Look Homeward
Introduction to Building Blocks for Fall Monitoring Projects
Not every elderly person will fall and fall frequently. According to G.F. Fuller, M.D. [1], the likelihood of falling increases with the number of risk factors acquired by the elderly individual. These factors include changes in medication; poor physical strength and stamina; and failing eyesight. These risk factors have to be noted by individuals seeking to help prevent falls, hand in hand with pinpointing ways to help make the home safe. Conventional and low-tech means for addressing these risk factors are readily available.
For instance, in this safety focus, the Center for Disease Control’s (CDC’s) Fact Sheet: “Check for Safety: A Home Fall Prevention Checklist for Older Adults”[2] points the way to very do-able instructions for professional caregivers’ preventing falls, such installing double railings on stairways, increasing lighting, and rearranging low-standing furniture. The many modifications like these that can be undertaken will help ensure elderly residents’ safety, although those with experience of working with the elderly caution [3] to make only incremental changes over time so as not to introduce too much unfamiliarity in the elderly residents’ own homes. Again, as with so much in home telehealth planning, the need to match the new tools/routines with the elderly clients’ needs and capabilities is central to producing an individualized at-home falls prevention program that will be followed.
The Building Blocks for Fall Monitoring Projects
Possibly for this very reason of individualized need, there are no widely accepted falls prevention programs that can prepare all elderly residents for preventing and avoiding falls in their own homes. However, extensive resources are being made readily available for those planners wanting to access and tailor information for developing falls prevention programs for the elderly. Some of these potential building blocks are:
- Healthsense, Inc. [4]. This package of services offers wireless monitoring for daily activity as well vital sign tracking via telehealth for individuals living at home and in community-based settings that the company’s web site says enable “aging in place.” This company’s E-Neighbor® monitoring system, through its automatic detection of a significant change in an individual’s performance of Activities of Daily Living (ADL) routines, for one, will send alerts to this person’s care providers “to be as proactive as possible in the care of the individual.” The system does not use gait monitoring tools of any sort nor require an obtrusive device that elderly clients must wear. According to the company’s CEO and co-founder, Brian Bischoff, this system represents more than a new
tracking
technology
but also a very
a new approach to integrating
changes into
a person’s lifestyle and care plan (not to mention a new way for clinical staff to interact with patients). As noted by one nurse and new user, Dana O’Donnell [5], Director of Liberty Lutheran Homecare (Ambler, PA), where a pilot program testing Health Sense Technologies is only now beginning (in early 2010), the very regular monitoring of clients’ movements as well as tracking ADL routines such as eating, numbers of trips to bathroom, and blood pressure rates, will provide clinical staff with the needed details for designing individualized fall prevention programs. As O’Donnell noted, the company and staff at Liberty are at a very early stage of learning the system and focusing on the new and needed proactive approach/response required by clinical staff for the system to be deemed successful.
These early interventions, according to Healthsense, Inc. executive Bischoff, are the next breakthrough in healthcare service delivery. They represent the “Tipping Point” for 2010, signaling a need for changing ways to care proactively for the burgeoning numbers of elderly at home or wherever they live.
Aegis Therapies [6] offers a home therapeutic program that can help clients achieve a greater range of motion and higher levels of strength. Such exercises demonstrated by rehabilitation therapists to patients may well help to prevent patients from falling. In all, these exercises target a general weakness in patients that is due to decreased mobility.
Which falls prevention devices/programs work best? The answer is: those that incorporate a tailored focus on a combination of all preventative activities, programs, and devices mentioned above. Take, for example, the explanation provided by Bridget Gallagher [7], SVP of Jewish Home Lifecare (New York, NY), who notes:
We have had a falls program since [the year] 2000. It starts with what we call a FRAT (Falls Risk Assessment Tool) based on a score ( anything above a score of 15 indicates a risk) that helps us identify home and community based clients that may be at risk for a fall and so we attempt to put in preventative measures. These preventative measures include a home safety check (lighting, scatter rugs, etc.) as well as an assessment by a PT who will frequently establish a balance and gait strengthening program….
[Use of electronic tracking devices are part of the program, too. As she explains:]We are currently rolling out two new pilots that include technology as an enhancement possibility to our Falls Management Best Practice.
The first is called HALO, which is a monitor attached to a chest strap with an "accelerator " in it that will alert us if the clients falls at a certain speed toward the ground. The second is the Phillips PERS (Personal Emergency Response System) which also has the "accelerator" technology on their on-call pendant so we are rolling out a pilot with these units as well.
The hope is that we will get more timely and up-to-date information about what is going on with our clients in their homes. Our experience has been that very few clients like reporting a fall, but it is a true Catch-22 because [if they don’t report the fall], we’re not able to put the preventative measures in that can help them avoid the next fall….
[The work in avoiding/preventing falls is ongoing. Gallagher notes:] There are so many factors that can put an older person at risk for falls...so there is the story of the client who was reporting multiple falls in the home but the day center team did not see any falls at the center. However, when we made a home visit, we discovered an extremely cluttered apartment, which was a real walking hazard even for our staff. We were able to arrange heavy duty cleaning and subsequently completely reduce the risk of falls for this client.
Many times there is a knowledge deficit of what equipment/lifestyle changes can increase safety…your favorite chair for the past 20 years may no longer be the safest place for you to get up and down in now that your 80...if you have had a fall, there is a human tendency to walk less in a mistaken attempt in avoiding a repeat, when a regular exercise program with plenty of walking established by one of our PTs is a much more likely plan to prevent the next fall.
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Conclusions, for now: There are no standard programs that are used particularly by those in home healthcare service delivery for preventing falls at home, according to many recent interviews undertaken by the author of this page. Instead, what appears to be key to preventing falls among the elderly is using a combination of telehealth measures as needed (blood pressure monitoring, gait assessment) and usual preventative measures such as ensuring elderly clients have annual eye check-ups, performing regular medication reviews, encouraging exercises, and making home modifications, as needed and wanted. From all of these building blocks, a sound, individualized preventive falls program can be created for elderly residents at home. It is, frankly, a low-tech Do-It-Yourself venture that nonetheless needs to be undertaken for ensuring the safety of each, very individual elderly resident living at home.
Links:
- Fuller, G.F. (2000). “Falls in the Elderly,” American Family Physician 61 (7): 2159-2168.
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- Retrieved Feb. 10, 2010, from:
http://www.cdc.gov/Ncipc/pub-res/toolkit/CheckListforSafety.htm
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- See, for instance, Fuller (2000), who notes that “normal physical and mental changes related to aging (but not associated with disease) decrease reserve function. As a result, elderly patients become more susceptible to falls when they are confronted with any challenge.”
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- Retrieved Feb. 1, 2010, from: http://www.healthsense.com/index.php/home-a-community-based-services
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- Telephone interview with Audrey Kinsella, Feb. 23, 2010.
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- Retrieved Feb. 3, 2010, from: http://www.aegistherapies.com/services-outcomes/aegis-at-home.aspx
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- Information sent by B.Gallagher via email, to Audrey Kinsella, March 1, 2010.
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