CHAPTER 2. STATE OF THE ART-LITERATURE REVIEW
2.2 B ACKGROUND OF THE RESEARCH
2.2.2 Fall Interventions
Figure 2. 2. Summary of fall risk factor
improving flexibility, leg strength, and balance [24, 27, 51, 26]. So, keeping active the lower body muscle, especially with physical activities, exercise, etc. With the help of technological assistance, the elderly can get immediate attention if they fall. Canes and walkers are used for centuries without high- cost or negative side effects with excellent clinical results [27]. However, the use of low-technology devices (canes, walkers) is a debatable issue. The literature suggested that mobility aids have been identified as a risk for falls or related to fall-related injury [43]. Other interventions that can be used to reduce fall or after fall effect, such as, use of sole sensor insole, hip protectors, vibrating insoles to facilitate plantar cutaneous sensation (a phenomenon of stochastic resonance), vinyl railing, vitamin D supplement, dietary amendments and supplementation, Yaktrax walker (specific shoe), technology interventions such as: speedy (a wrist- wearable watch-like fall detector), home monitoring system based on ZigBee wireless sensors, fall detection, airbag based fall-detection systems etc. [24, 52, 27, 53, 54, 55, 56, 57, 58]. Figure 2. 3. Summary of fall intervention, as represented below.
Figure 2. 3. Summary of fall intervention
To minimize the fall and related injuries in the elderly is to minimize the environmental hazards, with the help of addressing architectural modifications. Environment support can reduce these difficulties [59].
Some of the guidelines that can minimize falls through environmental modifications from the studies carried out in the western country are described below.
A study [60], mentioned the two vertical bars configuration in bathroom/
toilet-related that is considered as the most effective toilet grab-bar configuration for preventing fall, the height of it must consider the shortest adult can reach, and tallest is to be avoided head knocking [61]. A study suggested [42] in the kitchen area and cupboards, lower cabinets should have enough space to move the legs or wheelchair when necessary, and drawers should add safety lockers. Such precautions can minimize falls in the elderly. In furniture and cabinets, the elderly should avoid or change rickety chairs and stools to prevent falls [42]. It is also essential that the elderly should give attention while stepping on chairs or stools, leaning on tables or chairs, or any appliances that might be a risk during a stand-up.
For Lighting, switches should be placed so that it is easily accessible by the elderly. Tre must have proper lighting for the elderly to minimize injuries and most-fall issues due to lesser eyesight in the elderly [42].
Apart from environmental modification, exercise interventions help the elderly to prevent falls. The exercise intervention, such as muscle strengthening and balance retraining programs, can improve flexibility, leg strength, and balance for fall prevention as well as has motivational outcome [26, 27, 34, 62]. The balance Training (BT) method improves healthy older adults’ balance performance [63]. It is seen that stepping exercises have a significant impact on balance improvement [33]. The implication of self-paced exercises for exercise prescription can help, especially among sedentary adults, overweight people, who are most in need of effective interventions to improve adherence to exercise programs [64]. Although the elderly are aware of the positive impact of exercises, the elderly avoid doing exercises at recommended levels due to the negative aging stereotypes (negative self-views such as physical self-worth) [30, 28, 65, 66]. In the exercise domain, there is a need for further refinement of traditional balance training and balance assessment techniques to prevent elderly falls [67].
Technological interventions, such as fall detection system, or monitoring systems, can reduce post-fall problems encountered by older adults. It can differentiate an elderly’s active daily life activities with falls accurately and can contact an ambulance or send a message or trigger alarm when necessary. Fall detection technology may include sensors, cameras mounted on wearables in a particular location with a tiny computer to sense, process, and storage and communicate the input and output data. It can be roughly categorized into three techniques, wearable sensor-based, vision or video-based detection, and detection through a mixed approach. The pictorial representation of the operational units related to the methods of obtaining and processing the situational data from cameras or sensors is
shown in Figure 2. 4. For example, if a camera or wearable sensors detect elderly falls, data can be processed using a segmentation algorithm to recognize all the features captured in the real-time accidental scene;
simultaneously, it may transmit the information for confirmatory testing.
The results- along with the appropriate response (like an alert for immediate help required or elderly fall is detected), a signal can be generated for communication to the hospital in real-time that can potentially save a life or communicate to the user’s family and friends or for remote health monitoring.
Fall detection or monitoring system are based on various sampling techniques to detect older adults’ falls and differentiate them from the activities of their daily life. The detection process can be classified through signal sampling techniques, which includes Video Technology (using the camera), Wearable Sensor Technology (gyroscope, accelerometer, etc.), Environmental Sensor Technology (pressure sensor, Doppler radar sensor, etc.), Mixed Approach (a combination of any or all of the techniques) [68, 55, 69, 70, 71, 72, 73, 74].
Figure 2. 4. A Pictorial summary of processing data using sensors/ cameras
Video-based fall detection technique has a limited detection range with a weak script, and there is a risk of disclosing the elderly’s privacy. In the wearable fall detection methods, sensors are mounted on clothes, glasses, hats, shoes, etc. In the Environmental based fall detection method, sensors are mounted on locations like ceiling, ground, and floor. This method can overcome the privacy problem but has little accuracy. In a mixed approach, two or more techniques and multi-sensors are used to detect the fall. It is found that the wearable sensor-based fall detection system is more suitable as there will be no limitations of the detection location [68]. Different studies have been done based on the environmental sensor, wearable
technology, video fed technology, and mixed approach method, e.g., accelerometer, Arduino board, sensors, etc. The studies showed multiple different classifiers based on fall detection via an accelerometer [55, 71, 18]. In the case of remote health monitoring, the diagnostic system can be implemented on a wearable Shimmer device, and if a fall occurred, the base station receiver triggers an alarm with a source like a hospital or a designated carer and can get a response or required medical aid. The technological interventions are mostly post-fall interventions, apart from a few that promote exercise like exergaming. Exergaming is a technology that is based on developing exercises using gaming. Younger generations widely use it; in the recent decade, the elderly have also shown interest in them. A more in-depth study is needed in Exergaming technology as an elderly fall intervention, since the existing exergame like DDR, Wii, etc., are not explicitly designed for the elderly [75, 76]. In the Indian context, elderly and exergaming related researches are not found (as per our knowledge), so further investigation is required.
Few of the previous studies are showcased in the next section and showed in Table 2. 1. The table discusses interventions like technology, behavioral, exercise, etc., for fall detection classifiers, exercises like yoga and group assessment are concisely showcased.
Table 2. 1. Summary of selected literature on Fall Intervention