The Pages section of GPnotebook comprises more than 30,000 concise, interlinked clinical reference articles, each focused on a specific primary care topic.
Technology seems integral these days to the practice of medicine, and while usage is of course variable, the older adults that I see in my practice seem more comfortable with the latest smartphones and other devices than ever before. From online support programmes to portable electrocardiography devices, it is very interesting to see how new technology can benefit people’s health and wellbeing.
Experiencing a fall can have serious effects on older adults, leading to physical injuries, reduced confidence, loss of independence and even an increased risk of death. Tools that help prevent falls are both important and intriguing. That’s why I was keen to read a recently updated GPnotebook page about research on using smartphones for balance and gait assessment. The update is available here.
So what is this all about? The updated page notes that balance and gait algorithms on a smartphone use built-in inertial sensors such as accelerometers and gyroscopes. An accelerometer can detect the impact of footsteps and the up-and-down motion of the body’s centre of mass, and a gyroscope looks at body sway during balance tasks and rotational movements during turns while walking.
The sensor data are filtered and processed using algorithms to produce clinically relevant gait and balance parameters. The suggestion, then, is that this results in the ability to quantify stability during standing and to extract metrics such as stride length, step time and walking speed. Indeed, one study published in 2024 provided evidence for smartphone-based assessment being a valid and reliable method to assess standing balance.
The updated page also examines 2023 research on Apple’s “walking steadiness” indicator, a feature available on the iPhone 8 or newer models. This tool is widely recognised and validated for gait analysis. I found this notable since many people already carry this technology in their pockets.
When carried in a pocket or near the waist, the app that was studied monitors a variety of mobility metrics, including walking speed, asymmetry, the double support time (how long both feet are on the ground for), and walking step length. This app provides a “fall risk assessment”, giving users a predictive “walking steadiness” score (high, OK, or low) that estimates their fall risk over the next 12 months. It also has a function where users can receive notifications if their score is low.
The study suggested that the application provides good information in adults and older adults but was less reliable in children.
The updated page also highlights another study that examined how smartphones can be used to assess gait in patients with cerebral small vessel disease (CSVD). Although this research focused on a specific group, I found it particularly interesting.
The study evaluated how effectively smartphones combined with deep learning can detect gait events. The authors demonstrated that this method can reliably distinguish gait differences among healthy older adults, individuals with mild cognitive impairment, people with Parkinson’s disease, and those with CSVD during both single-task and dual-task walking. They suggested that the smartphone-based gait analysis is user-friendly and cost-effective and that it facilitates detection, making it promising for use in remote rehabilitation management, clinical assessment and related areas.
I have to say that while not broadly included in guidelines to this point, I think the development of these tools is very interesting and hopefully will show promise in the future.
In the meantime, I have mentioned this to a few family members to try out and would be tempted to mention it to interested patients – although we do not yet know the long-term role of this technology.
Another recently updated page along the same theme of maintaining and maximising function concerns the role of exercise in osteoarthritis.
I also found useful a page updated last year on the benefits of exercise in older adults, which are numerous. If you are looking for an Irish-based resource for older people on exercise at home, this page has some great home workouts.