Introduction to the series
This edition of Journeys in Motion is intended for physicians, therapists, and caregivers responsible for caring for seniors at risk for a fall. Administrative staff responsible for driving increased engagement with patients across their relationship with the provider or health system will also find value. The series speaks to the role clinical metrics can play in driving increased engagement with patients beyond reach methods that do not incorporate clinical status.
The series examines the possibilities and the priority for continuous, longitudinal assessment of motion health in senior adults. Increased understanding of longitudinal data and patterns in the data can help healthcare professionals deliver appropriate and timely intervention, improve outcomes, and help mitigate fall risk in individuals, cohorts, and populations.
The conversations with seniors create an opportunity to explore leveraging digital, smartphone-enabled gait and motion analysis to support and elevate the personal connection between clinicians, therapists, physicians and their patients. Specific attention is dedicated to examining the realities, motivations, and emerging opportunities operating in the senior’s care ecosystem that will fuel the accelerated deployment of “tech plus touch” connectivity with patients.
A “Tech plus Touch” approach to patient care leverages digital connectivity with the patient to increase insight into the patient's status as part of the broader care plan to improve clinical outcomes. “Tech plus Touch” is also intended to convey that technology can play an important complementary role in supporting the critical direct care provided by the clinician or therapist.
This Journeys in Motion issue is made up of 3 interrelated parts related to fall risk.
- The reality of a fall requires a response. The physical consequences of the fall and the emotional burden associated with the fear of falling underscore the urgency for meaningful, routine engagement with seniors regarding their motion health.
- The motivation for independence fuels a desire for connection with therapists. The motivations, aspirations, and recently acquired competencies in digital engagement across the senior population provide the foundation for a meaningful, insight-enabled conversation with seniors and fuel both the need and the opportunity for elevated connection between therapists and their senior patients.
- The window to actionable insights capable of transforming fall risk care for seniors has been opened. Combining digital engagement with the expertise of the physical therapists and the encouragement of a caregiver can yield a tapestry of connection, or a “tech plus touch” approach, that engages seniors across their journey to radically increase the motion health of seniors, the emotional well being and confidence of seniors, and help reduce fall risk.
Part 1: The reality of a fall requires a response
According to the CDC, the estimated annual economic burden of non-fatal falls exceeds $50 Billion dollars. Each year over 800,000 are hospitalized in the U.S. as a result of a fall, with 300,000 seniors hospitalized for hip fractures. The one-year mortality rate for senior adults who suffer a fall is 21% in the U.S. and 22% worldwide. By 2030, the CDC projects 7 fall deaths each hour in the United States.
The economic burden of falls represents only the direct medical costs associated with the fall and includes fees for hospital and nursing home care, doctors, rehabilitation, community-based services, use of medical equipment, prescription drugs, and insurance processing. These costs do not reflect the burden of disability, reduced quality of life, and reliance on caregivers and family members who care for the senior adult. Moreover, as the number of Americans age 65 and older increases over the next decade, the number of fall injuries and the cost to treat these injuries could soar.
The physical consequences of a fall and the emotional burden associated with the fear of falling underscore the priority for meaningful, routine engagement with seniors regarding their motion health.
Great attention is dedicated to ensuring the seniors living environment considers and addresses conditions that can exacerbate a fall. Measures aimed at eliminating the precursor to the fall include ensuring handrails are accessible in the bathroom, floor mats affixed to the floor, and the rise between steps is addressed. This is all important work and should be part of a comprehensive plan to reduce fall risk.
Still, just as we take great effort to address the physical space of the senior adult, we must also monitor indicators of changes to the physical anatomy. A fall can result from compromised anatomical structure or a weakening of the bone in the femoral head. Deterioration in the anatomical structure that results from bone loss leading to osteopenia or osteoporosis is not an event (i.e. a fall) but is instead a process. Deterioration of anatomical structure is a leading cause of hip fracture and is particularly problematic for older females who experience 75% of hip fractures.
As with any process, quality control and quality outcomes are achieved when responsible parties are able to monitor critical indicators that reveal improvement, status quo, or decline in performance. Consistently assessing gait and motion metrics represents a “quality control process” that respects the variations in motion performance that a senior can exhibit.
On the other hand, the efforts to avoid a fall carry their own set of burdens. Seniors understand and will share, without prompting, their awareness of the immediate- and near-term consequences of a fall. Seniors understand a fall can severely limit life expectancy, lead to a reduction in freedom, and/or require a change in residence. Still, as you get deeper into the conversation with seniors, many seniors will share that the fear of falling is already limiting their freedoms, destroying their peace of mind, and impacting their relationships with those they love.
A fear of falling collides directly with a desire for connection with the most important people in our lives. When connection is compromised, isolation is the natural result. The negative cascade can continue to depression leading to reduced activity. Ultimately, the fear of a fall increases the probability of a fall.
Dr. Elham Arghami, MD, a geriatrician at UCI Health, shared, “ Fear of falling causes seniors to limit their activities, social interactions and exercise. This inactivity leads to muscle weakness, especially in the spine and hip areas, and a loss of core strength that can lead to balance issues and falls.”
Decreased social interaction and reduced activity became a greater concern during the COVID-19 pandemic. As the pandemic moved deeper into year two (2021), seniors became increasingly disconnected from family, friends, and community which fueled loneliness and reduced activity, and very likely significant declines in the musculoskeletal health of seniors.
Part 1: Key Take Aways
- Ultimately, the priority of mitigating fall risk in seniors requires care teams to address the physical space (residence), monitor the physical status of the body, and the mental health of the senior.
- Insight into gait and motion is relevant regardless of the possible reason for the fall, either the result of an event (i.e. slipping on the bathroom floor) or the result of compromised bone health. In either case, understanding the senior’s capacity for normal gait speed and balance is critical to addressing the full range of possibilities that can contribute to a fall.
- These understandings are made possible by leveraging technology to secure insight through longitudinal engagement with the senior using digital technology.