Shakira wrote that “hips don’t lie” and unfortunately seniors’ sore, stiff hips often shout the truth about the natural digression of fitness and mobility that comes with aging. 

However, recent research on a “hip-assist” robotic device, which goes around a users’ waist, could help users improve stride and balance to regain a healthy fitness level. 

Mobility issues can affect a senior’s quality of life in and of themselves, but also lead to dangerous secondary effects such increasing the risk of falling.

Although many recent wearable robotic tools aimed at seniors are meant to deal with specific conditions such as Parkinson’s disease, the hip-assist robot appears to be more broadly for seniors with even mild mobility concerns.

“Aging is closely related to the loss of muscle mass, and a significant reduction occurs, especially in the lower limbs, which can lead to physical dysfunction,” the study authors wrote. “Technological development of [daily assistance robots] has been actively conducted as a concept of health management and assistance in daily life.”

The wearable robotic device, developed by scientists in Korea along with Samsung Electronics, fits around a user’s waist and, depending on the exercise, can employ both resistance and assistance to help users. The robot also is programmed for specific tailored workouts, study authors noted.

Over the course of a four-week exercise program, senior study participants were able to shed body fat, increase their stride length by 12% and “significantly” improve pelvic movement, the study showed.

Although the short timeline of the program was not enough to significantly build muscle strength, users still made noticeable gait and balance improvements, the researchers noted.

Samsung has not clarified when the EX1 robot will be commercially available, but previous reports indicate that they were hoping to have released the robot in 2023. Although that window has passed, presumably the study provides a meaningful checkpoint for validating its use. 

Another recent tool that addresses seniors’ balance is a smartphone app that monitors body sway and also includes fitness recommendations, McKnight’s reported Wednesday.

In senior care and living settings, a lot of fall prevention data and technology is controlled by caregivers or curated by software systems. 

However, at least one new intervention tries to empower seniors more directly with the ability to forestall a falling emergency. 

A new smartphone app helps seniors control their balance by monitoring a users’ body sway while they are standing still. The app, which also includes fall prevention exercises, is intended to help seniors adjust body coordination to prevent falls from occurring, the researchers said.

One out of four seniors in the US are likely to fall at some point each year, the researchers note. Even as new tech aims to reduce falls or subsequent fatalities, the number of self-reported fall incidents in healthcare facilities has risen in recent years, and was up 27% in 2022, according to McKnight’s Clinical Daily.

Data used to build the app was collected at the Motion Analysis Research Laboratory run by Binghamton University in New York. The researchers used a sophisticated motion analysis system, which involved motion-capture tech, to find the relationship(s) between gait speed and balance.

When researching use of the app itself, 94% of the senior study participants completed exercises and tests via the smartphone intervention, the study authors said.

“Participants self-reported enjoyment, difficulty and exercise effectiveness,” the study authors wrote. “Results of this study demonstrated the feasibility and effectiveness of delivering balance intervention through a smartphone-based application.”

While it’s unclear from the study how such an app might complement other monitoring or therapy tools in senior living communities, the researchers did acknowledge that the smartphone intervention would not work for all seniors, such as those with more severe mobility impairments. 

Future studies could be aimed at reviewing how stroke or Parkinson’s patients use the app and its exercise regimen, the study authors said.

Healthcare software and long-term care providers are on the same page in using technology to shape care goals, according to some leading executives in both fields.

As senior living and care providers and associations have focused on the concept of value-based care, which ties finances and insurance coverage to residents’ quality of life, tech developers have moved in tandem to meet the twin goals of reducing costs and improving services.

Although many new innovations have helped achieve this aim, healthcare leaders have expressed the greatest enthusiasm for the future of artificial intelligence and predictive analytics.

“Early is critical with seniors,” said Allison Rainey, head of nursing and clinical informatics for MatrixCare, during a recent discussion for the McKnight’s Long-Term Care News Market Leaders podcast. “We can really impact outcomes if we identify changes early. Proactive tools are critical. But too, because time is so important, we can identify the plan of care that might be appropriate.”

The panel included Rainey; Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living, and Bharat Monteiro, MatrixCare’s general manager for senior living. The experts discussed the need to coordinate on new software and tech tools so that they are both easier to use for providers, and tailored to their needs.

MatrixCare has been one of the leading companies developing interoperable tools for long-term care operators, so that resident and patient information can be shared along different points of care, such as hospitals and nursing homes. 

That can be a moving target, as the benefit of AI’s analytical and predictive capabilities also generates a mountain of data that must be contextualized, Rainey noted.

“Health journeys are very complicated,” she said. “What is meaningful and what is not? More interoperability means more patient data coming in. How do we include the social determinants of health in that? Now we have great AI tools to serve only [relevant] changes.”

Monteiro offered the example of increasingly robust falls prediction tools, for how tech is advancing to both improve resident and patient health and reduce costs. Falls can cost communities and facilities an average of $380,000 a year, and it is anticipated that residents will fall at least once during their stay in a residential care setting, Monteiro noted.

“AI can look at falls and data points and stratify patients into the highest risk [level] for falling. That’s the opening step,” Monteiro said. “If I can create smart care plans, then I’m able to provide proactive care for residents. If you reduce falls, you’re automatically keeping the patient in that area of resident longer, and the provider has better financial benefits because they’re not dealing with as many fall repercussions.”

Parkinson agreed and noted that, from a policy perspective, the key will be for providers to control hospitalization and re-hospitalization rates.

“If you can keep your hospitalization rates low, you will do really well in value based purchasing,” he said. “And I don’t think it would be possible to slaughter your re-hospitalization rate if you weren’t using EMRs [electronic medical records] or tools that EMRs provide.”

The panelists also noted that, for the time being, clinicians’ anxieties about new technology replacing them are unfounded and that care providers are stressing that human healthcare workers still must make the final decisions and analyze information from new software and predictive AI.

In fact, a recurring theme in high-level analyses of AI over the past year is that new tools can take over the more mundane, frustrating tasks that clinicians and caregivers have to do and can free up more time for them to work directly with residents and patients.

Jung Yin Tsang, from the University of Manchester in the United Kingdom, and colleagues assessed whether people with cataract, age-related macular degeneration (AMD) or glaucoma have a higher risk for falls or fractures than those without. The analysis included 410,476 people with cataract, 75,622 with AMD and 90,177 with glaucoma who were matched (1:5) to controls.

The researchers observed an increased risk for falls in those with cataract (hazard ratio [HR], 1.36), AMD (HR, 1.25), and glaucoma (HR, 1.38). Similarly, there was an increased risk for fractures seen for all eye diseases (HRs, 1.28, 1.18, and 1.31 for cataract, AMD and glaucoma, respectively). Fracture risk was increased in almost all body sites (e.g., hip, spine, forearm, skull or facial bones, pelvis, ribs or sternum, and lower leg fractures) versus matched comparators.

“The results of this study indicate that people with cataract, AMD or glaucoma have a higher risk of both falls or fractures compared with people without these eye diseases,” the authors write. “These populations would likely benefit from improved advice, access and referrals to falls prevention services and targeted interventions to prevent related adverse outcomes.”

One author disclosed ties to the pharmaceutical industry.

Abstract/Full Text

Anne C. Fernandez, PhD, from the University of Michigan in Ann Arbor, and colleagues used data from the January 2021 National Poll on Healthy Aging, which asked 2,023 US adults ages 50 to 80 years about past-year cannabis use, to identify demographic characteristics associated with cannabis use.

The researchers found that 12.1% reported cannabis use in the past year. Among those who reported cannabis use, more than one-third (34.2%) reported using cannabis products four or more days per week. Cannabis use was found to be less likely among people who identified as Hispanic ethnicity or as “other” races versus non-Hispanic white participants, while cannabis use was found to be more likely among unmarried/unpartnered and unemployed respondents. Alcohol consumption was also associated with an increased likelihood of cannabis use.

“As the stress of the pandemic and the increased legalization of cannabis by states converged, our findings suggest cannabis use increased among older adults nationally,” Fernandez said in a statement. “Older adults represent a vulnerable age group for cannabis use due to interactions with medications, risky driving, cannabis-related mental health impacts and increased possibility of falls and memory issues.”

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Sneha Kannan, MD, from Massachusetts General Hospital in Boston, and colleagues examined changes in hospital-acquired adverse events and hospitalization outcomes associated with private equity acquisitions of US hospitals. Data from 100% Medicare Part A claims were compared for 662,095 hospitalizations at 51 private equity-acquired hospitals and 4,160,720 hospitalizations at 259 matched control hospitals not acquired by private equity.

The researchers found that hospital-acquired adverse events or conditions occurred in 10,091 hospitalizations. Compared with those treated at control hospitals, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions (4.6 additional hospital-acquired conditions per 10,000 hospitalizations). This increase was driven by a 27.3% and a 37.7% increase in falls and central line-associated bloodstream infections, respectively, at private equity hospitals, despite placement of 16.2% fewer central lines. At private equity hospitals, there was a doubling of surgical site infections, from 10.8 to 21.6 per 10,000 hospitalizations, despite an 8.1% reduction in surgical volume; these infections decreased at control hospitals. Compared with control hospitals, there was a slight decrease in mortality at private equity hospitals (3.4%, on average), but no differential change was seen in mortality by 30 days after discharge.

“These findings heighten concerns about the implications of private equity on healthcare delivery,” the authors write.

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Richard D. Shih, MD, from Florida Atlantic University in Boca Raton, and colleagues assessed the rate of follow-up by older adults who sustain a fall-related head injury resulting in an emergency department visit.

The researchers found that 905 of 1,527 older adults reported follow-up with their primary care practitioner. Of those reporting follow-up, 72% reported receiving a fall assessment and 56% adopted a fall prevention strategy. A history of cancer or hypertension was significantly more common among participants with follow-up.

“When referred to physical therapy, patients may be more likely to adopt fall prevention interventions and home safety modifications that have been shown to reduce recurrent fall, hospitalization and mortality,” Shih said in a statement. “Given the importance of fall prevention in this high-risk group, we strongly endorse that fall-risk assessment and patient education is performed in the emergency department or by the primary care physician. The physician follow-up should include fall-risk assessment and initiation of any appropriate interventions to prevent subsequent falls and fall-related injury.”

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For older adults living in long-term care settings, tending to certain health concerns sometimes can become a challenge when doing so clashes with a desire to maintain a sense of privacy and dignity. 

This challenge has remained an issue for those older adults who have incontinence, which could be between 50% and 90% of residents at one time or another during their stays. Overall, 43% of assisted living residents need help with toileting, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics, with a range of 40% to 57% depending on the size of community.

Unfortunately, incontinence is not merely a matter of staying dry and comfortable. Many older adults who struggle with restroom-related issues are susceptible to falling and the subsequent cascade of health emergencies that follow.

But new technology solutions aim to make the process of monitoring incontinence both more effective, and more dignified, for both residents and their caregivers. 

The Village at Gainesville, a SantaFe Senior Living independent living, assisted living and memory care community in central Florida, recently began a pilot study in its memory care residences to integrate one new incontinence monitoring tool into its overall digital health systems. 

The community is using etectRx’s eBrief sensor system, which will offer remote, real-time monitoring via a disposable sensor that can go into incontinence products, the company announced recently.

“We are excited to collaborate with The Village at Gainesville,” Eric Buffkin, CEO of etectRx, said in a statement. “Our mutual goals for the project are to reduce residents’ incontinence-related health risks and demonstrate increased job satisfaction and productivity for the staff who care for residents day in and day out.”

Other conditions that can result from incontinence include wounds, infections and pressure ulcers, etectRx noted.

Although the senior living pilot study is a novel approach, several technology tools already are on the market that track incontinence in various ways, including products by Advosense and Smardii. 

In addition to sensors that can be applied or placed in clothing, tech developers also are marketing “smart” toilets to senior living operators. Those devises offer an external validator for such issues, another way of relieving care anxieties among senior living staff members.

Sari Aaltonen, PhD, from the University of Helsinki, and colleagues examined how accelerometer characteristics associate with self-reported physical activity, anthropometric, sociodemographic, health and cognitive characteristics in a population-based cohort study involving 38 nonagenarians.

On average, participants took 2,931 steps and had 11 minutes of moderate-to-vigorous physical activity and 13.6 hours of sedentary time per day. Physical activity bouts less than three minutes/day and sedentary bouts of 20 to 60 minutes/day were observed most often. The researchers identified positive correlations for many accelerometer-measured and self-reported physical activity characteristics. Associations were seen for low levels of many accelerometer-measured physical activity characteristics with low education, dizziness and fear of falling. There was also an association seen for fear of falling with accelerometer-measured sedentary behavior characteristics.

“A clinically important finding was that most of the accelerometer-measured physical activity characteristics correlated significantly with self-reported physical activity, indicating a good usability for many self-reported items in everyday settings,” the authors write. “Larger studies, including longitudinal aspects as well, can help in understanding the antecedents and underpinnings of both physical and mental health in this fast-growing understudied population segment.”

Abstract/Full Text

Janelle M. Guirguis-Blake, MD, from the Kaiser Permanente Center for Health Research in Portland, OR, and colleagues conducted a systematic review of the evidence on the effectiveness of interventions to prevent falls in community-dwelling older adults. Data were included from 83 fair- to good-quality randomized controlled trials with 48,839 participants. The researchers found that most studies examined the effectiveness of multifactorial and exercise interventions. Multifactorial interventions were associated with a significant reduction in the number of falls but not in the number of people with a fall, the number of falls resulting in injury, or the number of people with a fall resulting in injury. Exercise interventions were associated with a significant reduction in the number of falls, number of people with a fall, and number of falls resulting in injury, but no reduction in the number of people with a fall resulting in injury.

Based on these findings, the USPSTF recommends exercise interventions to prevent falls in community-dwelling adults aged 65 years or older at increased fall risk (Grade B). In addition, the decision to recommend multifactorial interventions for fall prevention should be individualized for community-dwelling adults aged 65 years or older at increased fall risk (Grade C).

The draft evidence review and draft recommendation statement have been posted for public comment. Comments can be submitted from Dec. 5, 2023, to Jan. 8, 2024.

Draft Evidence Review

Draft Recommendation Statement

Comment on Recommendation Statement