Fear of falling The first feature, the walking steadiness indicator, targets a major issue for older adults: falling. Falls are the leading cause of accidents, injury, and death for seniors in the US, and they’re responsible for billions in healthcare costs each year. Researchers have been studying falls — and trying to figure out ways to prevent them — for decades, says Jacob Sosnoff, who studies mobility in the department of physical therapy and rehabilitation science at the University of Kansas Medical Center.
People who work with older adults are excited that a company like Apple is interested in tech that could be used for this group. Experts have spent years frustrated that companies don’t design products to meet the needs of that demographic. There have been a few attempts to introduce new tools, but none got much traction, says Richard Schulz, a social psychologist studying aging at the University of Pittsburgh. “I think the reason is that the big boys — companies like Apple — never got into it,” Schulz says. The new features are a signal that the tide is starting to turn. “Apple getting into this is a big deal.” “We can do a really good job in the lab measuring walking impairment and making predictions and recommendations, but we’re not very good in the real world,” Sosnoff says.
Apple’s new walking steadiness feature aims to track people as they move through their daily lives. It uses metrics like walking speed, step length, and the time both feet are in contact with the ground to monitor how stable a user is. It can only be measured on the iPhone, not an Apple Watch, because some of the metrics have to be calculated from as close to the hip as possible, Apple says — so in a pocket or a bag works best. Apple Watch already has a fall detection feature that can prompt users to call emergency services or automatically make a call if the user is immobile for around a minute. The new iPhone capability focuses on prediction, rather than response: it can tell people if they’re walking steadily and issue an alert if it thinks they’re at an increased risk of falling. Apple says the system is based on data collected during a clinical study that included over 100,000 participants of all ages.
“Having people be aware of their fall risk is important” There are no major commercial products that track the quality of people’s movement, Sosnoff says. Until now, most movement trackers have focused on how much people moved. “That’s why there’s a lot of excitement about this,” he says. “Having people be aware of their fall risk is important.” But there’s also a downside to telling people that they might fall — fear of falling is linked to actually experiencing a fall. If alerts increase that fear, people might limit their physical activity or even stop leaving the house as much, says Clara Berridge, a professor at the University of Washington who studies healthcare technology in aging populations. “That will likely contribute to their actual risk of falling, because they’re decreasing their strength and activity,” she says.
It’s a fine balance, Sosnoff says. “We want people to be aware of the risks but not so overly concerned that they don’t do anything.” Sosnoff says he’s eager to see if the walking steadiness feature could actually reduce falls in real-world scenarios. One challenge for the tool could be monitoring people whose walking is impaired — like people with a limp, for example. Algorithms that track gait often don’t work as well in those situations, he says. If the Apple feature has that problem, it could flag people with different walking patterns who might not actually be a fall risk. The Apple feature may not be able to help everyone at fall risk. Walking patterns are only one of the many reasons people fall: poor eyesight with age can cause people to trip, certain medications can reduce balance, and items around the house (like loose rugs) can be hazardous. The Apple walking steadiness feature is designed to suggest that people who are at risk of falling do various stability exercises, which can be useful in some cases. But for some people, balance may not be the main problem. “Getting prompted to do exercises isn’t the only solution,” Berridge says.
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