Geriatrics: walking better with smartphones

Interview with Prof. Clemens Becker, head physician, Clinic for Geriatric Rehabilitation, Robert Bosch Hospital Stuttgart

Many end-users already have had a smartphone that counts steps and apps that help in disease prevention for a long time. But in professional medical use environments like hospitals and physicians' offices these little helpers are just arriving - or not even there yet. Still, these gadgets can make assessments easier and more precise. For example in geriatrics.


Photo: Physician with glasses and grey hair - Clemens Becker

Prof. Clemens Becker; ©privat

Prof. Clemens Becker explains in the interview with why geriatricians should use modern gadgets, why commercial apps are barely suited for older people and why the assessment of someone's walking steadiness means more than counting steps.Professor Becker, why are geriatric assessments still done with pencils, paper and stopwatches nowadays?

Prof. Clemens Becker: Unfortunately, in medicine, clinical and social innovations do not always go hand in hand with technical innovations. Geriatrics has seen and views itself as a "high touch - low tech" discipline. "High touch" means that it factors in the patients, family members and the social environment. This is still characteristic and makes sense because geriatrics is not able to be successful when it does not include older persons and their environment.

Our position at the Robert-Bosch-Hospital is that geriatrics can also be "high touch - high tech". Many colleagues know that we are able to work far more precisely with modern technological aids and garner more accurate clinical information. As I have mentioned before, sometimes, however, social innovations follow the technical innovations very slowly until a change happens suddenly within a very short time. I believe we are on the brink of that in geriatrics.

How do you get your colleagues excited about working with digital tools in geriatrics?

Becker: This is not about the "sex appeal" of a new technical method but rather about the additional knowledge that represents an improvement of results for the patients and also a better resource allocation. Therefore, I try to convince them to see this benefit.

What do geriatric assessments typically look like; what is being examined?

Becker: There are two main goals from the older person's point of view. First, 80-90 percent want to still be able to live in their own home and not be forced to move into a nursing home. And second, they would like to maintain a minimum level of personal and physical mobility.

This is also why measuring and defining mobility is a central theme in geriatrics. Today we primarily measure the capacity: how fast and how safely is a person able to walk? Rotational motions or specific motion sequences are being tested with the Timed Up and Go Test for example. The physician or therapist observes, acquires data and tries to detect unsteadiness.
Photo: Older woman walks with a rollator

The walking steadiness of patients is assessed in geriatrics, among other things. Smartphone sensors are able to register things here that would otherwise be invisible to the naked eye; © Burserstraat38

What benefit do smartphones and apps provide in this case?

Becker: The problem with the assessments is that observations are sometimes not objectifiable or that certain things are simply not noticeable with the naked eye. Yet the sensors in smartphones are able to provide this data.

They also help in measuring activity. This is something that was actually not indicated in previous assessments because we want to observe what people do on weekends, at night and at home - that is to say, when physicians, therapists and caregivers are not there. So far, we rely on details the persons provide themselves.

Many studies have shown us for example that walking speed is a great indicator of how great the risk of falls is for a person. Someone who walks very slowly also has a high fall risk. Smartphones let us record how someone moves in everyday life. This goes beyond mere step counting. We are also interested in how smooth somebody walks. That is impossible to accomplish with the naked eye because you need to observe at least 200 steps for an assessment. The prognosis is poor if the gait variability exceeds 4 percent.

How are the devices being used in this case?

Becker: The latest smartphones already feature the technology needed for adequate precise measurements such as accelerometers, gyroscopes and magnetometers. They also need especially certified apps, however. Commercially available apps are designed to detect the motion patterns of younger persons. In the coming years, there are also going to be scientifically validated apps, like the ones from the University of Bologna for example. The smartphone should then only be worn for a certain time on the belt to take a measurement.

What special requirements does geriatrics make on the apps?

Becker: Commercial apps target the consumer and not the healthcare market. Before apps can be used in geriatrics or for older persons to use them for health logging purposes, the visualization and interpretability of data needs to be improved. Data representation needs to be upgraded. This needs to be done by experts. In doing so, older persons might then be able to work with them on their own and derive the corresponding information.
Photo: Timo Roth; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Timo Roth and translated from German by Elena O'Meara.