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
Jacques S. Lee, MD, MSc, Mary Jane Hurley, BScN, Debra Carew, MScN, Rory Fisher, MD, Alex Kiss, PhD,
Neil Drummond, PhD
Objectives: 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.
Methods: 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.
Results: Eighty-six subjects were randomized and completed follow up (43 per group). There was no im-
portant 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 dif-
ference, 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%).
Conclusions: 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.
ACADEMIC EMERGENCY MEDICINE 2007; 14:301–308 ª 2007 by the Society for Academic Emergency
Keywords: personal emergency response system, anxiety, fear of falling, randomized controlled
trial, geriatric emergency medicine
a fall. Falls account for 49% of the approximately three
million annual injury-related ED visits by persons aged
65 years and older.1Only 5%–15% of these falls result
in an injury that would require hospitalization.2–4How-
ever, older patients have higher rates of adverse out-
mergency physicians frequently make difficult
disposition decisions about older persons pre-
senting to the emergency department (ED) after
comes after discharge, including recurrent falls, return
to the ED (RTED), and subsequent hospitalization.5Fear
of falling is an important, underrecognized complication
of falls, affecting between 45% and 75% of older persons
with a recent fall.2,3,6,7This has the potential to create a
vicious cycle of a fall leading to fear of falling, restricted
activity, decreased conditioning, and increased risk for
subsequent falls, injuries, and hospitalization.8–11
From the University of Toronto and Sunnybrook Research Insti-
tute Toronto (JSL), Sunnybrook Health Sciences Center (MJH,
DC, RF), and Institute for Clinical Evaluative Studies (AK), Tor-
onto, Ontario, Canada; and Department of Epidemiology and Bi-
ostatistics (ND), University of Calgary, Calgary, Alberta, Canada.
Received August 31, 2006; revisions received November 17,
2006, and November 20, 2006; accepted November 20, 2006.
Presented at the Canadian Association of Emergency Physicians
annual meeting, Montreal, Quebec, Canada, June 2004.
Supported by the Physicians Services Incorporated Foundation
of Ontario (grant PSIF 02-13), which provided peer-reviewed
funding for this study.
Contact for correspondence and reprints: Jacques S. Lee, MD,
MSc; e-mail: email@example.com.
ª 2007 by the Society for Academic Emergency Medicine
PII ISSN 1069-6563583
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Lee et al.?IMPACT OF PERS ON ELDERS AFTER A FALL