As falls and fall-related injuries remain a major challenge in the public health domain, reliable and immediate detection of falls is important so that adequate medical support can be delivered. Available home alarm systems are placed on the hip, but have several shortcomings. A fall detector based on accelerometers and placed at head level was developed, as well as an algorithm able to distinguish between activities of daily living and simulated falls. Accelerometers were integrated into a hearing-aid housing, which was fixed behind the ear. The sensitivity of the fall detection was assessed by investigation into the acceleration patterns of the head of a young volunteer during intentional falls. The specificity was assessed by investigation into activities of daily living of the same volunteer. In addition, a healthy elderly woman (83 years) wore the sensor during the day. Three trigger thresholds were identified so that a fall could be recognised: the sum-vector of acceleration in the xy-plane higher than 2 g; the sum-vector of velocity of all spatial components right before the impact higher than 0.7 m s(-1); and the sum-vector of acceleration of all spatial components higher than 6 g. The algorithm was able to discriminate activities of daily living from intentional falls. Thus high sensitivity and specificity of the algorithm could be demonstrated that was better than in other fall detectors worn at the hip or wrist at the same stage of development.

Power has been demonstrated to be an early and potent marker of frailty. The measurements currently available are tied to locality. Usually, measurements include single joint movements or movements of only the legs and the resistance is not adjusted for body weight. In this study, a portable method to measure power in the sit-to-stand transfer was developed and tested. Mean power was calculated from the vertical ground reaction force of body weight, the difference between height in a sitting and in an upright position and the time taken to stand up. The results of this power measurement were compared with an isokinetic force measurement, the "Nottingham power rig", and measurement of physical performance in a five-repetition chair rise (five-chair rise). A convenience sample of 33 healthy elderly subjects [mean (SD) age: 67.8 (6.7) years; 17 men, 16 women] was included. Measurement of power during the sit-to-stand transfer showed good correlation to isokinetic force measurement (r=0.68) and to the "Nottingham power rig" (r=0.6). Correlation to five-chair rise was poor (r=-0.08). In conclusion, the study shows that the method presented is able to measure power during performance of a daily task. The poor correlation between the introduced measurement and the five-chair rise suggests that it might be able to detect decline in muscle function earlier by the introduced measurement than by measurement of the functional status. As it is inexpensive and portable, its use in clinical practice and research contexts, including home-bound individuals, is feasible.

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Variables related to coordination of strength, measured during STS transfer, were able to explain a high proportion of variance of time to rise from a chair. Stabilization after reaching an upright position seems to be a parameter worth further investigation.

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