Title: Using body worn sensors to inform data-driven home modifications with the aim of reducing falls risk in older adults
Funder: Dunhill Medical Trust

Abstract: This project proposes the novel use of wearable sensors to gather real-world, in-situ data in order to develop a human-centred design tool for architects and designers, aimed at reducing the risk of falls for older adults in their dwellings. Negotiating living environments comfortably and safely is critical for retaining independence and quality of life. However, falls in the home are a leading cause of injury and mortality in older adults and place a significant burden on healthcare providers. Environmental features such as stairs and obstacles can be problematic for older adults who often have a reduced ability to make appropriate stepping adjustments to accommodate them. In laboratory studies, for example, we have shown that older adults do not adapt as well as young adults when negotiating stairs, especially in poor light and with visually ambiguous step surfaces (e.g. that appear to merge into each other), thus increasing trip and/or fall risk. Importantly, growing evidence suggests that simple modifications to the use and design of older adult spaces can reduce falls risk and enhance useability. We have shown in laboratory-based studies that modifying lighting and step-surface décor can optimise stair walking safety. Moreover, real-world data show that low-cost home modifications/repairs (e.g. incorporating improved lighting and step edge highlighters) reduced fall injuries by 26%. Optimising older adults’ living spaces for useability and safety is thus feasible and important. However, designers often do not have the tools to model their approaches based on meaningful safety data derived from human movement studies. To create appropriate and safe living environments for older adults, we believe a more human-centred and data-driven approach in design evaluation is needed that builds a holistic picture of how older adults interact with their living spaces. Aims: To identify characteristics of living environments that are associated with increased falls risk and/or sub-optimal movement patterns based on real-world data, and to implement optimal home-based modifications that can inform how architects and designers approach post-occupancy evaluations (optimising existing dwellings) and pre-occupancy evaluations (designing new dwellings). Objectives: • Conduct in-situ investigations that monitor occupant behaviour in dwellings over 7-days, with cutting-edge eye tracking and motion capture recording gaze and movement patterns, respectively. • Identify areas of the living environment associated with increased falls risk and/or suboptimal use, e.g. unsteadiness when entering a flight of stairs; reduced cadence; awkward reaching; and/or maladaptive gaze behaviour. • Implement modifications to the occupants' living environments optimised for comfort, accessibility, and reduced falls risk. These may include, but are not limited to, lighting, stairwell décor, grab rails, stair handrails, and layout of communal spaces. • Examine changes to occupant behaviour to assess the impact and efficacy of our modifications, and use knowledge gained to construct real-world guidance for home modifications. • Use 3D models of homes to quantify the relationships between occupants’ gaze and movement patterns within their environment, thus associating geometrical and visual properties to the participants’ experience. This will afford us a novel method for evaluating digital models of living spaces, not only for identifying existing problem areas and how they can be improved, but also for designing new homes using computer-generated models capable of predicting how modifications might influence fall/use outcomes. In the short term, identifying areas associated with falls risk will bring new perspectives to researchers and designers interested in falls prevention, whilst modifying occupants’ dwellings will have immediate benefits to them in respect of reduced falls risk. In the longer term, we will publish and share our evaluation methods (making them accessible to the wider design communities), and this will impact on older adults’ safety more widely through enhanced design practices, able to deliver, i) improved post-occupancy evaluations that identify optimal modifications to existing dwellings, ii) pre-occupancy evaluations for optimising safety and usability in new facilities, thus preventing the need for re-design/retrofitting of new buildings in the future, which is often out of scope for low-cost interventions.

Lay abstract: This project will use new technology to study how older adults move around their homes in order to create a new architecture and design tool that can make homes safer. Comfortable and safe homes are important for independent living. However, home falls are a leading cause of injury and death. Falls are more common in older adults, as age-related changes to the body can make it harder to deal with fall hazards. For example, falls often occur following trips on raised surfaces, yet common eye conditions, such as cataracts, can make it harder to see such hazards. Growing evidence suggests that we can make homes safer, using low-cost changes to their design. These can include things like improving lighting on stairs, and/or modifications to flooring. However, people that design homes often focus on visually pleasing features, e.g. soft or inappropriate lighting, while neglecting safety features, such as stair handrails. One reason for this oversight is that traditional design education (e.g. in universities) rarely focuses on safety research, and designers’ tools needed to inform safety decisions are often limited. We intend to address this issue by developing a new computer-based design approach, where designers can receive guidance on their planned design within their existing software that can generate photorealistic images of homes. We will use this technology to create images that show what an occupant would see as they move around a home. Designers could then ask what features of their design are problematic, with the computer suggesting, e.g. “based on real-world data (from this study), the floor-pattern will reduce (or increase) fall risk”. To achieve this, we must go into older adult homes and use wearable sensor technology to measure how older adults are moving during their everyday activities. We will use this information to identify hazardous areas of their homes. We will then upgrade features of the homes to make them less hazardous, with a team of tradespersons, e.g. by installing appropriate stair décor and/or light bulbs. Finally, we will use our results, and the detailed information that we collect, to build our computer-based design tool. Our research project will have these benefits: 1) make current participants homes safer; 2) reveal how to make homes safer in general; 3) provide new methods for architects/designers to enhance design practice, helping to make new homes safer more widely, and with long-term costs reduced because of fewer changes needed in the future.

Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: GENERIC HEALTH RELEVANCE;INJURIES AND ACCIDENTS