It Is Always on Your Mind: Experiences and Perceptions of Falling of Older People and Their Carers and the Potential of a Mobile Falls Detection Device
Background. Falls and fear of falling present a major risk to older people as both can affect their quality of life and independence. Mobile assistive technologies (AT) fall detection devices may maximise the potential for older people to live independently for as long as possible within their own homes by facilitating early detection of falls. Aims. To explore the experiences and perceptions of older people and their carers as to the potential of a mobile falls detection AT device. Methods. Nine focus groups with 47 participants including both older people with a range of health conditions and their carers. Interviews were audio recorded, transcribed verbatim, and thematically analysed. Results. Four key themes were identified relating to participants’ experiences and perceptions of falling and the potential impact of a mobile falls detector: cause of falling, falling as everyday vulnerability, the environmental context of falling, and regaining confidence and independence by having a mobile falls detector. Conclusion. The perceived benefits of a mobile falls detector may differ between older people and their carers. The experience of falling has to be taken into account when designing mobile assistive technology devices as these may influence perceptions of such devices and how older people utilise them. 1. Introduction The term assistive technologies (AT) covers a wide range of aids and devices designed to support older people with chronic long-term health conditions, disabilities or cognitive impairments to live at home independently. Included within the remit of AT is a plethora of devices ranging from simple mobility aids to complex computer based medical devices. Contemporary technological developments mean that mobile assistive technology (AT) devices have considerable potential—in theory at least—to contribute to the goal of enabling older people to live independently for as long as possible within their own homes by providing a range of support and alert services such as falls detection [1, 2]. Falls are a major public health problem in terms of their prevalence, morbidity, and mortality: additionally falls and fear of falling can significantly compromise the independence and quality of life of older people [3, 4]. There are a range of studies examining the detailed epidemiology of falls, potential prevention of falls, and exploring older peoples’ views on falls prevention advice [5–7]. In addition, previous research into falling has aimed to develop new interventions to detect those at risk of falling, rehabilitate those who have fallen, and
References
[1]
M. Brignell, R. Wootton, and L. Gray, “The application of telemedicine to geriatric medicine,” Age and Ageing, vol. 36, no. 4, pp. 369–374, 2007.
[2]
C. M. Blaschke, P. P. Freddolino, and E. E. Mullen, “Ageing and technology: a review of the research literature,” The British Journal of Social Work, vol. 39, no. 4, pp. 641–656, 2009.
[3]
N. Noury, P. Rumeau, A. K. Bourke, G. óLaighin, and J. E. Lundy, “A proposal for the classification and evaluation of fall detectors,” IRBM, vol. 29, no. 6, pp. 340–349, 2008.
[4]
N. Deshpande, E. J. Metter, F. Lauretani, S. Bandinelli, J. Guralnik, and L. Ferrucci, “Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study,” Journal of the American Geriatrics Society, vol. 56, no. 4, pp. 615–620, 2008.
[5]
L. Z. Rubenstein, “Falls in older people: epidemiology, risk factors and strategies for prevention,” Age and Ageing, vol. 35, no. 2, pp. ii37–ii41, 2006.
[6]
L. Yardley, M. Donovan-Hall, K. Francis, and C. Todd, “Older people's views of advice about falls prevention: a qualitative study,” Health Education Research, vol. 21, no. 4, pp. 508–517, 2006.
[7]
A. J. Campbell and M. C. Robertson, “Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions,” Age and Ageing, vol. 36, no. 6, pp. 656–662, 2007.
[8]
P. Kannus, J. Parkkari, S. Niemi et al., “Prevention of hip fracture in elderly people with use of a hip protector,” The New England Journal of Medicine, vol. 343, no. 21, pp. 1506–1513, 2000.
[9]
A. Drahota, D. Gal, and J. Windsor, “Flooring as an intervention to reduce injuries from falls in healthcare settings: an overview,” Quality in ageing, vol. 8, no. 1, pp. 3–9, 2007.
[10]
J. Fleming and C. Brayne, “Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90,” The British Medical Journal, vol. 337, Article ID a2227, 2008.
[11]
D. Wild, U. S. L. Nayak, and B. Isaacs, “How dangerous are falls in old people at home?” The British Medical Journal, vol. 282, no. 6260, pp. 266–268, 1981.
[12]
G. Ward, N. Holliday, S. Fielden, and S. Williams, “Fall detectors: a review of the literature,” Journal of Assistive Technologies, vol. 6, no. 3, pp. 202–215, 2012.
[13]
S. Martin, G. Kelly, W. G. Kernohan, B. McCreight, and C. Nugent, Smart Home Technologies for Health and Social Care Support, John Wiley & Sons, Chichester, UK, 2008.
[14]
M. Johnson, A. George, and D. T. Tran, “Analysis of falls incidents: nurse and patient preventive behaviours,” International Journal of Nursing Practice, vol. 17, no. 1, pp. 60–66, 2011.
[15]
K. Horton, “Falls in older people: the place of telemonitoring in rehabilitation,” Journal of Rehabilitation Research and Development, vol. 45, no. 8, pp. 1183–1194, 2008.
[16]
W. Li, T. H. M. Keegan, B. Sternfeld, S. Sidney, C. P. Quesenberry Jr., and J. L. Kelsey, “Outdoor falls among middle-aged and older adults: a neglected public health problem,” The American Journal of Public Health, vol. 96, no. 7, pp. 1192–1200, 2006.
[17]
G. J. Wijlhuizen, R. de Jong, and M. Hopman-Rock, “Older persons afraid of falling reduce physical activity to prevent outdoor falls,” Preventive Medicine, vol. 44, no. 3, pp. 260–264, 2007.
[18]
M. Rantakokko, M. M？nty, S. Iwarsson et al., “Fear of moving outdoors and development of outdoor walking difficulty in older people: clinical Investigations,” Journal of the American Geriatrics Society, vol. 57, no. 4, pp. 634–640, 2009.
[19]
J. Pigniez, “Fall detection technologies for the elderly,” Executive Summary for French National Health at Home Center, 2013, http://www.gerontechnology.com/fall-detection-technologies-for-the-elderly-2/316619.
[20]
F. Bagalà, C. Becker, A. Cappello et al., “Evaluation of accelerometer-based fall detection algorithms on real-world falls,” PLoS ONE, vol. 7, no. 5, Article ID e37062, 2012.
[21]
R. Y. W. Lee and A. J. Carlisle, “Detection of falls using accelerometers and mobile phone technology,” Age and Ageing, vol. 40, no. 6, pp. 690–696, 2011.
[22]
S. Parker, G. Nussbaum, H. Sonntag et al., “Computers helping people with special needs: lecture notes in computer science,” in ENABLE—A View on User's Needs, K. Miesenberger, J. Klaus, W. Zagler, and A. Karshmer, Eds., pp. 1016–1023, Springer, Berlin, Germany, 2008.
[23]
R. J. McCrindle, V. M. Williams, C. R. Victor et al., “Wearable device to assist independent living,” International Journal on Disability and Human Development, vol. 10, no. 4, pp. 349–354, 20112011.
[24]
J. Ritchie and J. Lewis, Qualitative Research Practice, Sage, Thousand Oaks, Calif, USA, 2006.
[25]
A. Tinker, “Assistive technology and its role in housing policies for older people,” Quality in Ageing and Older Adults, vol. 4, no. 2, pp. 4–12, 2003.
[26]
S. Cahill, E. Begley, J. P. Faulkner, and I. Hagen, “‘It gives me a sense of independence’—findings from Ireland on the use and usefulness of assistive technology for people with dementia,” Technology and Disability, vol. 19, no. 2-3, pp. 133–142, 2007.
[27]
A. Bowes and G. McColgan, Smart Technology and Community Care for Older People: Innovation in West Lothian, Age Concern Scotland, Glasgow, UK, 2006.
[28]
N. Goodwin, “The state of telehealth and telecare in the UK: prospects for integrated care,” Journal of Integrated Care, vol. 18, no. 6, pp. 3–10, 2010.
[29]
K. Shinohara and J. Wobbock, “In the shadow of misperception: assistive technology use and social interactions,” in Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI '11), Vancouver, Canada, 2011.
[30]
A. Dickenson, J. Goodman, A. Syme et al., “Domesticating technology. In-home requirements gathering with frail older people,” in Proceedings of the 10th International Conference on Human-Computer Interaction (HCI '03), vol. 4, pp. 827–831, 2003.
[31]
S. Brownsell and M. S. Hawley, “Automatic fall detectors and the fear of falling,” Journal of Telemedicine and Telecare, vol. 10, no. 5, pp. 262–266, 2004.
[32]
K. Doughty, K. Cameron, and P. Garner, “Three generations of telecare of the elderly,” Journal of Telemedicine and Telecare, vol. 2, no. 2, pp. 71–80, 1996.
[33]
F. G. Miskelly, “Assistive technology in elderly care,” Age and Ageing, vol. 30, no. 6, pp. 455–458, 2001.
[34]
J. Gatward, “Electronic assistive technology: benefits for all?” Housing, Care & Support, vol. 7, no. 4, pp. 13–17, 2004.
[35]
G. Williams, K. Doughty, and D. A. Bradley, “Safety and risk issues in using telecare,” Journal of Telemedicine and Telecare, vol. 6, no. 5, pp. 249–262, 2000.
[36]
J. K. Seale, C. McCreadie, A. Turner-Smith, and A. Tinker, “Older people as partners in assistive technology research: the use of focus groups in the design process,” Technology and Disability, vol. 14, no. 1, pp. 21–29, 2002.
