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Business Clinic
Striking a balance: mobile apps to reduce falls

Falls prevention is an important and growing area of providing services in adult social care, particularly in older people’s care provision. Nymbl has developed a system to support people and providers in this area.

Research shows that a third of people over the age of 65 fall at least once a year. Falls cost the NHS over £2bn per year and over 4 million bed days. The emotional impact of falling frequently leads to reduced mobility, fear of falling again and social isolation. An ageing population and increasing demands on services means that finding a solution to this issue is critical.

Nymbl is a balance measurement and improvement programme with apps and an intelligent portal designed to reduce the risk of falls in older people. The idea was born when Caroline Owen Jones and Tom Virden met retired spine surgeon, Dr Jean-Pierre Farcy who wanted to communicate his clinical experience as widely as possible with the people who needed it most.

Part of the knowledge he wanted to share was around the importance of balance as an indicator of a person’s state of health, as well as the ability to predict someone’s future state of health. He knew there was an opportunity to use smartphone technology to deliver the dual-task interventions, combining isometric poses with cognitive load, that had proved successful amongst his patients but needed support to see this vision through to reality. Caroline and Tom together with Jim Cook, Ed Likovich and a team of experts in technology and science, created Nymbl.

How does it work?

With funding and grants, the team developed two mobile apps. One of these, Nymbl Pro, evaluates balance based on CDC Steadi protocols and Dr Farcy’s expertise, and the other is for balance training.

Health and care providers use Nymbl Pro, a balance evaluation app, to assess a person’s current abilities. This assesses the person’s strength and static and dynamic stability. The user is then given a numerical baseline score which they should see improve over time as they train.

Once they have established their baseline, the user will move onto either the Nymbl Training app or take part in Nymbl Classes, or both. The training app allows a person to carry out dual-task training exercises in their own home. It progresses the person’s training levels based on their performance and engagement with the app. If the user prefers to engage in group activities, they can attend a Nymbl Class, which focuses on dual-task training as a shared experience. Nymbl has found that the average engagement in traditional balance classes is less than 10%, whereas a Nymbl Class boasts more than three times that figure.

The person’s progress is trackable remotely, so family and professionals can see engagement and improvements. The app also has an intelligent alerting system, which can provide warning if someone is at a high risk of falling. This approach improves outcomes at an individual level, encouraging intervention before emergency situations arise.

A difficult sector

The roll-out of Nymbl has seen some challenges. ‘We are fortunate compared with many other businesses in that the problem we are addressing is universally agreed upon and we were very quickly able to show the effectiveness of our solution,’ says Caroline, Nymbl Co-Founder.

Chief Executive Officer, Ed Likovich goes on to describe the difficulty of targeting the social care sector, saying, ‘One challenge is the adoption of technology in this market, but the company’s progress has been helped by the increasing penetration of older adults owning smart devices in their home, passing the 50% threshold in 2018.

‘A further challenge lies in designing apps in a way that older adults understand and are comfortable with.

‘There was a pervasive market belief that older adults were fearful of technology. What we found through focus groups is that the fear was based more on the complexity of the interface and the fear of breaking the device. We initially had three buttons and we found that it produced anxiety. Moving to a single button design brought dramatic results, for example a greater than 90% adoption by those who tried using it.’

The design of the apps was pivotal in ensuring engagement, and the Nymbl team have paid close attention to the experience of the users. Caroline says, ‘Working in older adult focused design is more than interface, even the colour palette matters for those with macular degeneration, requiring careful design regarding contrast, font size, leading and tracking.

Many of the conventions, common across all IOS/Android apps, are well understood in the younger population but entirely foreign to older adults. This means every aspect of the client engagement with the technology has to be thoroughly interrogated.’

Encouraging participation

The results from users so far is promising. Studies into user engagement conducted by Imperial College London have found that more than 25% of those offered the programme started using it. At 21 days of participation, the users can expect improvements in their balance and postural sway area reduced by 37%. At 30 days, studies amongst care home cohorts show a 28.3% numerical baseline score improvement, resulting in a 50% reduction in the number of people at an increased risk of falling.

Participation tends to be sustained, with 87% of independent living and care home residents completing at least three days a week of training, and at six months, over two thirds of those community members are still participating.

Nymbl’s aim for the future is to continue to develop and improve balance and prevent falls, particularly in older adults who don’t go to the gym.

Over to the experts…

How can Nymbl be applied in different care settings? What are the drawbacks? How does it differ from systems that are already being used?

Could make a huge difference

In an ageing society, technology can make a huge amount of difference to people requiring a bit of extra support at home, as well as benefitting the family members or friends looking after them.

A fall can have a huge impact on a loved one’s confidence and independence. Carers tell us that the risk of their loved one falling when they’re not around is what worries them the most, so prevention technologies have a key role to play in providing much needed support and reassurance.

Being able to see how a loved one’s balance is progressing, or being notified that they are at a higher risk of falling than usual, would be extremely helpful in falls prevention.

This kind of technology can help to relieve worry when carers go about other daily plans, like going to work, staying in touch with friends or simply taking a much-needed break to recharge. As well as allowing carers more freedom, it can also give loved ones peace of mind knowing they are being supported from a distance.

Falls prevention devices are just one asset in a range of technologies that can help make life easier for carers and enable those they support to live independently for longer. Tools that monitor medication or gas detectors, for example, could help reduce unplanned visits or hospitalisation. Devices that allow you to control the home environment can be useful if a loved one has difficulty controlling appliances, reaching for curtains or using doors. Other technologies like remote monitoring and alerts, remote healthcare and technology to improve physical health can all help.

For a guide to the technologies out there that can support carers, see Carers UK’s technology guide ‘What can tech do for you?’

Madeleine Starr MBE, Director of Business Development and Innovation, Carers UK 


A step towards improving care quality

Falls are one of the major factors contributing towards the increased level of hospital admissions amongst older people. The NHS says that people over the age of 75 are most at risk of being admitted to hospital as a result of a fall. The use of smartphone apps by residents and care workers provides an opportunity to prevent falls and hospital admissions.

By using smartphone technology, Nymbl can attack the problem at its source and enable people to improve their balance whilst encouraging exercise. The key to Nymbl’s success will be the ease of use of the app.

Smartphone apps have already proven their success by making monitoring fluids in real-time a reality. Care homes can see which residents have not had sufficient fluids and take appropriate action, reducing falls caused by dehydration by up to 33%.

The use of smartphone technologies, such as Nymbl, clearly demonstrates the vast opportunities which are available for preventative care – improving the quality of care for those in independent living or a care home.

It is important that we promote the growth and use of digital technologies in the social care sector and ultimately improve the quality of care delivered, but as Nymbl has found, this can be difficult. Our Association aims to help with this, by promoting this message to the NHS and central Government so that providers can be supported to adopt technology.

Innovative apps like Nymbl will make a real difference for both care workers and those in social care, reducing hospital admissions and improving people’s quality of life, and it’s important we get the message out there.

Robin Wells, Founding Director, Care Software Providers Association (CASPA) and Director, Person Centred Software  


A person-centred solution

The main difference between Nymbl and more traditional balance trainers is the integrated, person-centred approach.

If technology is done right, it is person-centred. Good technology and digital solutions used in health and social care should have a positive impact on the people receiving support, their family and professionals involved in their care.

Nymbl has considered the ability of its users when designing the system and has carried out research to ensure that the user experience (UX) is positive and does not cause anxiety. They have designed it from the start with the end user in mind.

Importantly, Nymbl has also incorporated evidence-based face-to-face classes into its offering, with Nymbl Classes also being available. These have themselves shown higher engagement than traditional balance classes. Initial results show promising participation and baseline score improvements and high levels of continuing participation after several months.

Nymbl has the potential to be implemented in a variety of settings from residential care, to homecare, supported living to respite day care, especially if it is used in conjunction with group Nymbl Classes. It has the potential to improve not just balance and falls risk, but also feelings of loneliness and isolation.

Current falls prevention strategies are often piecemeal and don’t offer an integrated approach. Nymbl offers users, their family, and those involved in their care the opportunity to collaborate in improving a person’s balance and reducing their chances of falls.

A key challenge for Nymbl will be encouraging widespread access to the Nymbl Classes to ensure that even the most geographically isolated users can benefit.

Claire Sutton, Digital Transformation Lead, National Care Forum 


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