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Vulnerable elderly populations and the socio-economic impact

Frailty is a state of high vulnerability, cumulating adverse health outcomes and can be defined according to Fried as «a physiologic state of increased vulnerability to stressors that results from decreased physiologic reserves, and even dysregulation, of multiple physiologic systems». Whether this state could first be silent, «when loss of reserve reaches an aggregate threshold that leads to serious vulnerability, the syndrome may become detectable by looking at clinical, functional, behavioral, and biological markers». Geriatricians have proposed a frailty index to identify people at high risk of frailty.
A senior can be ranged as frail when he/she cumulates at least three of the five following factors: a) generalized weakness, b) poor endurance, c) weight loss and/or undernourished, d) low activity (even homebound), and e) fear of falling and/or unsteady gait. Indeed, falls are particularly common and burdensome in the elderly population (Palumbo 2015). According to WHO, every year 37.3 million falls that are severe enough require medical attention. They represent a serious public health and socioeconomic problem due to high healthcare costs (annual cost of $31 Billion in the US only) and have a major impact on affected patients (Hartholt 2011). On the other hand, mild cognitive impairment (MCI) is a state of cognitive functioning that can be classified between healthy aging and dementia.
Such a cognitive decline may appear due to pre-dementia symptoms such as memory failure or result from a variety of other etiologies. The prevalence of MCI is set to lie between 15% to 20% for seniors (60+ years) and the annual rate of progression of MCI towards dementia reach 8% to 15% (Petersen 2016).

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Project Overview

This program will be accessible through a mobile application. Thanks to their links with everyday life, the exercises proposed aim to extend the independence of seniors living at home. To validate the effects of the program, a randomized controlled trial will be conducted in Switzerland, Belgium and Canada among 128 people aged 60 and over. The physiotherapy department of the Haute Ecole de Santé Valais developed the physical exercises, the cognitive exercises are developed by the Leenaards Memory Center of the CHUV in collaboration with the Institut Universitaire de Gériatrie de Montréal. The application is developed jointly by the Institute of Information Systems of the HES-SO Valais in Sierre, by the Applied Imaging Institute of HE-Arc in Neuchâtel and by MindMaze, Lausanne. This project brings together health professionals and technicians in the service of seniors' autonomy.

Expected results and impact

StayFitLonger has impacts on several levels. From a socio-economic perspective, StayFitLonger contributes to the Europe2020 aims of smart growth by developing sustainable growth – the project might for example help to reduce commuting from home to therapy centers by increasing the amount of home-based therapy. Aging does not just affect patients themselves, but also their families. Both the extra responsibility of taking care of a loved one and the psychological impact represent a burden for family members. Our goal is to slow down the progression of physical and cognitive decline. By monitoring and assisting patients, StayFitLonger will not only improve the quality of life of the patients themselves, but also reduce the burden on the people around them.

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Results and Impact

Stay Fit Longer is a mobile platform including a fall prevention program consisting of physical and cognitive exercises, developed by physiotherapists and neuropsychologists. Throughout the duration of their training, users are accompanied by a virtual guide and each senior can adapt the exercises according to their preferences and interests (e.g., level of difficulty, virtual guide appearance, topic of the quiz). The wide variety of fun activities, real-time feedback on physical and cognitive exercises, psychoeducation content as well as remote performance monitoring by healthcare professionals are added values of this program.

Stay Fit Longer is the first computerized multidomain intervention for healthy aging at home whose effectiveness has been scientifically demonstrated. The program has been validated in a randomized clinical trial that included 128 healthy (robust and fragile) participants aged 60 years and older in three countries. Participants adhered to the program for twelve months. The study results show significant cognitive benefits of the Stay Fit Longer program for all participants, especially for fragile seniors after six months of training. The program also reduced the fear of falling, reduced difficulties encountered in activities of daily living and improve the quality of life of users. The participation rate was very satisfactory, with 95% of the users willing to recommend the program to their pairs.

These results represent a strong support for commercialization as the healthcare professionals consulted as well as the study participants unanimously agree on scientific evidence being a must for adoption of the solution. The consortium has an international and industrial partner responsible for introducing Stay Fit Longer to the market, who is currently evaluating different commercialisation strategies.