Serving an aging population
Gerontechnologist Lawrence Normie describes his work on devices that improve the lives and health of older adults
Is it possible, within a few minutes before the event, to predict a fall in someone who has a medical condition affecting their balance and stability? And can these predictions be made reliably enough for preventive measures to be taken? As a "gerontechnologist" working at the Israeli Center for Assistive Technology and Aging, GeronTech, these are the kinds of questions I am attempting to answer. The problem is an urgent one. Each year, falls due to age-related postural and walking instability lead to thousands of serious injuries among people over the age of 60. For people over the age of 75, the statistics are especially disturbing: in around one-third of falls by over-75s that result in a hip fracture, the prognosis is death within 12 months.
Faced with this problem, dozens of groups in academia and industry are attempting to develop ways of preventing falls. Many commercially available devices can already detect falls when they happen, usually via a combination of a tri-axial accelerometer (similar to those found in gaming-console motion sensors) and a digital signal controller programmed with algorithms representing typical acceleration profiles of falls. But being able to predict – and then prevent – a fall before it happens is much harder. This is partly because falls among older people have so many causes. For example, they may occur because of a sudden drop in blood pressure, a problem with the inner ear's balance mechanism (vestibular disorder) or the effects of degenerative neurological disorders such as Parkinson's disease. Medications prescribed to manage various age-related diseases can also disturb balance and stability.
The solution we are developing at GeronTech, in common with those of other groups, employs inertial sensors (MEMS accelerometers and rate gyroscopes) along with a suite of physiological sensors that monitor heart and breathing rates, blood oxygen saturation, skin conductivity and muscle tone (via an electromyogram). Eventually, we hope to add piezoelectric sensor arrays embedded in the patient's shoe insoles, in order to monitor relative load distribution on the legs and feet.
We do not expect eventually to incorporate all of these physiological sensors into a commercial device, since they would be inconvenient, cumbersome and uncomfortable to attach every day. Instead, we hope to identify sufficient correlations between salient kinematic and physiological parameters that we can "train" a fall-prediction algorithm to function using data from the less-intrusive inertial sensors alone. For instance, during the moments preceding a fainting or vestibular disturbance episode, we might expect to identify subtle yet characteristic changes in gait and posture that indicate high risk of an imminent fall.
A new and growing field In general, gerontechnologists work to improve quality of life among older adults by developing technological solutions to problems they experience in daily life. Some of us also work on adapting the environment to be accessible to, and more inclusive of, older citizens and people with disabilities. Familiar examples of "inclusive design" include curb-kneeling buses that enable people in wheelchairs to board, audible signals at pedestrian crossings and large, simplified-format ATM screens for people with impaired vision.
As a formal discipline, gerontechnology is barely 20 years old. It is also highly multidisciplinary, as biomedical, mechanical, electronics and computer engineers work together with ergonomists, industrial designers, psychologists, ethicists and physicists to solve problems. For these reasons, there is no formal qualification that one can obtain to be called a gerontechnologist, and my own route into the field was far from direct.
After completing a BSc in pure and applied physics at the former University of Manchester Institute of Science and Technology (now part of the University of Manchester), I became a systems engineer in the radar guided missiles group at Marconi Defence Systems. The company supported me through a part-time Master's course in microwaves, communications and modern optics at University College London, and after just over four years I joined a defence consultancy, CAP Scientific. While at CAP I quickly fell into the role of cross-group "house doctor" and troubleshooter for technical problems related to radar, sonar, optical and other types of military sensors.
After immigrating to Israel at the end of the 1980s, I initially joined the naval radar group at Israel Aerospace Industries. But eventually, I decided I'd had enough of the defence industry, so I started a hi-tech industrial consulting partnership with a friend from the UK. As is common in consultancies, my assignments varied a lot, but over the years I became increasingly involved in rehabilitation engineering – a field that concerns the development of technologies to help patients recover their motor, sensory or cognitive function. So when I spotted an advertisement in 1998 for a director to help develop and lead a new centre for assistive technology and ageing, it seemed like a good way of combining my know-how on rehab engineering and the business and marketing experience I had acquired as a consultant.
Varied skill set As the executive director of a small non-profit research centre, my resources are limited, so my daily responsibilities extend considerably beyond management and administration. Virtually all of the projects we work on, including those where we collaborate with other research institutions, require my hands-on involvement. This makes my job both incredibly interesting and very challenging, as I need to constantly keep abreast of gerontechnology's diverse knowledge areas.
A typical work week entails writing, editing, or reviewing scientific manuscripts, mentoring engineering and industrial design students, writing grant proposals, participating in technical committee meetings, updating the centre's website and – if I am lucky – finding enough spare time to work at the bench on various electronics or electronic encephalography projects. I also spend several weeks each year working as an independent expert for the European Commission's framework programmes for trans-European collaborative research and development, which have allocated considerable sums of money in gerontechnology-related grants over the past decade.
Both my undergraduate training in physics and my postgraduate degree in electronics contributed to the skill set my job requires, and my experience of systems analysis and technical project management has been very useful, too. Perhaps more surprisingly, much of my work in the defence industry has also proved relevant. For example, in addition to the falls prediction system described above, I am developing a nine-degrees-of-freedom inertial sensor body-area network for measuring and logging movement disorder patterns in people with Parkinson's disease. This involves techniques that are similar to those used in the design of inertial guidance systems for aerospace platforms such as guided missiles, since it requires a thorough understanding of (among other things) how to apply Euler angles and quaternions to describe the equations of motion for rigid bodies. In this respect, I like to say that I am turning swords into ploughshares.
To new physics graduates (or postgraduates) considering a career in gerontechnology, I would recommend finding a suitable academic position at one of the many universities, either in Britain or overseas, that have multidisciplinary units working on relevant projects. If you are already enrolled at an institution that operates such a programme, so much the better. A graduate physicist who chooses to work in the field will find that they have considerable flexibility and latitude to specialize in a wide variety of sub-disciplines, many of them well suited to the analytical problem-solving type of training given in physics courses.
For physicists like me who entered gerontechnology mid-career, the academic option may not be feasible. Nevertheless, the world's ageing population means there is a growing demand for a physicist's skills among private research institutions, start-up companies and even some large consumer electronics and telecommunications firms that engage in gerontechnology R&D. If you have acquired management, marketing and perhaps also legal experience along the way, opportunities in the field are even broader. The gerontechnology field is still young and flexible enough to accommodate the skills of a physicist in numerous roles, as we seek to meet the challenge of ageing well.
Further information: If you want to know more about gerontechnology, I recommend the following organizations:
- The International Society for Gerontechnology (ISG) Founded in the early 1990s by a group of like-minded engineers, scientists and psychologists, the ISG convenes a biennial international conference, organizes regular master classes for PhD students and publishes a quarterly peer-reviewed journal, Gerontechnology, of which I am an associate?editor. (www.gerontechnology.org)
- The Gerontechnology (ISG) LinkedIn group I administer this group, which currently has more than 900 members, on behalf of the ISG (you don't need to be a member of the ISG to join). The group provides a platform to exchange information and opinion (usually based on current and topical news items from the academic and clinical literature) and also hosts notifications about meetings and conferences.
- The Association for the Advancement of Assistive Technology in Europe (AAATE) Like the ISG, the AAATE holds regular conferences and workshops, and it also publishes a peer-reviewed journal, Technology and Disability. (www.aaate.net)
Lawrence Normie is executive director of GeronTech in Jerusalem, Israel, www.gerontech.org, e-mail email@example.com