Background: Impairment of physical function is a major indicator of frailty. Functional performance tests have been shown to be useful for identification of frailty in older adults. However, these tests are often not translatable into unsupervised and remote monitoring of frailty status at home and/or community settings. Objective: In this study, we explored daily postural transition quantified using a chest-worn wearable technology to identify frailty in community-dwelling older adults. Methods: Spontaneous daily physical activity was monitored over 24 h in 120 community-dwelling elderly (age: 78 ± 8 years) using an unobtrusive wearable sensor (PAMSys™, BioSensics LLC, Watertown, MA, USA). Participants were classified as non-frail and pre-frail/frail using Fried's criteria. A validated software package was used to identify body postures and postural transition between each independent postural activity such as sit-to-stand, stand-to-sit, stand-to-walk, and walk-to-stand. The transition from walking to sitting was further classified as quick sitting and cautious sitting based on presence/absence of a standing posture pause between sitting and walking. A general linear model univariate test was used for between-group comparison. Pearson's correlation was used to determine the association between sensor-derived parameters and age. Logistic regression model was used to identify independent predictors of frailty. Results: According to Fried's criteria, 63% of participants were pre-frail/frail. The total number of postural transitions, stand-to-walk, and walk-to-stand were, respectively, 25.2, 30.2, and 30.6% lower in the pre-frail/frail group when compared to the non-frail group (p < 0.05, Cohen's d = 0.73-0.79). Furthermore, the ratio of cautious sitting was significantly higher by 6.2% in pre-frail/frail compared to non-frail (p = 0.025, Cohen's d = 0.22). Total number of postural transitions and the ratio of cautious sitting also showed significant negative and positive correlations with age, respectively (r = -0.51 and 0.29, p < 0.05). After applying a logistic regression model, among tested parameters, walk-to-stand (odds ratio [OR] = 0.997 p = 0.013), quick sitting (OR = 1.036, p = 0.05), and age (OR = 1.073, p = 0.016) were recognized as independent variables to identify frailty status. Conclusions: This study demonstrated that daily number of specific postural transitions such as walk-to-stand and quick sitting could be used for monitoring frailty status by unsupervised monitoring of daily physical activity. Further study is warranted to explore whether tracking the daily number of specific postural transitions is also sensitive to track change in the status of frailty over time.

Keywords:
Frailty, Postural transition, Physical activity, Wearable sensor, Cautious sitting, Quick sitting, Walking to sitting, Telehealth
1.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G: Frailty in older adults evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146-M157.
2.
Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J: Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci 2009;64:675-681.
3.
Fairhall N, Langron C, Sherrington C, Lord SR, Kurrle SE, Lockwood K, Monaghan N, Aggar C, Gill L, Cameron ID: Treating frailty-a practical guide. BMC Med 2011;9:1.
4.
Liu CK, Fielding RA: Exercise as an intervention for frailty. Clin Geriatr Med 2011;27:101-110.
5.
Fugate Woods N, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB: Frailty: Emergence and consequences in women aged 65 and older in the women's health initiative observational study. J Am Geriatr Soc 2005;53:1321-1330.
6.
Rothman MD, Leo-Summers L, Gill TM: Prognostic significance of potential frailty criteria. J Am Geriatr Soc 2008;56:2211-2216.
7.
Schwenk M, Howe C, Saleh A, Mohler J, Grewal G, Armstrong D, Najafi B: Frailty and technology: a systematic review of gait analysis in those with frailty. Gerontology 2014;60:79-89.
8.
Mohler MJ, Fain MJ, Wertheimer AM, Najafi B, Nikolich-Zugich J: The frailty syndrome: clinical measurements and basic underpinnings in humans and animals. Exp Gerontol 2014;54:6-13.
9.
Najafi B, Aminian K, Paraschiv-Ionescu A, Loew F, Bula CJ, Robert P: Ambulatory system for human motion analysis using a kinematic sensor: monitoring of daily physical activity in the elderly. IEEE Trans Biomed Eng 2003;50:711-723.
10.
Schwenk M, Hauer K, Zieschang T, Englert S, Mohler J, Najafi B: Sensor-derived physical activity parameters can predict future falls in people with dementia. Gerontology 2013;60:483-492.
11.
Mohler MJ, Wendel CS, Taylor-Piliae RE, Toosizadeh N, Najafi B: Motor performance and physical activity as predictors of prospective falls in community-dwelling older adults by frailty level: application of wearable technology. Gerontology 2016;62:654-664.
12.
Armstrong DG, Najafi B, Shahinpoor M: Potential applications of smart multifunctional wearable materials to gerontology. Gerontology, Epub ahead of print.
13.
Theou O, Jakobi JM, Vandervoort AA, Jones GR: A comparison of physical activity (PA) assessment tools across levels of frailty. Arch Gerontol Geriatr 2012;54:e307-e314.
14.
Schwenk M, Mohler J, Wendel C, D'Huyvetter K, Fain M, Taylor-Piliae R, Najafi B: 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. Gerontology 2015;61:258-267.
15.
Ganea R, Paraschiv-Ionescu A, Salarian A, Bula C, Martin E, Rochat S, Hoskovec C, Piot-Ziegler C: Kinematics and dynamic complexity of postural transitions in frail elderly subjects. Conf Proc IEEE Eng Med Biol Soc 2007;2007:6118-6121.
16.
Galán-Mercant A, Cuesta-Vargas AI: Differences in trunk accelerometry between frail and non-frail elderly persons in functional tasks. BMC Res Notes 2014;7:100.
17.
Greene BR, Doheny EP, Kenny RA, Caulfield B: Classification of frailty and falls history using a combination of sensor-based mobility assessments. Physiol Meas 2014;35:2053.
18.
World Medical Association: World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013;310:2191-2194.
19.
Folstein MF, Folstein SE, McHugh PR: “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
20.
Kempen GI, Yardley L, Van Haastregt JC, Zijlstra GR, Beyer N, Hauer K, Todd C: The short FES-I: a shortened version of the Falls Efficacy Scale-International to assess fear of falling. Age Ageing 2008;37:45-50.
21.
Najafi B, Aminian K, Loew F, Blanc Y, Robert PA: Measurement of stand-sit and sit-stand transitions using a miniature gyroscope and its application in fall risk evaluation in the elderly. IEEE Trans Biomed Eng 2002;49:843-851.
22.
Najafi B, Armstrong DG, Mohler J: Novel wearable technology for assessing spontaneous daily physical activity and risk of falling in older adults with diabetes. J Diabetes Sci Technol 2013;7:1147-1160.
23.
Cohen J: Statistical Power Analysis for the Behavioral Sciences. London, Routledge Academic, 2013.
24.
Lawrence I, Lin K: A concordance correlation coefficient to evaluate reproducibility. Biometrics 1989;255-268.
25.
Tukey JW: Exploratory Data Analysis. London, Pearson, 1977.
26.
Galán-Mercant A, Cuesta-Vargas AI: Differences in trunk accelerometry between frail and nonfrail elderly persons in sit-to-stand and stand-to-sit transitions based on a mobile inertial sensor. JMIR Mhealth and Uhealth 2013;1:e21.
27.
Ganea R, Paraschiv-Ionescu A, Büla C, Rochat S, Aminian K: Multi-parametric evaluation of sit-to-stand and stand-to-sit transitions in elderly people. Med Eng Phys 2011;33:1086-1093.
28.
De Bruin ED, Najafi B, Murer K, Uebelhart D, Aminian K: Quantification of everyday motor function in a geriatric population. J Rehab Res Dev 2007;44:417.
29.
Lord SR, Murray SM, Chapman K, Munro B, Tiedemann A: Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Gerontol A Biol Sci Med Sci 2002;57:M539-M543.
30.
Bohannon RW: Sit-to-stand test for measuring performance of lower extremity muscles. Percept Motor Skills 1995;80:163-166.
31.
Jones CJ, Rikli RE, Beam WC: A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 1999;70:113-119.
32.
Peterson MJ, Giuliani C, Morey MC, Pieper CF, Evenson KR, Mercer V, Cohen HJ, Visser M, Brach JS, Kritchevsky SB: Physical activity as a preventative factor for frailty: the health, aging, and body composition study. J Gerontol A Biol Sci Med Sci 2009;64:61-68.
33.
Brown M, Sinacore DR, Binder EF, Kohrt WM: Physical and performance measures for the identification of mild to moderate frailty. J Gerontol A Biol Sci Med Sci 2000;55:M350-M355.
34.
Davis DH, Rockwood MR, Mitnitski AB, Rockwood K: Impairments in mobility and balance in relation to frailty. Arch Gerontol Geriatr 2011;53:79-83.
35.
Toosizadeh N, Mohler J, Wendel C, Najafi B: Influences of frailty syndrome on open-loop and closed-loop postural control strategy. Gerontology 2015;61:51-60.
36.
Weiss A, Herman T, Plotnik M, Brozgol M, Giladi N, Hausdorff J: An instrumented timed up and go: the added value of an accelerometer for identifying fall risk in idiopathic fallers. Physiol Meas 2011;32:2003.
37.
Hahn ME, Chou L-S: Age-related reduction in sagittal plane center of mass motion during obstacle crossing. J Biomech 2004;37:837-844.
38.
Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek M, Holland C: Effectiveness of the interventions in preventing the progression of pre-frailty and frailty in older adults: a systematic review protocol. JBI Database System Rev Implement Rep 2016;14:4-19.
39.
Toosizadeh N, Mohler J, Lei H, Parvaneh S, Sherman S, Najafi B: Motor performance assessment in Parkinson's disease: association between objective in-clinic, objective in-home, and subjective/semi-objective measures. PLoS One 2015;10:e0124763.
40.
Lamoth CJ, van Deudekom FJ, van Campen JP, Appels BA, de Vries OJ, Pijnappels M: Gait stability and variability measures show effects of impaired cognition and dual tasking in frail people. J Neuroeng Rehab 2011;8:1.
41.
van Iersel MB, Munneke M, Esselink RA, Benraad CE, Rikkert MGO: Gait velocity and the timed-up-and-go test were sensitive to changes in mobility in frail elderly patients. J Clin Epidemiol 2008;61:186-191.
42.
Schwenk M, Grewal G, Holloway D, Muchna A, Garland L, Najafi B: Interactive sensor-based balance training in older cancer patients with chemotherapy-induced peripheral neuropathy: a randomized controlled trial. Gerontology 2016;62:553-563.
43.
Schwenk M, Grewal GS, Honarvar B, Schwenk S, Mohler J, Khalsa DS, Najafi B: Interactive balance training integrating sensor-based visual feedback of movement performance: a pilot study in older adults. J Neuroeng Rehab 2014;11:1.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.