Fall-risk screening system framework for physiotherapy care of elderly W. Rueangsirarak a,b,c , A.S. Atkins a , B. Sharp a,⇑ , N. Chakpitak b , K. Meksamoot b a Faculty of Computing, Engineering and Technology, Staffordshire University, Staffordshire ST18 0AD, UK b College of Art Media and Technology, Chiang Mai University, Chiang Mai 50200, Thailand c School of Information Technology, Mae Fah Luang University, Chiang Rai 57100, Thailand article info Keywords: Elderly falling risks Motion capture technology Case based reasoning abstract In 2008 the global older population (aged 65 and over) was estimated to be about 7% of the world’s pop- ulation; it is estimated to reach 2 billion by 2050 accounting for 22% of the world total population. This demographic trend sets new challenges to health services and policies, and imposes a significant financial and social burden on economies as a whole. The decline in musculoskeletal system in the aging popula- tion is the biggest cause of injury death in older people who require effective physiotherapy treatment. However the current demand for physiotherapists outstrips current supply. To address this problem this paper described an innovative approach which consists of a screening risk assessment of the elderly which can be combined with a case based reasoning system to support physiotherapist in managing the care of the elderly following a fall. Although the study is based on a small cohort of the Thai popula- tion it is believed that this approach can address the shortage of physiotherapists and bring a significant improvement in the health care of older people. Ó 2012 Elsevier Ltd. All rights reserved. 1. Introduction The National Statistics Office of Thailand highlighted that the el- derly population in 2001 represented 9.4% of the total population, and in 2007 it had increased to 10.7%. This concern has found reso- nance in other countries. For example, in the UK, the percentage of the population aged 65 and over increased from 15% in 1984 to 16% in 2009, an increase of 1.7 million people (Office of National Statis- tics, 2009). In USA people over 65 represented 12.4% of the popula- tion in the year 2000 but are expected to grow to be 19% of the population by 2030 (Department of Health & Human Services, n.d.). By 2050, it is projected that the population of China ages 60+ and 80+ will reach 440 million and 101 million, respectively. The global older population (aged 65 and over) was estimated to be about 7% of the world’s population in 2008; however, by 2050, it is projected to reach 2 billion older people accounting for 22% of the world total population (Fig. 1)(Banister, Bloom, & Rosenberg, 2010). Thus, the elderly population is increasing at an alarming rate worldwide. Consequently there is an increasing research activity and governmental strategies addressing the challenging health care issues associated with the aging population. The demands associ- ated with their health care impose a substantial financial and social burden on economies as a whole, because the elderly require more medical care than younger people. This paper focuses on the health care issues of the elderly in Thailand. One of the major changes that occur after the age 50 years old is the decline in muscular strength with losses at an approximate rate of 12–14% per decade (Hurley & Roth, 2000). This decline often leads to falling risks and as a result older people are most likely to suffer serious injuries, disability, psychological consequences and death following a fall. Such injuries represent a large expenditure to the health service. Elderly patients with high risks of falling should undergo a thorough evaluation to determine and treat the underlying causes of a fall and reduce the risk of recurrent falls. Such measures can provide a better quality of life for patients and help their care providers with the enormity of the tasks (Fuller, 2000). A recent survey of the elderly population in Thailand indicated that most of the elders are struggling with the Musculo Skeletal System disorder. In Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, there are many geriatric patients who are experienc- ing an unprecedented level of musculoskeletal disorders (Tongsawad, 1998). Most of the accidents in geriatric patients are related to falling and tripping, and often to hip fractures and head traumas, and increasing the risk of early death (Hayes et al., 1996; Tunmukkayakul, 1983). Additionally, an approximately one-third of community-dwelling elders and approximately 43% of institu- tionalized elders have trouble with falling each year (Welsh, 2006). Tideiksaar (2010) explains that these falls are neither acci- dental nor random events, and can be predictable. Many of the fac- tors that contribute to these falls are potentially amenable to interventions and by reducing and perhaps eliminating the risk factors; falls can be reduced or prevented altogether. 0957-4174/$ - see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.eswa.2012.02.023 ⇑ Corresponding author. Tel.: +44 17 8535 3585; fax: +44 17 8535 3431. E-mail address: B.Sharp@staffs.ac.uk (B. Sharp). Expert Systems with Applications 39 (2012) 8859–8864 Contents lists available at SciVerse ScienceDirect Expert Systems with Applications journal homepage: www.elsevier.com/locate/eswa