Fall Prevention and Management App Prototype for the Elderly and Their Caregivers: Design, Implementation, and Evaluation

Fall Prevention and Management App Prototype for the Elderly and Their Caregivers: Design, Implementation, and Evaluation

Eseohen Imoukhome (Dalhousie University, Nova Scotia, Canada), Lori E. Weeks (Dalhousie University, Nova Scotia, Canada) and Samina Abidi (Dalhousie University, Nova Scotia, Canada)
DOI: 10.4018/IJEACH.2020010104

Abstract

The objective of this article is to develop a validated mobile app prototype to empower the elderly and caregivers to manage falls that provides personalized and actionable educational materials at the point of care and improves the engagement of the elderly and caregiver in adopting validated fall management practices; To determine the usefulness and suitability of a fall management mobile app to the elderly and caregivers. The method used is a knowledge management approach is used to implement the app based on 2 validated models: Patient Health Engagement Model and Rockwood frailty index. A mixed method evaluation including a cognitive walk through is used to collect end-user feedback from the elderly and caregivers, on the usability, usefulness, and suitability of the app. The app was deemed easy to use, informative and understandable. Potential improvement areas include: larger print; less wordy interfaces; better navigation features; data sharing functionalities; and voice readers. These suggestions will be incorporated in the future. The conclusion of this article is that smartphones have vast potential in providing relevant and creditable fall management information to elderly and caregivers.
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Introduction

Falls are common among the elderly. About a third of community-dwelling older people fall at least once a year and in half of such cases, the falls are recurrent (Tinetti & Kumar, 2010). According to the Public Health Agency of Canada (2014), falls remain the leading cause of injury-related hospitalizations among seniors. A meta-regression analysis (American Geriatrics Society, British Geriatrics Society & American Academy of Orthopaedic Surgeons Panel on Falls Prevention, 2001) of the predisposing risk factors has shown that gait difficulties, muscular weakness and an impaired standing balance are the most prevalent risk factors for falls among elderly. Some falls could result in the loss of consciousness or head injury, while other falls may lead to more problems if individuals cannot get off the floor right away or call for help. Although it is extremely helpful and important to detect and prevent falls, it is also important to prepare patients and caregivers with the understanding of what to do when there is an incidence of a fall.

Most fall interventions that have emerged in recent years are focused primarily on fall detection and prevention (Hawley-Hague, Boulton, Hall, Pfeiffer, & Todd, 2014), for example, personal emergency response systems (PERS) (Porter, 2005) and passive sensors (Skubic, Alexander, Popescu, Rantz & Keller, 2009). These interventions give the elderly and their caregivers information that will help in preventing falls from occurring and enable the elderly to alert their caregivers if a fall occurs. Despite the availability of these tools, falls are still likely to occur. The fear of falling can further be amplified in the presence of the “long lie”, which is identified as involuntarily remaining on the ground for at least an hour following a fall (Lord, Sherrington, Menz, & Close 2007). The “long lie” occurs in 30% of fallers (Fleming & Brayne, 2008) and can lead to health complications such as pneumonia, hypothermia, dehydration, rhabdomyolysis and pressure sores (Laurence, 2016).

Although, there is ample information available on fall detection and prevention (Hamm, Money, Atwal & Paraskevopoulos, 2016; Clemson, Mackenzie, Ballinger, Close & Cumming, 2008; Gillespie et al., 2012) there are barriers and challenges such as knowledge and skills deficits and fragmentation of care among providers and across healthcare settings when it comes to fall management (Kwan & Strau, 2015; Tinetti, Gordon, Sogolow, Lapin, & Bradley, 2006). There is a need to provide a platform for patients and their caregivers, where useful, relevant and valid fall related information is readily available for them to access quickly.

Studies have shown that the elderly react favorably to fall detection technologies (Horton, 2008; Londei et al., 2009; Marquis-Faulkes, McKenna, Newell, & Gregor, 2005; Brownsell, & Hawley, 2004), and because many people want to remain living in their homes as long as possible, they are willing to accept new technologies that support their independence (Brownsell, & Hawley, 2004; Brownsell, Bradley, Bragg, Catlin, & Carlier, 2000). The rapid growth of mobile technologies within health service delivery and public health systems has provided new opportunities to deliver health services to patients, clinicians and caregivers alike (Mechael et al., 2010). Although, fewer elderly currently use mobile technology to manage their health, they are much more open towards such usage of these devices, especially ability to share data with their healthcare providers (Wang, 2019). There are several areas where mobile health technologies have been implemented for use among the elderly including chronic disease self-management, medication adherence, exercise and diet (Changizi & Kaveh, 2017).

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