New Methods to Monitor Stair Ascents Using a Wearable Pendant Device Reveal How Behavior, Fear, and Frailty Influence Falls in Octogenarians

Goals: To investigate if the stair negotiation by older people during activities of daily life (ADL) can be accurately identified using a freely worn pendant device. To investigate how usual stair-ascent performances during ADL relate to clinical assessments and prospective falls. Methods: ADL were recorded for 30 min by 52 community-dwelling older people (83 ± 4 years) using a small pendant device. Classification accuracy was assessed using annotated video and four-fold cross validation. Correlations between sensor-derived stair-ascent features (comprising intensity, variability, and stability) and a battery of clinical tests (comprising physiological, psychological, health, and follow-up falls) were investigated. Results: Accurate identification of stair events (99.8%, Kappa 0.92) was possible in both “frail” and “athletic” participants by scaling the barometer threshold to stair cadences. Cautious double-stepping strategy could be identified remotely. Stair-ascent performance was correlated with ascent strategy (r = -0.67), age (r = -0.44), concern about falling (r = -0.43), fall-risk scores (r = -0.41), processing speed (r = -0.38), and contrast sensitivity (r = 0.32). Follow-up falls were correlated with ascent stability (r = -0.35). Conclusion: Remote analysis of stair ascents is feasible. In our healthy older people, outcomes appeared more related to mental rather than physiological factors. The ascent strategies we observed in some older people may have reflected an appropriate behavioral response to increased concerns about falling. Significance: Given acceptance of wearable devices is increasing; reduced functional performance and altered strategies for undertaking ADL could soon be routinely tracked to augment health care.