Wearable Sensors and the Assessment of Frailty among Vulnerable Older Adults: An Observational Cohort Study

Background: The geriatric syndrome of frailty is one of the greatest challenges facing the U.S. aging population. Frailty in older adults is associated with higher adverse outcomes, such as mortality and hospitalization. Identifying precise early indicators of pre-frailty and measures of specific frailty components are of key importance to enable targeted interventions and remediation. We hypothesize that sensor-derived parameters, measured by a pendant accelerometer device in the home setting, are sensitive to identifying pre-frailty. Methods: Using the Fried frailty phenotype criteria, 153 community-dwelling, ambulatory older adults were classified as pre-frail (51%), frail (22%), or non-frail (27%). A pendant sensor was used to monitor the at home physical activity, using a chest acceleration over 48 h. An algorithm was developed to quantify physical activity pattern (PAP), physical activity behavior (PAB), and sleep quality parameters. Statistically significant parameters were selected to discriminate the pre-frail from frail and non-frail adults. Results: The stepping parameters, walking parameters, PAB parameters (sedentary and moderate-to-vigorous activity), and the combined parameters reached and area under the curve of 0.87, 0.85, 0.85, and 0.88, respectively, for identifying pre-frail adults. No sleep parameters discriminated the pre-frail from the rest of the adults. Conclusions: This study demonstrates that a pendant sensor can identify pre-frailty via daily home monitoring. These findings may open new opportunities in order to remotely measure and track frailty via telehealth technologies.

[1]  He Zhou,et al.  Motor Planning Error: Toward Measuring Cognitive Frailty in Older Adults Using Wearables , 2018, Sensors.

[2]  M. Cesari,et al.  Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) International Consensus Group , 2013, The journal of nutrition, health & aging.

[3]  Bijan Najafi,et al.  Assessing Upper-Extremity Motion: An Innovative, Objective Method to Identify Frailty in Older Bed-Bound Trauma Patients. , 2016, Journal of the American College of Surgeons.

[4]  Andrew Zisserman,et al.  Return of the Devil in the Details: Delving Deep into Convolutional Nets , 2014, BMVC.

[5]  T. Vasankari,et al.  Validation of Cut-Points for Evaluating the Intensity of Physical Activity with Accelerometry-Based Mean Amplitude Deviation (MAD) , 2015, PloS one.

[6]  K. Aminian,et al.  Barcoding Human Physical Activity to Assess Chronic Pain Conditions , 2012, PloS one.

[7]  Sylvain Arlot,et al.  A survey of cross-validation procedures for model selection , 2009, 0907.4728.

[8]  Kenneth Rockwood,et al.  Accumulation of Deficits as a Proxy Measure of Aging , 2001, TheScientificWorldJournal.

[9]  Michael Schwenk,et al.  Wearable Sensor-Based In-Home Assessment of Gait, Balance, and Physical Activity for Discrimination of Frailty Status: Baseline Results of the Arizona Frailty Cohort Study , 2014, Gerontology.

[10]  Association of physical activity and sedentary lifestyle patterns with obesity and cardiometabolic comorbidities in Greek adults: Data from the National Epidemiological Survey , 2013, Hormones.

[11]  Sujit K. Ghosh,et al.  Essential Wavelets for Statistical Applications and Data Analysis , 2001, Technometrics.

[12]  Q. Xue.  The frailty syndrome: definition and natural history. , 2011, Clinics in geriatric medicine.

[13]  Kamiar Aminian,et al.  Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes. , 2002, Journal of biomechanics.

[14]  Michael Schwenk,et al.  Frailty and Technology: A Systematic Review of Gait Analysis in Those with Frailty , 2013, Gerontology.

[15]  L. Mâsse,et al.  Physical activity in the United States measured by accelerometer. , 2008, Medicine and science in sports and exercise.

[16]  Bijan Najafi,et al.  Instrumented Trail-Making Task to Differentiate Persons with No Cognitive Impairment, Amnestic Mild Cognitive Impairment, and Alzheimer Disease: A Proof of Concept Study , 2016, Gerontology.

[17]  Kamiar Aminian,et al.  Physical Behavior in Older Persons during Daily Life: Insights from Instrumented Shoes , 2016, Sensors.

[18]  K. Patrick,et al.  Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine , 1995 .

[19]  Sandra Haider,et al.  Associations between daily physical activity, handgrip strength, muscle mass, physical performance and quality of life in prefrail and frail community-dwelling older adults , 2016, Quality of Life Research.

[20]  Johannes B. J. Bussmann,et al.  To total amount of activity….. and beyond: perspectives on measuring physical behavior , 2013, Front. Psychol..

[21]  B. Najafi,et al.  Precision Medicine: A Wider Definition , 2015, Journal of the American Geriatrics Society.

[22]  Bijan Najafi,et al.  Toward Using a Smartwatch to Monitor Frailty in a Hospital Setting: Using a Single Wrist-Wearable Sensor to Assess Frailty in Bedbound Inpatients , 2017, Gerontology.

[23]  Bijan Najafi,et al.  Novel Wearable Technology for Assessing Spontaneous Daily Physical Activity and Risk of Falling in Older Adults with Diabetes , 2013, Journal of diabetes science and technology.

[24]  Bijan Najafi,et al.  Assessing Upper Extremity Motion: An Innovative Method to Identify Frailty , 2015, Journal of the American Geriatrics Society.

[25]  Kelly R Evenson,et al.  Physical activity as a preventative factor for frailty: the health, aging, and body composition study. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[26]  Ignacio Ara,et al.  Frailty is associated with objectively assessed sedentary behaviour patterns in older adults: Evidence from the Toledo Study for Healthy Aging (TSHA) , 2017, PloS one.

[27]  L. Lipsitz,et al.  Validation and Comparison of Two Frailty Indexes: The MOBILIZE Boston Study , 2009, Journal of the American Geriatrics Society.

[28]  Xujiao Chen,et al.  Frailty syndrome: an overview , 2014, Clinical interventions in aging.

[29]  Kenneth Rockwood,et al.  The association between sedentary behaviour, moderate-vigorous physical activity and frailty , 2014 .

[30]  Bijan Najafi,et al.  The Frailty Syndrome: Clinical measurements and basic underpinnings in humans and animals , 2014, Experimental Gerontology.

[31]  Nikola Bogunovic,et al.  A review of feature selection methods with applications , 2015, 2015 38th International Convention on Information and Communication Technology, Electronics and Microelectronics (MIPRO).

[32]  Manuel Montero-Odasso,et al.  Clinical Frailty Scale in an Acute Medicine Unit: a Simple Tool That Predicts Length of Stay , 2016, Canadian geriatrics journal : CGJ.

[33]  I. Cameron,et al.  Developing Interventions for Frailty , 2015 .

[34]  T. Tombaugh,et al.  The Mini‐Mental State Examination: A Comprehensive Review , 1992, Journal of the American Geriatrics Society.

[35]  M. Mehl,et al.  Wellbuilt for wellbeing: Controlling relative humidity in the workplace matters for our health , 2019, Indoor air.

[36]  P. Lewinsohn,et al.  Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. , 1997, Psychology and aging.

[37]  Bijan Najafi,et al.  Upper-Extremity Function Predicts Adverse Health Outcomes among Older Adults Hospitalized for Ground-Level Falls , 2016, Gerontology.

[38]  R. Sorelle.  US Department of Health and Human Services gives states wider latitude in choosing services to be covered by Medicaid. , 2001, Circulation.

[39]  Ricardo Oliveira Guerra,et al.  Using the Short Physical Performance Battery to screen for frailty in young‐old adults with distinct socioeconomic conditions , 2013, Geriatrics & gerontology international.

[40]  Genevieve N Healy,et al.  Prolonged sedentary time and physical activity in workplace and non-work contexts: a cross-sectional study of office, customer service and call centre employees , 2012, International Journal of Behavioral Nutrition and Physical Activity.

[41]  Gareth R. Jones,et al.  Physical Activity across Frailty Phenotypes in Females with Parkinson's Disease , 2012, Journal of aging research.

[42]  A Galán-Mercant,et al.  Clinical frailty syndrome assessment using inertial sensors embedded in smartphones , 2015, Physiological measurement.

[43]  L. Fried,et al.  Frailty in older adults: evidence for a phenotype. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[44]  Olga Theou,et al.  A comparison of physical activity (PA) assessment tools across levels of frailty. , 2012, Archives of gerontology and geriatrics.

[45]  M. Woollacott,et al.  Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. , 2000, Physical therapy.

[46]  Huan Liu,et al.  Feature subset selection bias for classification learning , 2006, ICML.

[47]  H. Makizako,et al.  Impact of physical frailty on disability in community-dwelling older adults: a prospective cohort study , 2015, BMJ Open.

[48]  Jean-Pierre Michel,et al.  Frailty Syndrome: A Transitional State in a Dynamic Process , 2009, Gerontology.

[49]  S. Stawicki,et al.  Patient Frailty: Key Considerations, Definitions and Practical Implications , 2016 .

[50]  R. Varadhan,et al.  Frailty in Older Adults: A Nationally Representative Profile in the United States. , 2015, The journals of gerontology. Series A, Biological sciences and medical sciences.

[51]  A. Murray,et al.  A Review of Frailty Syndrome and Its Physical, Cognitive and Emotional Domains in the Elderly , 2017, Geriatrics.

[52]  Kamiar Aminian,et al.  Capturing human motion using body‐fixed sensors: outdoor measurement and clinical applications , 2004, Comput. Animat. Virtual Worlds.

[53]  O. Rioul,et al.  Wavelets and signal processing , 1991, IEEE Signal Processing Magazine.

[54]  C Kent Kwoh,et al.  Objective physical activity measurement in the osteoarthritis initiative: Are guidelines being met? , 2011, Arthritis and rheumatism.

[55]  Frailty Index and Cognitive Decline in Alzheimer's Disease: Data from the Impact of Cholinergic Treatment USe Study , 2016, Journal of the American Geriatrics Society.

[56]  Javad Razjouyan,et al.  Improving Sleep Quality Assessment Using Wearable Sensors by Including Information From Postural/Sleep Position Changes and Body Acceleration: A Comparison of Chest-Worn Sensors, Wrist Actigraphy, and Polysomnography. , 2017, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[57]  Bijan Najafi,et al.  Postural Transitions during Activities of Daily Living Could Identify Frailty Status: Application of Wearable Technology to Identify Frailty during Unsupervised Condition , 2017, Gerontology.

[58]  Kamiar Aminian,et al.  Ambulatory system for human motion analysis using a kinematic sensor: monitoring of daily physical activity in the elderly , 2003, IEEE Transactions on Biomedical Engineering.

[59]  Zhuowei Yu,et al.  Cognitive frailty, a novel target for the prevention of elderly dependency , 2015, Ageing Research Reviews.

[60]  安藤 寛,et al.  Cross-Validation , 1952, Encyclopedia of Machine Learning and Data Mining.

[61]  Susan Redline,et al.  Sleep Disturbances and Frailty Status in Older Community‐Dwelling Men , 2009, Journal of the American Geriatrics Society.

[62]  C. Tudor-Locke,et al.  Challenges and Opportunities for Measuring Physical Activity in Sedentary Adults , 2001, Sports medicine.

[63]  Linda P Fried,et al.  Frailty in the clinical scenario , 2015, The Lancet.

[64]  Georgios Paliouras,et al.  A Comparison of Logistic Regression to Decision Tree Induction in the Diagnosis of Carpal Tunnel Syndrome , 1999, Comput. Biomed. Res..

[65]  D A Bennett,et al.  Change in Frailty and Risk of Death in Older Persons , 2009, Experimental aging research.

[66]  Kamiar Aminian,et al.  Quantification of everyday motor function in a geriatric population. , 2007, Journal of rehabilitation research and development.

[67]  The Older Population of the United States. , 1959 .

[68]  L. Yardley,et al.  Development and initial validation of the Falls Efficacy Scale-International (FES-I). , 2005, Age and ageing.

[69]  A. Tricco,et al.  Process description and evaluation of Canadian Physical Activity Guidelines development , 2010, The international journal of behavioral nutrition and physical activity.

[70]  S. Verschueren,et al.  Effects of multi-domain interventions in (pre)frail elderly on frailty, functional, and cognitive status: a systematic review , 2017, Clinical interventions in aging.

[71]  Isabelle Guyon,et al.  An Introduction to Variable and Feature Selection , 2003, J. Mach. Learn. Res..

[72]  Brent C Taylor,et al.  A Comparison of Frailty Indexes for the Prediction of Falls, Disability, Fractures, and Mortality in Older Men , 2009, Journal of the American Geriatrics Society.

[73]  David Melzer,et al.  Variation in thresholds for reporting mobility disability between national population subgroups and studies. , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[74]  Sonia Ancoli-Israel,et al.  Sleep disturbances and risk of frailty and mortality in older men. , 2012, Sleep medicine.

[75]  Majid Sarrafzadeh,et al.  A Combination of Indoor Localization and Wearable Sensor–Based Physical Activity Recognition to Assess Older Patients Undergoing Subacute Rehabilitation: Baseline Study Results , 2019, JMIR mHealth and uHealth.