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

University of Toronto, Toronto, Ontario, Canada
Academic Emergency Medicine (Impact Factor: 2.01). 05/2007; 14(4):301-8. DOI: 10.1197/j.aem.2006.11.017
Source: PubMed


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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    • "However, the sample may have been biased as there were a large number of potential participants who declined to participate, and those selected for participation may not have been those who were most likely to benefit from a PERS, e.g. those with high baseline levels of anxiety (Lee et al., 2007). "
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    • "The self-administration and short completion time makes the HADS an attractive instrument for use in trials. It is, however, difficult to interpret treatment effects because the minimal important difference of the HADS it is not known[11] "
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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.
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    ABSTRACT: As the demographic of older people continues to grow, health services that support independence among community-dwelling seniors have become increasingly important. Personal Emergency Response Systems (PERS) are medical alert systems, designed to serve as a safety net for seniors living alone. Health care professionals often recommend that seniors in danger of falls or other medical emergencies obtain a PERS. The purpose of the study was to investigate the experience of seniors living with and using a PERS in their daily lives, using a qualitative grounded theory approach. Five focus groups and 10 semi-structured interviews, with a total of 30 participants, were completed using a grounded theory approach. All participants were PERS subscribers over the age of 80, living alone in a naturally occurring retirement community (NORC) with high health service utilization in a major urban centre in Ontario. Constant comparative analysis was used to develop themes and ultimately a model of why and how seniors obtain and use the PERS. Two core themes, unpredictability and decision-making around PERS activation, emerged as major features of the theoretical model. Being able to get help and the psychological value of PERS informed the context of living with a PERS. A number of theoretical conclusions related to unpredictability and the decision-making process around activating PERS were generated.
    BMC Geriatrics 07/2015; 15(1):81. DOI:10.1186/s12877-015-0079-z · 1.68 Impact Factor
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