When it comes to falls, especially those that irreparably sideline people’s lives, Canadians needn’t take it lying down. Innovators across Canada are developing wearable sensors, technological devices that incorporate artificial intelligence, and re-engineered footwear to disrupt the crisis of falling.
When Dr. Alex Mihailidis spoke at the Falls Prevention Conference in June 2018 in St. John’s, NL, his audience didn’t hear a lot from him on the merits of grab-bars in bathrooms or getting rid of throw rugs. Instead, Dr. Mihailidis, scientific co-director of AGE-WELL, the pan-Canadian network that brings together a wide spectrum of stakeholders and innovators to develop technology-based solutions to support healthy aging, urged his audience to disrupt the status quo: “Our goal must be to develop disruptive technologies that can enable aging in place, safety and high quality of life.”
Falls are the most common form of injury in Canada, and not only for older adults. Children, workers, harried caregivers running up and down stairs – basically, all of us are at risk. Fall-related injuries are on the rise, putting serious pressure on the healthcare system. Last year, falls accounted for almost 1,800 emergency department visits and 416 hospital admissions each day, according to the Canadian Institute for Health Information, while a study from Simon Fraser University reveals that fall-related injuries cost the Canadian economy $2.8 billion a year.
“We’ve been trying to reduce falls, prevent falls and lessen the injury from falls for a long time – but they still continue to happen,” says Dr. Mihailidis.“So we’ve been shifting our focus to new technologies that don’t just detect a fall after it’s happened, but can help us predict and prevent them before they happen. Using artificial intelligence (AI) to predict falls, for instance, is less costly than treating an individual who has already fallen.”
AGE-WELL funds many innovations through a research project in British Columbia called PRED-FALL: Technologies to Predict, Prevent and Detect Falls. “The aim of this project is to develop and evaluate new technologies to predict, detect and prevent falls and fall-related injuries among people at high risk in both long-term care and acute care environments,” explains Dr. Mihailidis. “By using video cameras and wearable sensors, we are able to analyze real-life data to identify differences in movement patterns during falls.” The idea is to deliver early warning signs for falls, and provide real-time feedback to assist in exercise and rehabilitation. The end product may rely on sensors located in a smartphone or watch.
Dr. Mihailidis highlights work by Zain Hassan, an AGE-WELL trainee at the University of Toronto, who has been developing a computer vision system that incorporates AI to predict falls in older adults with dementia. The system analyzes walking patterns, path trajectory and wandering patterns: “We use this data to build predictive models that will ultimately help us stop people from falling and from injuring themselves – and ultimately from going to the hospital and becoming dependent on others.”
The AGE-WELL team also works on innovations that help lessen the effect of falls when they do occur. “There’s evidence that recovery from a fall is dramatically impacted the longer the individual remains on the floor or elsewhere without help,” says Dr. Mihailidis. “It’s imperative that assistance arrive quickly.” His team is currently testing an automatic, ceiling-mounted fall detection system known as the HELPER, which sends an alert to a caregiver’s smartphone.
Hip protectors to the rescue
The PRED-FALL team is developing and evaluating low-cost solutions to reduce the likelihood of an injury when a fall happens. These include compliant flooring, fall mats and padded furniture, along with wearable protective gear. The project is co-led by Dr. Stephen Robinovitch, a professor in the Department of Biomedical Physiology and Kinesiology and School of Engineering Science at Simon Fraser University. “About 25 percent of older adults who break their hips will die within the year,” says Dr. Robinovitch, who has studied the efficacy of hip protectors (to minimize severity of injury from falls) as well as wearable sensors (to predict falls caused by slips and trips). His findings? “Wearable hip protectors have been shown to reduce the risk for hip fracture by up to 80 percent.”
But the challenge has been convincing people to wear them consistently. Instead of garment-based hip protectors, which need frequent laundering, Dr. Robinovitch’s team has come up with the next generation of hip protectors: stick-on pads that can be worn for up to 21 days. The team is working with Blue Tree Medical to get the product to market.
Along with Dr. Fabio Feldman, manager of Seniors Fall and Injury Prevention at Fraser Health in British Columbia, Dr. Robinovitch is co-leading an AGE-WELL-supported trial in a BC care facility to test a new technology called compliant flooring. This shock-absorbing floor, when forcefully struck by an object, compresses and pops back up. Initial reports indicate that such flooring could make a significant difference in the frequency of hip fractures and head injuries incurred during a fall.
Dr. Robinovitch and his colleagues also study wearable sensors (including accelerometers, gyroscopes and magnetometers) during laboratory experiments incorporating falls, near-falls and activities of daily living. “We got into this area to try to understand the mechanics of falls and what leads to them. Was the individual sitting, standing or walking? Did they shift weight incorrectly or suddenly? The more we learn about the cause of a fall the better we can devise systems to prevent them from happening.”
These advances in technology aren’t exclusively for older adults, says Dr. Mihailidis. “A lot of these innovations can help younger people who are recovering from traumatic brain injury or orthopedic knee replacements, for example.”
It’s ironic that a lot of research to help Canadians navigate safely above ground actually takes place below ground in the Challenging Environment Assessment Lab (CEAL) at the Toronto Rehabilitation Institute. Located four storeys below ground, the CEAL lab is one of a network of 13 labs that are part of the iDAPT Centre (Intelligent Design for Adaptation, Participation and Technology). The Centre also features the RBC iDAPT Innovations Gallery, a dynamic and fully interactive learning centre with an array of multimedia displays that profile and promote its research.
Dr. Geoff Fernie, senior scientist at Toronto Rehab–University Health Network, is one of the innovators who oversee the development and testing of new technologies, often using the lab’s hydraulic motion simulator, which mimics everyday environmental challenges – be it ice and snow, challenging terrains and slopes, or rain and headlight glare.
Dr. Fernie, who has been researching various aspects of mobility since the 1970s, says, “We’ve been trying to prevent falls by changing people’s behaviour, namely the way they move. That, it turns out, is not an effective way to prevent injurious falls that sideline people’s lives. The most effective solution is to change the environment, whether it’s better designed stairs, better flooring or safer footwear.”
In 2016, Dr. Fernie and his colleagues at iDAPT tested 98 models of winter footwear in the Winter Lab, where they were able to simulate snow, wind, ice and slippery inclines. “We found that 90 percent of the boots available to Canadians were junk,” says Dr. Fernie. “They had no grip and didn’t keep people upright. You put snow tires on your car in the winter. Surely you should worry about the boots you’re going to wear in the same weather.”
The tests’ results, in which boots were assigned a grade of one to three “snowflakes,” were widely published (www.ratemytreads.com), and ultimately prompted manufacturers to improve the quality of their footwear. “A year later we tested 202 pairs of boots, and this time we found that 20 percent of the season’s footwear made the grade.”
The purpose of all these technological innovations, says Dr.Mihailidis, supports the concept of aging in place. “And it’s about more than safety bars in bathrooms. It’s about keeping people of all ages from falling, keeping them where they should be and want to be: In their homes and in their communities.”
By the Numbers
653,808: Emergency Department (ED) visits reported for injury after falls in Canada, accounting for 32 percent of all reported ED visits for injury and trauma
114,383: ED visits due to falls in the home, making the home the most common place for a fall
170,000: ED visits due to slipping, tripping and stumbling
152,504: Overnight hospitalizations due to falls
14.3: Average number of days in hospital for a fall, compared to 7.5 days for all hospital stays
32,000: Number of hospital stays due to hip fracture, the most common injury from falling, followed by fracture of the lower leg and ankle (16,135) and head injuries (13,997)
(Source: Canadian Institute for Health Information)
A tough pill to swallow
“Falls are preventable,” says Professor Maureen Markle-Reid of the McMaster University School of Nursing and a director with the Aging, Community and Health Research Unit at McMaster University in Hamilton, ON. “We advise Canadians – of any age – to follow three basic rules: Build your strength, improve your balance and take stock of your pills.” Medication, according to Professor Markle-Reid, can affect balance and lead to falls. “Certain sedatives increase the risk of falls. Multiple prescription medications taken at once can leave a person unsteady on their feet. Tracking your meds is a no-brainer.” And, as they say, there’s an app for that – several, in fact. MyMedRec, for example, helps individuals track their medicines and health issues, and even sends reminders.
Reach for it: Studies determine optimal handrail height
When Vicki Komisar, a post-doctoral fellow with the Injury Prevention and Mobility Laboratory at Simon Fraser University, examined optimal height and structural strength of handrails in the community, she discovered an interesting (and easy) fix. “Our research indicates that the higher the handrail, the better the chances of an individual’s recovering from a near-fall or slip,” says Komisar, who has also studied biomedical engineering at the University of Toronto and Toronto Rehab–UHN. “In our studies, we’ve found that raising the height of the handrail to 38 inches greatly decreased the likelihood of injury, and increasing the height of a handrail to 42 inches dramatically improved the individual’s chance of recovery from a slip or moment of imbalance.” Komisar hopes ongoing studies into handrail heights will influence design standards and building codes across Canada so that stairwells are ultimately safer for everyone.