations, a growing body of literature has focused on free-living wearable-sensor-based FRAs. The objective of this narrative literature review is to discuss papers investigating natural data collected by wearable sensors for a duration of at least 24 h to identify fall-prone older adults.

Methods
Databases (Scopus, PubMed and Google Scholar) were searched for studies based on a rigorous search strategy.

Results
Twenty-four journal papers were selected, in which inertial sensors were the only wearable system employed for FRA in the wild. Gait was the most-investigated activity; but sitting, standing, lying, transitions and gait events, such as turns and missteps, were also explored. A multitude of free-living fall predictors (FLFPs), e.g., the quantity of daily steps, were extracted from activity bouts and events. FLFPs were further categorized into discrete domains (e.g., pace, complexity) defined by conceptual or data-driven models. Heterogeneity was found within the reviewed studies, which includes variance in: terminology (e.g., quantity vs macro), hyperparameters to define/estimate FLFPs, models and domains, and data processing approaches (e.g., the cut-off thresholds to define an ambulatory bout). These inconsistencies led to different results for similar FLFPs, limiting the ability to interpret and compare the evidence.

Conclusion
Free-living FRA is a promising avenue for fall prevention. Achieving a harmonized model is necessary to systematically address the inconsistencies in the field and identify FLFPs with the highest predictive values for falls to eventually address intervention programs and fall prevention.
Original languageEnglish
Pages (from-to)178-190
Number of pages13
JournalGait and Posture
Volume85
Early online date28 May 2020
DOIs
Publication statusPublished - 1 Mar 2021

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