Kinematic analysis of activities of daily living performance in frail elderly

(2022) 22:244 Schmidle et al. BMC Geriatrics https://doi.org/10.1186/s12877-022-02902-1 Open Access RESEARCH Kinematic analysis of activities of daily living performance in frail elderly Stephanie Schmidle1*, Philipp Gulde1,2, Sophie Herdegen1, Georg‑Eike Böhme3 and Joachim Hermsdörfer1 Abstract Background: Frailty is accompanied by limitations of activities of daily living (ADL) and frequently associated with reduced quality of life, institutionalization, and higher health care costs. Despite the importance of ADL performance for the consequence of frailty, movement analyses based on kinematic markers during the performance of complex upper extremity-based manual ADL tasks in frail elderly is still pending. The main objective of this study was to evaluate if ADL task performance of two different tasks in frail elderlies can be assessed by an activity measurement based on an acceleration sensor integrated into a smartwatch, and further to what degree kinematic parameters would be task independent. Methods: ADL data was obtained from twenty-seven elderly participants (mean age 81.6 ± 7.0 years) who per‑ formed two ADL tasks. Acceleration data of the dominant hand was collected using a smartwatch. Participants were split up in three groups, F (frail, n = 6), P (pre-frail, n = 13) and R (robust, n = 8) according to a frailty screening. A variety of kinematic measures were calculated from the vector product reflecting activity, agility, smoothness, energy, and intensity. Results: Measures of agility, smoothness, and intensity revealed significant differences between the groups (effect sizes combined over tasks η2p = 0.18 – 0.26). Smoothness was particularly affected by frailty in the tea making task, while activity, agility, a different smoothness parameter and two intensity measures were related to frailty in the gardening task. Four of nine parameters revealed good reliability over both tasks (r = 0.44 – 0.69). Multiple linear regression for the data combined across tasks showed that only the variability of the magnitude of acceleration peaks (agility) contributed to the prediction of the frailty score (R2 = 0.25). Conclusion: The results demonstrate that ADL task performance can be assessed by smartwatch-based measures and further shows task-independent differences between the three levels of frailty. From the pattern of impaired and preserved performance parameters across the tested tasks, we concluded that in persons with frailty ADL perfor‑ mance was more impaired by physiological deficiencies, i.e., physical power and endurance, than by cognitive func‑ tioning or sensorimotor control. Keywords: Activities of Daily Living, Frailty, Kinematic Analysis, Wearables, Accelerometry Introduction Life expectancy rapidly increases in virtually all developed countries [1], which consequently leads to a *Correspondence: 1 Human Movement Science, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany Full list of author information is available at the end of the article larger number of older people as well as an altered ratio between young and old. Old age and its complex processes is known to be accompanied by many geriatric phenomena, like multimorbidity [2] disability [3], and frailty [4], which are, as they are quite unspecific concepts, highly interrelated. The phenomenon of frailty has increasingly received attention during the past decades, © The Author(s) 2022. 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The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Schmidle et al. BMC Geriatrics (2022) 22:244 as it has been shown to be linked to adverse health outcomes including falls, delirium, institutionalization, and mortality [4–6]. In a broader sense, frailty is understood as a complex concept consisting of various physical, cognitive, nutritional, and social factors [7, 8], representing a high burden for affected individuals, formal and informal caregivers as well as health care systems [9]. According to the well-known standardized phenotype of frailty by Fried et al. [4], the following five criteria are assessed to determine frailty status: unintentional weight loss, exhaustion, slow walking speed, low grip strength, and low physical activity. To be classified as frail, at least three criteria must be present. In contrast, the presence of one or two indicators is categorized as pre-frail, whereas the absence of any indicator is termed robust. It is assumed that frailty among older persons is a dynamic process which is characterized by frequent transitions between frailty states over time. Within this context, transitions to states of advanced frailty are more common than vice versa (hysteresis) [6]. Therefore, early detection of risks associated with the aging process is important to minimize and/or slow down its negative consequences [10]. In case of frailty, this becomes particularly clear when we take a closer look at the disease-related risks that threaten independency of daily living in older people. Elderly people, categorized as frail, show an elevated risk of disability [5, 11, 12]. Thus, frail individuals demonstrate higher rates of developing or worsening disabilities in mobility as well as in basic (b-ADL) and instrumental (i-ADL) activities of daily living over time. These associations can equally be observed among pre-frail elderly, though with a lower magnitude of effect (e.g., [5, 13–16]). ADL typically involve various self-care activities with different degrees of complexity. In general, b-ADL are defined as ‘activities essential for an independent life or necessary for survival, representing everyday tasks required for self-care’ [10]. Whereby i-ADL cover somewhat a more complex set of behaviors [17] and are more sensitive to early cognitive decline [18]. Limitations of b-ADL are frequently measured using the Katz ADL scale [19] or the Barthel Index [20]. I-ADL, on the other hand, are commonly assessed by the Lawton & Brody scale [17]. Changes in ADL performance (...truncated)