Ambulatory Monitoring of Near Falls: A Novel Measure of Fall Risk

描述(由申请人提供)：跌倒是老年人中常见的、使人虚弱的问题，也是发病率的重要来源。本提案的目的是研究一种评估跌倒风险的新方法。在过去的三十年里，在理解导致跌倒的因素方面取得了巨大的进步，然而，评估工具还不是最优的。在临床上，可以进行观察步态分析，以表征平衡、行走能力和跌倒的风险。为了获得更多的洞察力，平衡和步态可能会受到挑战，例如，使用障碍课程。然而，如果这些方法被证明是不够的，并且老年医生或神经科医生需要了解患者在进行日常生活活动时发生了什么，那么将依靠自我报告。事实上，尽管自我报告具有主观性，也存在与回忆有关的已知问题，但目前在很大程度上，自我报告是衡量摔倒频率和风险的金标准。我们认为，通过为希望评估跌倒的临床医生提供一种类似于心脏病专家的Holter监护仪的方法：近距离跌倒的动态监测(NF)，可以获得更多的好处。Near Fall指的是失足、绊倒、绊倒或失去平衡，在这种情况下，恢复机制被激活以防止摔倒。也许在较短的研究时间内，自动识别核因子应该是跌倒风险的敏感和客观的标记物。我们最近开始研究使用动态监护仪来识别神经营养不良的可能性。在实验室检测的前期工作中，主要是在年轻人中，我们能够实现高于85%的敏感性和85%的特异性的检测率。本研究旨在为更大规模的效度研究铺平道路。为此，我们定义了以下具体目标：1.开发算法，在实验室条件下自动识别老年人的神经营养不良。2.开发和评估在真实世界条件下检测核磁共振的算法(使用加速计和陀螺仪，并确定哪种配置和组合是理想的)。3.a)建立一个由运动传感器记录的带注释的神经营养数据库，作为研究参与者进行日常生活活动的基础。B)通过NIH资助的开放访问的PhysioNet资源网站提供该档案。为了实现这些目标，30名有多次跌倒史的老年人、30名年龄匹配的对照组和10名有反复跌倒史的帕金森病患者将在实验室进行测试，使用先前建立的平衡、步态和跌倒风险测试。随后，他们将被要求连续3天佩戴动态监护仪。我们将评估哪些方法最佳地检测核因子，以及核因子与基于实验室的测量之间的关联。这项探索性研究的结果应该有助于促进研究跌倒和跌倒风险的第三种方法，一种基于动态监测的方法，最终可能导致更全面的跌倒风险评估选择。 与公共卫生相关：老年人跌倒是发病率和死亡率的主要原因，与之相关的医疗费用也很高。我们认为，开发一种新的跌倒风险评估方法可以获得很大好处：对近距离跌倒进行动态监测。在受试者进行日常生活活动时，自动识别近距离跌倒(例如，绊倒、失误、绊倒)，可以根据实际表现提供跌倒风险的敏感和客观标记，最终可能导致改进评估和治疗方案。

DESCRIPTION (provided by applicant): Falls are a common, debilitating problem among older adults and a significant source of morbidity. The objective of the present proposal is to investigate a novel approach to the evaluation of fall risk. During the past three decades, tremendous advances have been made in the understanding of the factors that contribute to falls, however, assessment tools are not yet optimal. In the clinic, observational gait analysis may be performed to characterize balance, walking abilities and fall risk. For further insight, balance and gait may be challenged, e.g., using an obstacle course. However, if these approaches prove insufficient and the geriatrician or neurologist needs to understand what occurs as a patient carries out routine activities of daily living, self-report will be relied upon. In fact, despite its subjective nature and the known problems concerning recall, self-report is currently, to a large degree, the gold standard of fall frequency and risk. We suggest that much can be gained by offering the clinician who wishes to evaluate falls an approach similar to that of the cardiologist's Holter monitor: ambulatory monitoring of near falls (NF). A near fall refers to a misstep, trip, stumble or loss of balance in which recovery mechanisms are activated to prevent a fall. Automatic identification of NF should, a priori, provide a sensitive and objective marker of fall risk, perhaps over a shorter study period. We recently began to investigate the potential of using an ambulatory monitor to identify NF. In preliminary work in laboratory testing, mostly in young adults, we were able to achieve detection rates better than 85% sensitivity and 85% specificity. The present proposal is designed as a bridge to larger scale validity studies. To this end, we have defined the following specific aims: 1. To develop algorithms to automatically identify NF in older adults under laboratory conditions. 2. To develop and evaluate algorithms for the detection of NF (using accelerometers and gyroscopes and determining which configuration and combinations are ideal) in real-world conditions. 3. A) To establish an annotated data base of NF, as recorded by movement sensors, as study participants carry out their routine activities of daily living. B) To make this archive available via the open-access NIH-funded PhysioNet Resource website. To achieve these objectives, 30 older adults with a history of multiple falls, 30 age-matched controls and 10 patients with Parkinson's disease with a history of recurrent falls will be tested in the lab using previously established tests of balance, gait and fall risk. Subsequently, they will be asked to wear an ambulatory monitor for 3 consecutive days. We will assess which methods optimally detect NF and the association between NF and laboratory-based measures. The results of this exploratory study should help to promote a third approach to the study of falls and falls risk, one based on ambulatory monitoring that may, ultimately, lead to more comprehensive fall risk assessment options. PUBLIC HEALTH RELEVANCE: Falls in older adult are a major cause of morbidity and mortality, with significant associated healthcare costs. We suggest that much can be gained by developing a new approach to fall risk assessment: ambulatory monitoring of near falls. Automatic identification of near falls (e.g., trips, missteps, stumbles), as subjects carry out their routine activities of daily living, may provide a sensitive and objective marker of fall risk based on actual performance that may, ultimately, lead to improved assessment and treatment options.