A randomized clinical trial to assess the impact on an emergency response system on anxiety and health care use among older emergency patients after a fall.
ABSTRACT Personal emergency response systems (PERSs) are reported to reduce anxiety and health care use and may assist in planning the disposition of older patients discharged from the emergency department (ED) to home. This study measured the impact of a PERS on anxiety, fear of falling, and subsequent health care use among older ED patients.
This study was a randomized controlled trial comparing PERS use with standard ED discharge planning in subjects 70 years of age or older discharged home after a fall. Outcome assessors were blinded to the study objectives. Anxiety and fear of falling were measured at baseline and 30 days using the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) and modified Falls Efficacy Scale (mFES). Return to the ED, hospitalization, and length of stay were recorded after 30 and 60 days.
Eighty-six subjects were randomized and completed follow up (43 per group). There was no important difference in mean reduction in anxiety (mean change treatment - control, +0.35; 95% confidence interval [CI] = -1.5 to 0.76; p = 0.55) or fear of falling (mean change, +4.5; 95% CI = -6.7 to 15.7; p = 0.70). Return visits to the ED occurred in eight of 43 patients in both the control and treatment groups (risk difference, 0.0%; 95% CI = -16% to 16%). Hospitalization occurred in six of 43 in the control group versus three of 43 in the treatment group (risk difference treatment - control = -7.0%; 95% CI = -19.8% to 5.9%).
In contrast to previous studies, there was no evidence that a PERS reduced anxiety, fear of falling, or return to the ED among older persons discharged from the ED.
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ABSTRACT: As part of a larger study on fall-related risk factors, this study investigated the relationship between living alone status and fall-related variables among community-dwelling adults who lived in a rural county in eastern North Carolina. A convenience sample of 666 community-dwelling adults ages 50 and over participated in this 4-year study and completed a fall questionnaire. Significant findings were found in relation to living alone status and experiencing a fall, who they informed about their fall, injuries, safety equipment, ambulatory devices, and personal emergency response system usage. Three hundred thirty-eight participants stated they lived alone, compared to 300 who lived with others. The percentage reporting a fall was appreciably larger for those living alone (52%) than for those living with others (48%) in both genders in all age groups except for the 61-70 year old adults where the percentage was less. Findings from this research enhance knowledge about the prevalence and contributing fall-related factors in adults who live alone compared to those who live with others. Insights gained from this research will assist community and public health leaders and health care professionals in developing more efficacious intervention strategies to prevent or reduce falls, and associated psychological and physical consequences.Journal of Community Health 04/2009; 34(4):301-10. · 1.28 Impact Factor
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ABSTRACT: Interpretation of the Hospital Anxiety and Depression Scale (HADS), commonly used to assess anxiety and depression in COPD patients, is unclear. Since its minimal important difference has never been established, our aim was to determine it using several approaches. 88 COPD patients with FEV1 </= 50% predicted completed the HADS and other patient-important outcome measures before and after an inpatient respiratory rehabilitation. For the anchor-based approach we determined the correlation between the HADS and the anchors that have an established minimal important difference (Chronic Respiratory Questionnaire [CRQ] and Feeling Thermometer). If correlations were >/= 0.5 we performed linear regression analyses to predict the minimal important difference from the anchors. As distribution-based approach we used the Effect Size approach. Based on CRQ emotional function and mastery domain as well as on total scores, the minimal important difference was 1.41 (95% CI 1.18-1.63) and 1.57 (1.37-1.76) for the HADS anxiety score and 1.68 (1.48-1.87) and 1.60 (1.38-1.82) for the HADS total score. Correlations of the HADS depression score and CRQ domain and Feeling Thermometer scores were < 0.5. Based on the Effect Size approach the MID of the HADS anxiety and depression score was 1.32 and 1.40, respectively. The minimal important difference of the HADS is around 1.5 in COPD patients corresponding to a change from baseline of around 20%. It can be used for the planning and interpretation of trials.Health and Quality of Life Outcomes 01/2008; 6:46. · 2.27 Impact Factor
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ABSTRACT: Purpose – The aim of this review is to explore recent literature regarding the development of fall detector technology as part of a service evaluation on the use of fall detectors across the region funded by NHS West Midlands. It also aims to explore the application and the use of products designed to detect falls and alert for help from end-user and health and social care staff perspectives. Design/methodology/approach – A comprehensive review of the literature of the last ten years was conducted, search terms were used to identify relevant literature from research databases and the main themes from the literature were summarised. This work was carried out to inform a service evaluation of the use of fall detectors across the West Midlands region and was funded by NHS West Midlands. Findings – It was found that whilst there are a wide variety of new technologies regarding fall detectors in development, the range of technologies currently available through health and social services to users are limited. Health and social care staff appear to be less convinced of the benefits of fall detectors than end-users. There was also a lack of robust evidence regarding different approaches to technology in the management and detection of falls. Users had mixed views regarding the use of fall detectors, with some people having concerns about privacy, lack of human contact, user-friendliness and appropriate training, whilst others clearly identified the benefits of detecting falls and raising an alert. The implications of these findings for practice are discussed. Originality/value – This paper will be of value to those working in falls services, telecare or industry partners developing fall detector technology.Journal of Assistive Technologies. 09/2012; 6(3):202-215.