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“Low-Tech” Personal Emergency Response Systems Reduce Costs and Improve Outcomes
Abstract
A relatively inexpensive low-technology solution can be used by managed care organizations (MCOs) to improve outcomes and significantly reduce health care costs among community-residing elderly patients. Clinical studies indicate that usage of monitored Personal Emergency Response Systems (PERS) reduce mortality rates by nearly four times, reduce hospital utilization by 59 percent, and yield a positive benefit-to-cost ratio of over seven to one (every dollar spent on PERS results in $7.19 in health care cost savings).
... Personal emergency response systems (PERS) or so-called home alarm systems support elderly persons to age-in-place by providing them with immediate access to emergency assistance. PERSs can relieve anxiety, enhance feelings of security, and improve the general quality of life of elderly people living alone [2,12]. Clinical studies showed that usage of PERS can reduce hospital utilization rates among community-residing subscribers [24] and yield a positive benefit-to-cost ratio [2,25,26]. ...
... PERSs can relieve anxiety, enhance feelings of security, and improve the general quality of life of elderly people living alone [2,12]. Clinical studies showed that usage of PERS can reduce hospital utilization rates among community-residing subscribers [24] and yield a positive benefit-to-cost ratio [2,25,26]. Meanwhile, three generations of telecare technologies have been developed. ...
... The present study aimed for four objectives: (1) in a sample of German PERS subscribers, the level of satisfaction by using different satisfaction measures was evaluated, (2) to examine the wearing time of the portable help button when alone at home in everyday life as well as the use of PERS after falls, (3) to elaborate the rela-tion between satisfaction and PERS subscribers' use of PERS in daily life, and (4) as a minor aspect, to investigate the psychometric properties of the German translation of QUEST 2.0 with regard to its applicability for this target group. ...
... Personal emergency response systems (PERS) or so-called home alarm systems support elderly persons to age-in-place by providing them with immediate access to emergency assistance. PERSs can relieve anxiety, enhance feelings of security, and improve the general quality of life of elderly people living alone [2,12]. Clinical studies showed that usage of PERS can reduce hospital utilization rates among community-residing subscribers [24] and yield a positive benefit-to-cost ratio [2,25,26]. ...
... PERSs can relieve anxiety, enhance feelings of security, and improve the general quality of life of elderly people living alone [2,12]. Clinical studies showed that usage of PERS can reduce hospital utilization rates among community-residing subscribers [24] and yield a positive benefit-to-cost ratio [2,25,26]. Meanwhile, three generations of telecare technologies have been developed. ...
... The present study aimed for four objectives: (1) in a sample of German PERS subscribers, the level of satisfaction by using different satisfaction measures was evaluated, (2) to examine the wearing time of the portable help button when alone at home in everyday life as well as the use of PERS after falls, (3) to elaborate the rela-tion between satisfaction and PERS subscribers' use of PERS in daily life, and (4) as a minor aspect, to investigate the psychometric properties of the German translation of QUEST 2.0 with regard to its applicability for this target group. ...
Despite a wide distribution, little is known about the relationship between subscriber satisfaction and the extent of use or non-use of personal emergency response systems (PERS).
To examine the degree of satisfaction with PERS, the wearing time and its use in case of a fall.
Telephone and face-to-face interviews were conducted with 52 elderly community-dwelling PERS users.
PERS subscribers were very satisfied with their device; however, 24% of the participants reported that they never wear the alarm button, and only 14% wear it 24 hours each day. After falls PERS was not activated by 83% (n=11) of the subscribers who fell alone and lay on the floor longer than 5 minutes. None of the five different satisfaction measures and only the subscriber's estimation of relevance of the PERS showed to be a significant predictor of PERS use in daily life.
High rates of non-use of PERS in everyday life and after falls can be found. Subscribers' estimation of relevance but not satisfaction predicts the usage of PERS in everyday life. Further research is needed to better understand the reasons not using a PERS.
... Telesurveillance services staffed by non-health professional personnel has been shown to be effective in improving the general quality of life of the elderly, as well various outcomes as anxiety, the feeling of being safe at home, the perception of a positive effect on health [5,6]. It also has been shown to have a positive effect on the elders' functional independence and autonomy in activities of daily living [5,7891011. ...
... Telesurveillance services staffed by non-health professional personnel has been shown to be effective in improving the general quality of life of the elderly, as well various outcomes as anxiety, the feeling of being safe at home, the perception of a positive effect on health [5,6]. It also has been shown to have a positive effect on the elders' functional independence and autonomy in activities of daily living [5,7891011. The prompt handling of requests for help within an hour has reduced mortality rates [12]. ...
... Also, use of this type of service has a positive effect on the burden on caregivers, especially regarding their level of anxiety about the safety of their family member [6,7,16]. Finally, telesurveillance staffed by non-health professional personnel has been demonstrated to be cost-effective, mainly because it is associated with a reduction of hospitalizations [5,11,17]. Although a clear literature exists on telesurveillance services staffed by non-health professional personnel, up to now, little is known about services to elders at home provided by nurses. ...
Telesurveillance is a technologically based modality that allows the surveillance of patients in the natural setting, mainly home. It is based on communication technologies to relay information between a patient and a central call center where services are coordinated. Different types of telesurveillance systems have been implemented, some being staffed with non-health professionals and others with health professional, mainly nurses. Up to now, only telesurveillance services staffed with non-health professionals have been shown to be effective and efficient. The objective of this study was to document outcomes and cost evolution of a nurse-staffed telesurveillance system for frail elderly living at home.
A quasi experimental design over a nine-month period was done. Patients (n = 38) and caregivers (n = 38) were selected by health professionals from two local community health centers. To be eligible, elders had to be over 65, live at home with a permanent physical, slight cognitive or motor disability or both and have a close relative (the caregiver) willing to participate to the study. These disabilities had to hinder the accomplishment of daily life activities deemed essential to continue living at home safely. Three data sources were used: patient files, telesurveillance center's quarterly reports and personal questionnaires (Modified Mini-Mental State, Functional Autonomy Measurement System, Life Event Checklist, SF-12, Life-H, Quebec User Evaluation of Satisfaction with Assistive Technology, Caregiver Burden). The telesurveillance technology permitted, among various functionalities, bi-directional communication (speaker-receiver) between the patient and the response center.
A total of 957 calls for 38 registered clients over a 6-month period was recorded. Only 48 (5.0%) of the calls were health-related. No change was reported in the elders' quality of life and daily activity abilities. Satisfaction was very high. Caregivers' psychological burden decreased substantially. On a 3 months period, length of hospital stays dropped from 13 to 4 days, and home care services decreased from 18 to 10 visits/client. Total cost of health and social public services used per client dropped by 17% after the first 3 months and by 39% in the second 3 months.
The ratio of 0.50 calls per client to the call center for health events is three times higher than that reported in the literature. This difference is probably attributable to the fact that nurses rather than non-health professional personnel were available to answer the clients' questions about their health and medications. Cost evolution showed that registering older adults at a telesurveillance center staffed by nurses, upon a health professional recommendation, costs the health care system less and does not have any negative effects on the well-being of the individuals and their families. Telesurveillance for the elderly is effective and efficient.
... While a number of studies have described the profiles of alarm users [4,6,7], and found the rate of uptake in different communities of older persons to be low [8], those who do not use/ purchase alarms are an under researched group. Some studies have identified reasons for non-use, such as: cost [5,9], lack of perceived need [5] lack of awareness in the community [9] and being unattractive in appearance [10]. However, little is actually known about individuals who choose not to purchase an alarm; especially whether they would be assessed as less at risk of having an emergency than purchasers and how often they experience emergency situations in which an alarm would have been likely to reduce any negative impact. ...
... While a number of studies have described the profiles of alarm users [4,6,7], and found the rate of uptake in different communities of older persons to be low [8], those who do not use/ purchase alarms are an under researched group. Some studies have identified reasons for non-use, such as: cost [5,9], lack of perceived need [5] lack of awareness in the community [9] and being unattractive in appearance [10]. However, little is actually known about individuals who choose not to purchase an alarm; especially whether they would be assessed as less at risk of having an emergency than purchasers and how often they experience emergency situations in which an alarm would have been likely to reduce any negative impact. ...
... While a number of studies have described the profiles of alarm users [4,6,7], and found the rate of uptake in different communities of older persons to be low [8], those who do not use/ purchase alarms are an under researched group. Some studies have identified reasons for non-use, such as: cost [5,9], lack of perceived need [5] lack of awareness in the community [9] and being unattractive in appearance [10]. However, little is actually known about individuals who choose not to purchase an alarm; especially whether they would be assessed as less at risk of having an emergency than purchasers and how often they experience emergency situations in which an alarm would have been likely to reduce any negative impact. ...
... While a number of studies have described the profiles of alarm users [4,6,7], and found the rate of uptake in different communities of older persons to be low [8], those who do not use/ purchase alarms are an under researched group. Some studies have identified reasons for non-use, such as: cost [5,9], lack of perceived need [5] lack of awareness in the community [9] and being unattractive in appearance [10]. However, little is actually known about individuals who choose not to purchase an alarm; especially whether they would be assessed as less at risk of having an emergency than purchasers and how often they experience emergency situations in which an alarm would have been likely to reduce any negative impact. ...
Background
Personal alarms support independent living and have the potential to reduce serious consequences after a fall or during a medical emergency. While some Australian states have government funded personal alarm programs, others do not; but user-pays services are available. Although several studies have examined the profiles of alarm users, little is known about the risk profile of non-users. Specifically, whether there are “at risk” individuals who are unable, or choose not to purchase a service, who experience a home-based emergency in which an alarm could have mitigated an adverse outcome. This study aimed to describe the ‘risk profile’ of purchasers and non-purchasers of alarms; explore the reasons behind the decision to purchase or not to purchase and identify how often emergency assistance was needed and why.
Methods
Purchasers and non-purchasers were followed for one year in this prospective cohort study. Demographic, decision-making and risk factor data were collected at an initial face-to-face interview, while information about emergencies was collected by monthly calls.
Results
One hundred and fifty-seven purchasers and sixty-five non-purchasers completed the study. The risk profiles between the groups were similar in terms of gender, living arrangements, fall history and medical conditions. Purchasers (Mean = 82.6 years) were significantly older than non-purchasers (Mean = 79.3 years), (t(220) = −3.38, p = 0.000) and more functionally dependent on the IADL (z = −2.57, p = 0.010) and ADL (z = −2.45 p = 0.014) function scores. Non-purchasers (Mean = 8.04, SD = 3.57) were more socially isolated with significantly fewer family networks than purchasers (Mean = 9.46, SD = 3.25) (t(220) = −2.86, p = 0.005). Both groups experienced similarly high numbers of emergencies, 38.2 % of purchasers and 41.5 % of non-purchasers had at least one emergency where an alarm could have assisted. Main reasons for non-purchase were: cost (77 %), limited alarm range (51 %), no need (39 %) and lack of suitable contacts (30 %).
Conclusion
There are older individuals who are at high risk of an emergency who are choosing, often for financial and lack of family support reasons, not to purchase a personal alarm service. Greater availability of government funded subsidy schemes would enable these individuals to access a service. Increasing the range over which alarms work could increase their appeal to a broader range of older persons living in the community. Future research should consider how strategies that improve social isolation from family and challenge clients’ beliefs about their own health and independence can support increased access to personal alarm services.
... Acil durumlarda yaşlı bireyin merkezi araması durumunda eğitilmiş personel tarafından arama yanıtlanır ve gerekli görülürse sağlık çalışanına haber verilir (Vincent, Reinharz, Deaudelin, Garceau and Talbot 2006). Bu hizmet ile yaşlıların yaşam kalitesinin, fonksiyonel bağımsızlıklarının, otonomilerinin iyileştirildiği; anksiyeteleri ile günlük yaşam aktivitelerindeki bağımlılıklarının azaldığı görülmüştür (Bernstein 2000). Yaşlı sağlığını geliştiren tele-gözetim uygulamasının aile üzerine de olumlu etkileri bulunmaktadır (Johnston, Wheeler, Deuser and Sousa 2000). ...
... Yaşlı sağlığını geliştiren tele-gözetim uygulamasının aile üzerine de olumlu etkileri bulunmaktadır (Johnston, Wheeler, Deuser and Sousa 2000). Aynı zamanda tele-gözetim uygulaması, hastaneye yatışları da anlamlı düzeyde azaltması nedeniyle maliyet-etkin bir yöntemdir (Bernstein 2000). ...
Tele medicine is a sub-branch of tele health. According to the World Health Organization, telemedicine
is defined; The delivery of health care services, where distance is a critical factor, by all health care
professionals using information and communication technologies for the exchange of valid information for
diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing
education of health care providers, all in the interests of advancing the health of individuals and their
communities. The purpose of this article to investigate the uses of telemedicine and tele-nursing practices in the elderly.
... 20 Even for the telesurveillance services staffed by non-healthprofessional personnel, it has been reported that those services were effective in improving the general quality of life of the elderly, as well as in improving various outcomes such as anxiety, the feeling of being safe at home and the perception of a positive effect on health. 21 In addition, telesurveillance services have been shown to have a positive effect on elders' functional independence and autonomy in the activities of daily living. 21,22 On the other hand, the subjects were opposed to sadness and apathy detection by the robot. ...
... 21 In addition, telesurveillance services have been shown to have a positive effect on elders' functional independence and autonomy in the activities of daily living. 21,22 On the other hand, the subjects were opposed to sadness and apathy detection by the robot. They might want to protect themselves from unwanted access to their personal information (i.e. ...
Researchers in robotics have been increasingly focusing on robots as a means of supporting older people with cognitive impairment at home. The aim of this study is to explore the elderly’s needs and preferences towards having an assistive robot in the home. In order to ensure the appropriateness of this technology, 30 subjects aged 60 and older with memory complaints were recruited from the Memory Clinic of the Broca Hospital. We conducted an interview-administered questionnaire that included questions about their needs and preferences concerning robot functions and modes of action. The subjects reported a desire to retain their capacity to manage their daily activities, to maintain good health and to stimulate their memory. Regarding robot functions, the cognitive stimulation programme earned the highest proportion of positive responses, followed by the safeguarding functions, fall detection and the automatic help call.
... The results of this trial have been cited in several subsequent reports as providing evidence of the psychological benefits of PERSs, specifically anxiety reduction. [16][17][18]20,30,31 The primary goal of this study was to determine if the addition of a PERS to ED discharge planning by a geriatric-trained nurse reduces anxiety and fear of falling. Reducing anxiety and fear of falling are important goals by themselves but could have the additional benefit of reducing deconditioning, falls, and subsequent health care use. ...
... Despite this, the results of this sole previous randomized trial have been cited in several subsequent reports as providing evidence for the psychological benefits of PERS. 16,18,20,30,31 The present study was specifically designed to evaluate the impact of a PERS on anxiety using the HADS-A, a reliable, valid, and responsive measure of anxiety. 39,41,42 No decrease in anxiety associated with use of the PERS was demonstrated. ...
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.
... Personal emergency alarm systems have been widely used to support older people and shown to have positive effects on the lives of older people living alone by gaining faster assistance in a health emergency, increasing the client's sense of security, reducing the fear of falling at home and enhancing the client's capacity to perform everyday activities. [5][6][7][8] However, the ability of such systems to reduce unnecessary ambulance attendances and deliver cost benefits to healthcare systems within the context of aging has yet to be established. The aim of this study was to determine whether the use of the MePACS personal alarm system, with the option of being managed by a client's nominated contact person, is a cost-saving strategy from a government health service perspective. ...
Objectives: MePACS is a triage and support based personal alarm, emergency response system designed to assist older and/or disabled people to live safely in their homes. We aimed to estimate avoidable ambulance attendances and transports to emergency departments and quantify the cost savings attributed to MePACS compared to a general population of ambulance users without a personal alarm system. Methods: Alarm activation and demographic data for clients registered in the program from June 2016 to May 2017 and funded through the Personal Alert Victoria service were extracted from the routinely-collected MePACS electronic data system. Information on alarm use, event outcomes and ambulance attendances were extracted. Using published Ambulance Victoria data a comparison cohort was simulated to model the experience of a general population, without access to a personal alarm system, who experienced a health emergency and called Australia’s emergency call service number. The incremental management cost, incorporating the operation cost of MePACS and ambulance fees, was calculated to compare the potential cost savings of MePACS with the comparison cohort. Results: Among 18,421 eligible clients, there were 7,856 emergency alarm activations due to falls or medical events from 4,275 clients (79.5% female; 81.1% aged >75 years; 91.8% living alone). MePACS resulted in approximately one-third of ambulance attendance being avoided. Potential annual cost savings of 1,414,732.8 Australian dollars (AUD) (76.8 AUD per person per year (95% confidence interval (CI): 60.0, 93.6, p<0.001) were attributed to avoidable ambulance utilisations for 18,421 MePACS clients. Conclusion: Triage-based personal alarm systems, such as MePACS, provided a cost-saving strategy due to fewer ambulance attendances and transports to emergency departments for older and/or disabled people living alone in the community.
... During a 1-year follow-up period of 106 patients using PERS, Roush et al. found that there was a statistically significant decrease in hospital admissions per person and in time in hospital [10]. A study by Bernstein concluded that use of monitored PERS reduces mortality rates nearly fourfold and hospital utilization by 59% [11]. In the study of Mann et al., fear of falling was most often given as the reason for using a PERS in Mann et al. study [9]. ...
About 500,000 elderly people in Switzerland suffer a fall each year. Thus medical attention and help are essential for these people, who mostly live alone without a caregiver. Only 3% of people aged over 65 in Switzerland use an emergency system. Personal telehealth devices allow patients to receive enough information about the appropriate treatment, as well as followup with their doctors and reports of any emergency, in the absence of any caregiver. This increases their quality of life in a cost-effective fashion. "Limmex"-a new medical emergency watch-was launched in Switzerland in 2011 and has been a great commercial success. In this paper, we give a brief review of this watch technology, along with the results of a survey of 620 users conducted by the Department of Emergency Medicine in Bern.
COVID-19 tedavisi konusunda bilimsel araştırmalar halen devam etmektedir. Mevcut veriler semptomu olmayan veya hafif hastalığı olanlarda antiviral tedavi başlanması konusunda tereddütler olduğunu göstermektedir. Ancak erken dönemde başlanan antiviral tedavinin viral yükü azalttığı ve hastalık semptomlarını hafiflettiği belirtilmektedir. Bu bilgiler ışığında hekim hasta özelinde ve risk faktörlerini değerlendirerek karar vermek durumunda kalmaktadır. Bu konudaki belirsizlikler ve randomize kontrollü çalışmalar devam ederken geriatrik popülasyondaki hastalarda tercih edilen tedaviler başlı başına ayrı bir konudur ve bu başlık altında hem güncel tedavilere hem de geriatrik hastalardaki tedavi seçeneklerine değinilecektir.
Objectives
To describe the patterns of personal emergency response systems (PERS) use in a statewide cohort of older Australians.
Methods
PERS data from clients enrolled in the Personal Alarm Victoria program between January 2014 and June 2017 were analysed. Alarm activation reasons were extracted, and a medical record audit was performed for a sub‐cohort of patients admitted to a local hospital following an alarm event. Descriptive statistics were used.
Results
There were 42,180 clients enrolled during the study (mean age 80 years, 80% female, 93% living alone). An ambulance attended 44% of the fall‐related events and 81% of events coded as unwell. Activation reasons were distributed equally between a fall and feeling unwell, and a repeating pattern of activation reasons was observed. In our sub‐cohort (n = 92), the majority of admissions (86%) followed an alarm activation coded as unwell.
Conclusion
We demonstrated recurring patterns associated with the reasons for alarm use.
This paper explores the perceptions and experiences of falls among Personal Alert Victoria (PAV) clients and identifies barriers and enablers to engagement in falls prevention interventions. Data were collected via semistructured telephone interviews (n = 12) and a client survey with open‐ended and closed‐ended questions (n = 46). Descriptive statistics and thematic analysis was guided by the COM‐B model (capability, opportunity, and motivation) for behaviour change. The interview and survey explored experiences of falls, falls risk factors, access and participation in falls prevention interventions, access to health and support services, and experiences using the PAV service. Capability barriers identified included poor health, lack of time, low health literacy, and perceived high intensity of exercise classes. Opportunity barriers were lack of transport, high cost, and long waiting times for falls prevention interventions. Motivation barriers were the belief that falls are inevitable and a perceived lack of relevance of falls prevention interventions. Enablers identified were a focus on broader health and well‐being benefits (capability), hospitalisations or rehabilitation that incorporates falls prevention in recovery (opportunity), and raising awareness of falls risk (motivation). Findings suggest that further research is required to inform the tailoring of positive health messages to improve the uptake of falls prevention interventions by PAV clients.
A cyber physical system involves the combination of sensors, actuators, and computation modules to solve issues that lie across the physical and computational areas. This emerging technology will lead to a significant improvement in the health care industry and also will enhance the quality of life of our communities, including older and disabled persons. Our objective in this chapter is to give insights from the current research to provide future perspectives for scientific research and development. We reviewed the current research and inventions in the field of cyber physical systems (CPS) focusing on the health care industry where computational intelligence is used for decision support. In this chapter, we discuss the current state of the art and trends in cyber physical system in health care industry and summarize the issues that need to be overcome. We conclude by identifying the future challenges in this technology that needs to be addressed in order to identify and facilitate priority research in this emerging field.
Little is known as yet about the impact of telesurveillance services on social participation. To document the interaction between telesurveillance services and social participation of the elderly living at home, a study was conducted in the context of a government call center employing nurses. A focus group study was realized with elders (n=4), caregivers (n=6), healthcare system practitioners and industry employees (n=7). A qualitative analysis was performed using the Disability Creation Process model and generally accepted criteria for evaluating telehealth interventions. The results showed, on the one hand, factors that facilitate the use of telesurveillance services (user's intellectual capabilities, acceptance of clinical settings, relevance of recommendations, cost of service, and accessibility) and, on the other, factors that reinforce such use (user behaviors; level of satisfaction; impact on informal caregiver; system's level of performance; technical features; and life-habit aspects such as personal transportation, sleep, housekeeping, personal care, interpersonal relationships, and recreational activities).
Personal Emergency Response Systems (PERS) allow an individual to contact 911 or family members by pushing a button on a pendant which communicates with the PERS console to dial the emergency numbers. While simple to use, traditional PERS devices have limitations, some of which are overcome with more recently introduced home monitoring systems. This paper discusses PERS benefits, barriers to use, options, and alternatives that are currently available or in development.
Through a Personal Emergency Link system, the Senior Citizen Home Safety Association has rendered 24-hour care to more than 111,000 service users in Hong Kong who are mostly vulnerable seniors and chronic invalids living alone or living with their elderly spouses/caregivers only. This article will describe how the Personal Emergency Link system is used to link seniors living in the community. Measures taken to prevent failure of the system will be described. With the use of different technology applications, many human touches and warm caregiving are rendered to the elderly and needy.
It would be useful to better understand the personal determinants of successful interventions in the community, especially those interventions already recognized for their efficacy and efficiency, such as elder home care telesurveillance. This is a modality of health care services that transmits, via a call center on a 24/7 basis, the clinical information necessary to follow elders outside medical centers. Community health workers refer elders to this service. A qualitative research design was realized to understand why so much difference in the implementation of this service had arisen in two comparable sites previously judged receptive. The research objectives were as follows: (1) to document the personal determinants associated with telesurveillance adoption by community health workers, in two sites previously judged receptive; and (2) to point out the personal determinants that can explain successful adoption of telesurveillance. According to the Theory of Interpersonal Behavior, the results showed that habits (e.g., community health workers' knowledge of new information technologies) and perceived barriers in clinical practice were fundamental determinants in the adoption of telesurveillance.
This article provides a review of studies on assistive technology (AT) use by older persons in the United States and Brazil. There has been very little study of AT use in Brazil. The Brazilian author of this article conducted the one study that specifically explored the use of AT by older Brazilians. Economic, political, and cultural differences between the United States and Brazil likely account for the lower rate of AT use in Brazil. Another important difference between the United States and Brazil is the disproportionately smaller number of occupational therapists (OTs) in Brazil, while in the United States OTs are the primary healthcare professionals for assessing need, recommending AT, and training individuals in the use of the AT. The need for additional research is highlighted in the conclusion of this article.
Palliative care patients who live alone report greater psychological distress, and are less likely to die at home than those living with a family carer. However, there is a lack of research on the value of models of care that specifically address this disadvantage. This article describes the experiences of terminally ill 'home alone' people using one of two models of care aimed at maintaining participants' need for independent living, focusing on the effect of these two models of care on their physical, social and emotional needs. Twenty six palliative care patients of Silver Chain Hospice Care, in Western Australia, were randomly assigned to either having a personal alarm or additional care-aide hours in their home. An in-depth qualitative study was conducted in two phases in 2010 using face-to-face interviews. The care-aide model of care resulted in benefits such as easing the burden of everyday living; supporting well-being; enhancing quality of life and preserving a sense of dignity; and reducing loneliness and isolation. The personal alarm model of care imparted a sense of security; provided peace of mind; and helped to deal with feelings of isolation. Participants in both groups felt that they could remain at home longer. By providing a safer, more secure environment through the use of a personal alarm or additional care-aide hours, patients were able to continue their activities of daily living, could build a sense of 'normality' into their lives, and they could live independently through support and dignity.
Introduction : Au sein de la population vieillissante, les chutes à domicile représentent une problématique importante (1 personne âgée/3 chute au moins 1 fois/année). Pour détecter automatiquement les chutes en respectant la vie privée, une technologie novatrice a été développée : la vidéosurveillance intelligente. Objectif : Explorer la perception et la réceptivité des personnes âgées concernant l’introduction de cette nouvelle technologie, à domicile. Méthodologie : Trente personnes âgées ont participé à une entrevue structurée (devis mixte). Une analyse de contenu (données qualitatives) et des analyses descriptives (données quantitatives) ont été effectuées puis combinées. Résultats : 93,4% des participants sont favorables (ou partiellement) à la vidéosurveillance intelligente et 43,3% l’utiliserait pour le sentiment de sécurité et la confidentialité procurés. Conclusion : Le contexte de vie des personnes âgées influence leur perception et réceptivité envers la vidéosurveillance intelligente. Il s’agit maintenant d’évaluer cette technologie dans divers milieux de vie. Backgroung: Among the elderly, at-home falls are a significant problem (on average, 1 elder/3 falls at least 1/year). In order to automatically detect falls while maintaining privacy, an innovative technology was developed: an intelligent videomonitoring system. Objective: To explore the perception and receptivity of the elderly regarding the introduction of this new technology at home. Methodology: Using a mixed methods design, 30 elderly underwent a structured interview. A content analysis (qualitative data) and descriptive analyses (quantitative data) were executed and then combined. Findings: 93.4% of the participants were favorable (or partially) to the intelligent videomonitoring system and 43.3% would use it for the sense of security and the privacy provided. Conclusion: The living situation of the elderly influences their perception and receptivity regarding an intelligent videomonitoring system. The next step will be to evaluate this new technology in various living environments.
To describe the incidence and extent of lying on the floor for a long time after being unable to get up from a fall among people aged over 90; to explore their use of call alarm systems in these circumstances.
1 year follow-up of participants in a prospective cohort study of ageing, using fall calendars, phone calls, and visits.
Participants' usual place of residence (own homes or care homes), mostly in Cambridge.
90 women and 20 men aged over 90 (n=110), surviving participants of the Cambridge City over-75s Cohort, a population based sample.
Inability to get up without help, lying on floor for a long time after falling, associated factors; availability and use of call alarm systems; participants' views on using call alarms to summon help if needed after falling.
In one year's intensive follow-up, 54% (144/265) of fall reports described the participant as being found on the floor and 82% (217/265) of falls occurred when the person was alone. Of the 60% who fell, 80% (53/66) were unable to get up after at least one fall and 30% (20/66) had lain on the floor for an hour or more. Difficulty in getting up was consistently associated with age, reported mobility, and severe cognitive impairment. Cognition was the only characteristic that predicted lying on the floor for a long time. Lying on the floor for a long time was strongly associated with serious injuries, admission to hospital, and subsequent moves into long term care. Call alarms were widely available but were not used in most cases of falls that led to lying on the floor for a long time. Comments from older people and carers showed the complexity of issues around the use of call alarms, including perceptions of irrelevance, concerns about independence, and practical difficulties.
Lying on the floor for a long time after falling is more common among the "oldest old" than previously thought and is associated with serious consequences. Factors indicating higher risk and comments from participants suggest practical implications. People need training in strategies to get up from the floor. Work is needed on access and activation issues for design of call alarms and information for their effective use. Care providers need better understanding of the perceptions of older people to provide acceptable support services.
The individual considerations of frail women who are elderly as to the use of personal emergency response systems (PERS) are discussed within this article, and they derived from a larger longitudinal study that explores the home care experience of older widows. Participants were 11 frail women (aged 81-94) who perceived a risk of "falling and not being found" and did not have a PERS. A descriptive phenomenological method was used to analyze PERS-related data obtained during interviews with each woman in her home. With regard to considering the use of a PERS, experiences were structured variously by "getting by fine without it," "waiting to get it until I really need it," "convincing myself that I might get it later," and "borrowing no more trouble than I already have." Consistent interventions by home care professionals may perhaps be needed to increase PERS utilization rates. To develop effective interventions, further descriptive research is deemed necessary to explore drawbacks and barriers to PERS use by older frail women.
This article describes how older persons perceive and use personal emergency response systems (PERSs), including issues related to device design, and report reasons for nonuse of PERSs. Data for this study were collected through a semistructured questionnaire that included fixed and open-ended response questions. Six hundred six participants 60 years and older were surveyed. Descriptive statistics were used to report sample characteristics. The most often-stated reason for using a PERS was related to concerns with falling (40% of responses). Asked how a PERS has been helpful, 75.6% of participants expressed an enhanced feeling of security with their PERS. Lack of perceived need (57.0% of responses), cost (37.0%), and lack of knowledge of the device (23.7%) were the most frequently stated reasons for not using a PERS. This study found that, while PERSs provide benefits for many elders, there appear to be many older persons who could benefit who do not have one. Only 16% of participants in this study, all of whom had disabilities, used a PERS.
There is little research guiding interventions to help old homebound women prepare to manage an intrusion event. During a phenomenological study of the experience of reaching help quickly, I compared intentions during a possible intrusion event for 9 women subscribing to a personal emergency response system and 5 nonsubscribers. The phenomenon of contemplating what I would do if an intruder got in my home had 4 components. Only 2 personal emergency response system subscribers voiced the definitive intention to use the personal emergency response system. Findings underpin a new empirical perspective of competence grounded in situations relevant to living alone at home rather than specific tasks of daily living.
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