REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled trial Sensor-based fall risk assessment--an expert 'to go'. Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital Incidence and Prediction of Falls in Dementia: A Prospective Study in Older People Fall prevention in acute care hospitals: a randomized trial. Falls prevention: the efficacy of a bed alarm system in an acute-care setting. An Electronic Medical Record (EMR)-Based Intervention to Reduce Polypharmacy and Falls in an Ambulatory Rural Elderly Population Does access to bed-chair pressure sensors reduce physical restraint use in the rehabilitative care setting? Inpatient Fall Prevention: Use of In-room Webcams Nurses' experiences with bed exit alarms may lead to ambivalence about their effectiveness. Evaluating the use of a targeted multiple intervention strategy in reducing patient falls in an acute care hospital: a randomized controlled trial. Evaluation of a nonintrusive monitor to reduce falls in nursing home patients. Effects of Electronic Health Information Technology Implementation on Nursing Home Resident Outcomes Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients
Background : falls in hospitals are a major problem and contribute to substantial healthcare burden . Advances in sensor technology afford innovative approaches to reducing falls in acute hospital care . However , whether these are clinical ly effective and cost effective in the UK setting has not been evaluated . Methods : pragmatic , parallel-arm , individual r and omised controlled trial of bed and bedside chair pressure sensors using radio-pagers ( intervention group ) compared with st and ard care ( control group ) in elderly patients admitted to acute , general medical wards , in a large UK teaching hospital . Primary outcome measure number of in-patient bedside falls per 1,000 bed days . Results : 1,839 participants were r and omised ( 918 to the intervention group and 921 to the control group ) . There were 85 bedside falls ( 65 fallers ) in the intervention group , falls rate 8.71 per 1,000 bed days compared with 83 bedside falls ( 64 fallers ) in the control group , falls rate 9.84 per 1,000 bed days ( adjusted incidence rate ratio , 0.90 ; 95 % confidence interval [ CI ] , 0.66–1.22 ; P = 0.51 ) . There was no significant difference between the two groups with respect to time to first bedside fall ( adjusted hazard ratio ( HR ) , 0.95 ; 95 % CI : 0.67–1.34 ; P= 0.12 ) . The mean cost per patient in the intervention group was £ 7199 compared with £ 6400 in the control group , mean difference in QALYs per patient , 0.0001 ( 95 % CI : −0.0006–0.0004 , P= 0.67 ) . Conclusions : bed and bedside chair pressure sensors as a single intervention strategy do not reduce in-patient bedside falls , time to first bedside fall and are not cost-effective in elderly patients in acute , general medical wards in the UK . Trial registration : is rct n.org identifier : IS RCT N44972300 BACKGROUND Falls are a predominant problem in our aging society , often leading to severe somatic and psychological consequences , and having an incidence of about 30 % in the group of persons aged 65 years or above . In order to identify persons at risk , many assessment tools and tests have been developed , but most of these have to be conducted in a supervised setting and are dependent on an expert rater . OBJECTIVES The overall aim of our research work is to develop an objective and unobtrusive method to determine individual fall risk based on the use of motion sensor data . The aims of our work for this paper are to derive a fall risk model based on sensor data that may potentially be measured during typical activities of daily life ( aim # 1 ) , and to evaluate the result ing model with data from a one-year follow-up study ( aim # 2 ) . METHODS A sample of n = 119 geriatric in patients wore an accelerometer on the waist during a Timed ' Up & Go ' test and a 20 m walk .  Fifty patients were included in a one-year follow-up study , assessing fall events and scoring average physical activity at home in telephone interviews . The sensor data were processed to extract gait and dynamic balance parameters , from which four fall risk models -- two classification trees and two logistic regression models -- were computed : models CT#1 and SL#1 using accelerometer data only , models CT#2 and SL#2 including the physical activity score . The risk models were evaluated in a ten-times tenfold cross-validation procedure , calculating sensitivity ( SENS ) , specificity ( SPEC ) , positive and negative predictive values ( PPV , NPV ) , classification accuracy , area under the curve ( AUC ) and the Brier score . RESULTS Both classification trees show a fair to good performance ( models CT#1/CT#2 ) : SENS 74%/58 % , SPEC 96%/82 % , PPV 92%/ 74 % , NPV 77%/82 % , accuracy 80%/78 % , AUC 0.83/0.87 and Brier scores 0.14/0.14 . The logistic regression models ( SL#1/SL#2 ) perform worse : SENS 42%/58 % , SPEC 82%/ 78 % , PPV 62%/65 % , NPV 67%/72 % , accuracy 65%/70 % , AUC 0.65/0.72 and Brier scores 0.23/0.21 . CONCLUSIONS Our results suggest that accelerometer data may be used to predict falls in an unsupervised setting . Furthermore , the parameters used for prediction are measurable with an unobtrusive sensor device during normal activities of daily living . These promising results have to be vali date d in a larger , long-term prospect i ve trial Objective To determine the efficacy of a targeted multifactorial falls prevention programme in elderly care wards with relatively short lengths of stay . Design Cluster r and omised trial . Setting 24 elderly care wards in 12 hospitals in Sydney , Australia . Participants 3999 patients , mean age 79 years , with a median hospital stay of seven days . Interventions A nurse and physiotherapist each worked for 25 hours a week for three months in all intervention wards . They provided a targeted multifactorial intervention that included a risk assessment of falls , staff and patient education , drug review , modification of bedside and ward environments , an exercise programme , and alarms for selected patients . Main outcome measure Falls during hospital stay . Results Intervention and control wards were similar at baseline for previous rates of falls and individual patient characteristics . Overall , 381 falls  occurred during the study . No difference was found in fall rates during follow-up between intervention and control wards : respectively , 9.26 falls per 1000 bed days and 9.20 falls per 1000 bed days ( P=0.96 ) . The incidence rate ratio adjusted for individual lengths of stay and previous fall rates in the ward was 0.96 ( 95 % confidence interval 0.72 to 1.28 ) . Conclusion A targeted multifactorial falls prevention programme was not effective among older people in hospital wards with relatively short lengths of stay . Trial registration Australian New Zeal and Clinical Trials Registry ACTRNO 12605000467639 Background Falls are a major cause of morbidity and mortality in dementia , but there have been no prospect i ve studies of risk factors for falling specific to this patient population , and no successful falls intervention/prevention trials . This prospect i ve study aim ed to identify modifiable risk factors for falling in older people with mild to moderate dementia . Methods and Findings 179 participants aged over 65 years were recruited from outpatient clinics in the UK ( 38 Alzheimer 's disease ( AD ) , 32 Vascular dementia ( VAD ) , 30 Dementia with Lewy bodies ( DLB ) , 40 Parkinson 's disease with dementia ( PDD ) , 39 healthy controls ) . A multifactorial assessment of baseline risk factors was performed and fall diaries were completed prospect ively for 12 months . Dementia participants experienced nearly 8 times more incident falls ( 9118/1000 person-years ) than controls ( 1023/1000 person-years ; incidence density ratio : 7.58 , 3.11–18.5 ) . In dementia , significant univariate predictors of sustaining at least one fall included diagnosis of Lewy body disorder ( proportional hazard ratio ( HR ) adjusted for age and sex : 3.33 , 2.11–5.26 ) , and history of falls in the preceding 12 months ( HR : 2.52 , 1.52–4.17 ) . In multivariate analyses , significant potentially modifiable predictors were symptomatic orthostatic hypotension ( HR : 2.13 , 1.19–3.80 ) , autonomic symptom score ( HR per point 0–36 : 1.055 , 1.012–1.099 ) , and Cornell depression score ( HR per point 0–40 : 1.053 , 1.01–1.099 ) . Higher levels of physical activity were protective ( HR per point 0–9 : 0.827 , 0.716–0.956 ) . Conclusions The management of symptomatic orthostatic hypotension , autonomic symptoms and depression , and the encouragement of physical activity may provide the core elements for the most fruitful strategy to reduce falls in people with dementia . R and omised controlled trials to assess such a strategy are a priority CONTEXT Falls cause injury and death for persons of all ages , but risk of falls increases markedly with age . Hospitalization further increases risk , yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient  falls . OBJECTIVE To investigate whether a fall prevention tool kit ( FPTK ) using health information technology ( HIT ) decreases patient falls in hospitals . DESIGN , SETTING , AND PATIENTS Cluster r and omized study conducted January 1 , 2009 , through June 30 , 2009 , comparing patient fall rates in 4 urban US hospitals in units that received usual care ( 4 units and 5104 patients ) or the intervention ( 4 units and 5160 patients ) . INTERVENTION The FPTK integrated existing communication and workflow patterns into the HIT application . Based on a valid fall risk assessment scale completed by a nurse , the FPTK software tailored fall prevention interventions to address patients ' specific determinants of fall risk . The FPTK produced bed posters composed of brief text with an accompanying icon , patient education h and outs , and plans of care , all communicating patient-specific alerts to key stakeholders . MAIN OUTCOME MEASURES The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit . A secondary outcome was fall-related injuries . RESULTS During the 6-month intervention period , the number of patients with falls differed between control ( n = 87 ) and intervention ( n = 67 ) units ( P=.02 ) . Site-adjusted fall rates were significantly higher in control units ( 4.18 [ 95 % confidence interval { CI } , 3.45 - 5.06 ] per 1000 patient-days ) than in intervention units ( 3.15 [ 95 % CI , 2.54 - 3.90 ] per 1000 patient-days ; P = .04 ) . The FPTK was found to be particularly effective with patients aged 65 years or older ( adjusted rate difference , 2.08 [ 95 % CI , 0.61 - 3.56 ] per 1000 patient-days ; P = .003 ) . No significant effect was noted in fall-related injuries . CONCLUSION The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00675935 The present study examined the clinical efficacy of a bed alarm system in reducing falls from bed on a geriatric evaluation and treatment unit . A nine-month case-controlled study was design ed , in which 70 patients ( 60 women , 10 men ; mean age 84 years , range 67 - 97 years ) at increased risk for bed falls were r and omly assigned to either an experimental or a control group . Subjects in the experimental group ( n = 35 ) received a bed alarm system and those in the control group ( n = 35 ) did not . Outcome measures included bed falls , performance of the bed alarm system , and staff attitudes toward the use of the system . Although results failed to demonstrate a statistical difference in bed falls between the experimental ( n = 1 ) and control ( n = 4 ) groups ( p = 1.00 ) , there was a clinical trend toward reduced falls in the experimental group . The system functioned properly , activating an alarm in all instances when patients were transferring from bed , and with the exception of one case , nurses could respond in a timely fashion to assist patients and prevent bed falls . The system did not produce any adverse effects in patients , nor did the device interfere with the rendering of medical care . The system was well accepted by patients , families , and nurses . These data suggest that bed alarm systems are beneficial in guarding against bed falls and are an acceptable method of preventing falls Background Falls are the leading cause of injury-related deaths in the aging population .  Electronic medical record ( EMR ) systems can identify at-risk patients and enable interventions to decrease risk factors for falls . Objective The objectives of this study were to evaluate an EMR-based intervention to reduce overall medication use , psychoactive medication use , and occurrence of falls in an ambulatory elderly population at risk for falls . Design Prospect i ve , r and omized by clinic site . Patients / Participants Six-hundred twenty community-dwelling patients over 70 at risk for falls based on age and medication use . Interventions A st and ardized medication review was conducted and recommendations made to the primary physician via the EMR . Measurements and Main Results Patients were contacted to obtain self reports of falls at 3-month intervals over the 15-month period of study . Fall-related diagnoses and medication data were collected through the EMR . A combination of descriptive analyses and multivariate regression models were used to evaluate differences between the 2 groups , adjusting for baseline medication patterns and comorbidities . Although the intervention did not reduce the total number of medications , there was a significant negative relationship between the intervention and the total number of medications started during the intervention period ( p < .01 , regression estimate −0.199 ) and the total number of psychoactive medications ( p < .05 , regression estimate −0.204 . ) The impact on falls was mixed ; with the intervention group 0.38 times as likely to have had 1 or more fall-related diagnosis ( p < .01 ) ; when data on self-reported falls was included , a nonsignificant reduction in fall risk was seen . Conclusions The current study suggests that using an EMR to assess medication use in the elderly may reduce the use of psychoactive medications and falls in a community-dwelling elderly population BACKGROUND The common use of physical restraints in older people in hospitals and nursing homes has been associated with injurious falls , decreased mobility and disorientation . By offering access to bed-chair pressure sensors in hospitalized patients with perceived fall risk , nurses may be less inclined to resort to physical restraints , thereby improving clinical outcomes . AIMS AND OBJECTIVES To investigate whether the access of bed-chair pressure sensors reduces physical restraint use in geriatric rehabilitation wards . DESIGN R and omized controlled trial . METHODS Consecutively , patients admitted to two geriatric wards specialized in stroke rehabilitation in a convalescent hospital in Hong Kong , and who were perceived by nurses to be at risk of falls were r and omly assigned to intervention and control groups . For the intervention group subjects , nurses were given access to bed-chair pressure sensors . These sensors were not available to control group subjects , as in usual practice . The trial continued until discharge . The primary outcomes were the proportion of subjects restrained by trunk restraint , bedrails or chair-board and the proportion of trial days in which each type of physical restraint was applied . The secondary outcomes were the proportions of those who improved in the mobility and transfer domains of modified Barthel index on discharge and of those who fell . RESULTS One hundred and eighty subjects were r and omized . Fifty ( 55.6 % ) out of the 90 intervention group subjects received the intervention . There was no significant difference between the intervention and control groups in the proportions and duration of having the three types of physical restraints . There was also no group difference in the chance of improving in mobility and transfer ability , and of having a fall . CONCLUSION Access to bed-chair pressure sensor device neither reduced the use of physical restraints nor improved the clinical outcomes of older patients with perceived fall risk . RELEVANCE TO CLINICAL PRACTICE The provision of bed-chair pressure sensors may only be effective in reducing physical restraints when it is combined with an organized physical restraint reduction programme Objectives Patient falls are a challenging safety and quality issue in acute care setting s. This study compared inpatient falls on medical-surgical units with and without Webcams  and assessed the Morse Risk Assessment ( MRA ) for effectiveness in identifying fall risk . Methods Ten hospitals in one health system that exceeded the benchmark for falls were chosen for a 6-month study . One medical-surgical unit in each of the 10 hospitals was r and omly assigned to an intervention or control group . The intervention group used Webcams that viewed the bed with a central monitoring system . A “ virtual bed rail ” function was used for those patients with a Morse Risk Assessment ( MRA ) of greater than 25 . Results  Consent rate was 20.7 % for the intervention group . A significant difference ( P ⩽ 0.05 ) between groups was found in fall rate per 1000 admissions , but no significant difference was found in fall rate per 1000 patient days . The Morse Risk Assessment was a significant predictor of risk . Conclusions Webcams are one option to increase surveillance for high-risk patients . The use of the MRA with a 50 + score for high risk is recommended . More research is needed on patient acceptance of this form of intervention and effectiveness in preventing falls on various inpatient units or with specific age groups The literature reports conflicting evidence regarding the effectiveness of any single intervention , including bed exit alarms , in preventing falls . Yet bed exit alarms are widely used in healthcare setting s as part of comprehensive fall-prevention programs even though no large-scale r and omized controlled trials have demonstrated their effectiveness . As a part of a quality improvement project , bed alarms were piloted on two nursing units in a Level I trauma center . Nurses ' patterns of use , their experiences and beliefs about bed alarms , and the literature regarding bed exit alarms were explored . Alarms were used with confused and agitated patients who did not fall . Nurses said that bed alarms may have helped prevent falls , but , even with bed alarms in use , nurses still needed to monitor their patients hourly . The conflicting experiences of nurses using the alarms , combined with nurses ' comments and literature both supporting and not supporting bed alarms , shed light on the dilemma nurses face when prioritizing safe patient care and the ambivalence some nurses experience regarding bed alarms AIM This article is a report of a r and omized controlled trial to examine the effectiveness of a targeted multiple intervention strategy in reducing the number of patient falls in an acute care hospital . BACKGROUND Prevention of patient falls remains a challenge that has eluded healthcare institutions . The effectiveness of targeted multiple fall prevention interventions in reducing the incidences of falling has not been established . METHODS Patients who scored 5 and above on the Hendrich II Fall Risk Model , a fall assessment tool , were recruited in 2006 . Patients who were r and omized to the intervention group received targeted multiple interventions . Both the research groups received the st and ard fall prevention interventions from the ward nurses . The rates of fall incidences for both groups were reported with 95 % CI , calculated using Wilson method and compared using the Chi-square test . The relative risk was estimated and 95 % CI was calculated using the methods described by Armitage and Berry . The times to first fall events were constructed using the Kaplan-Meier method . The hazard ratio was reported at 95 % CI and the comparison was made using the log-rank test . RESULTS There were 912 and 910 participants in the control and intervention groups , respectively . The fall incidence rates were 1·5 % ( 95 % CI : 0·9 - 2·6 ) and 0·4 % ( 95 % CI : 0·2 - 1·1 ) in the control and intervention groups , respectively . The relative risk estimate of 0·29 ( 95 % CI : 0·1 - 0·87 ) favours the intervention group . CONCLUSION This study showed that targeted multiple interventions were effective in reducing the incidences of falls in patients in the acute care setting OBJECTIVE A clinical study was conducted to measure the effectiveness and operational characteristics of a new device intended to reduce the incidence of falls in elderly patients at high risk of falling . The NOC.watch device consists of a credit-card size device contained within an adhesive " patch"worn on the thigh continuously for many days . The patch is small , wireless , disposable , waterproof , shockproof , and unobtrusive . When a patient 's leg becomes weight-bearing ( such as when a patient gets out of bed or st and s up unassisted ) , the receiver emits an audible signal which both alerts the patient to sit down and also summons a caregiver . DESIGN A crossover design was used to compare the fall rate of patients while wearing the NOC.watch device with the fall rate while not wearing it .  Patients ( n = 47 ) wore the device for one week , and were monitored for fall activity before , during , and after this week . The three time periods were referred to as the " Pre , " " During , " and " Post " periods , respectively . PARTICIPANTS The study was conducted between November 1 , 2000 , and April 1 , 2001 , in the Medicare unit of a skilled nursing facility in northern California . Forty-seven patients admitted to the unit with a fall risk assessment ( FRA ) score of at least 6 were entered into the study , with a mean FRA of 11.4 . MEASUREMENTS The main outcome measure was fall rate per 100 patient days . Qualitative observations of adverse effects on skin integrity , degree of staff and patient acceptance of the system , and lack of false alarms are also reported . Poisson regression with generalized estimating equations was used for analysis of fall rates . RESULTS Forty-seven patients wore the device . Total number of patient-days of observation were 273 , 299 , and 497 in the Pre , During , and Post periods , respectively , for a total of 1,069 days of observation . These patients had 11 falls in the Pre period ( 4.0 falls per 100 days ) , 1 fall in the During period ( 0.3 falls per 100 days ) and 17 falls in the Post period ( 3.4 falls per 100 days ) . This 91 % reduction in fall rate while wearing the NOC.watch is statistically significant with P = 0.02 . False alarms were qualitatively reported to be low or nonexistent , and patient and caregiver acceptance of the device was reported to be high . No adverse effects on skin integrity were noted . Cognitively impaired patients , who have difficulty remembering to call for assistance , appeared to respond particularly well to the device alarm . CONCLUSIONS The prototype NOC.watch device appears to have a large impact on reducing fall risk in nursing home patients , with minimal adverse effects . However , due to the lack of an equivalent control group , these results should be confirmed with a larger , r and omized , controlled study to better estimate the true magnitude of the effect of the NOC.watch device on fall rates Objective : To examine the effects of electronic health information technology ( HIT ) on nursing home residents . Methods : The study evaluated the impact of implementing a comprehensive HIT system on resident clinical , functional , and quality of care outcome indicators as well as measures of resident awareness of and satisfaction with the technology . The study used a prospect i ve , quasi-experimental design , directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area . Results : No statistically significant impact of the introduction of HIT on residents was found on any outcomes , with the exception of a significant negative effect on behavioral symptoms . Residents ’ subjective assessment of the HIT intervention were generally positive . Discussion : The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes . The single negative finding suggests that further investigation is needed on possible impact on resident behavior BACKGROUND Bed alarm systems intended to prevent hospital falls have not been formally evaluated . OBJECTIVE To investigate whether an intervention aim ed at increasing bed alarm use decreases hospital falls and related events . DESIGN Pair-matched , cluster r and omized trial over 18 months . Nursing units were allocated by computer-generated r and omization on the basis of baseline fall rates . Patients and outcome assessors were blinded to unit assignment ; outcome assessors may have become unblinded . ( Clinical Trials.gov registration number : NCT00183053 ) SETTING 16 nursing units in an urban community hospital . PATIENTS 27 672 in patients in general medical , surgical , and specialty units . INTERVENTION Education , training , and technical support to promote use of a st and ard bed alarm system ( intervention units ) ; bed alarms available but not formally promoted or supported ( control units ) . MEASUREMENTS Pre-post difference in change in falls per 1000 patient-days ( primary end point ) ; number of patients who fell , fall-related injuries , and number of patients restrained ( secondary end points ) . RESULTS Prevalence of alarm use was 64.41 days per 1000 patient-days on intervention units and 1.79 days per 1000 patient-days on control units ( P = 0.004 ) . There was no difference in change in fall rates per 1000 patient-days ( risk ratio , 1.09 [ 95 % CI , 0.85 to 1.53 ] ; difference , 0.41 [ CI , -1.05 to 2.47 ] , which corresponds to a greater difference in falls in control vs. intervention units ) or in the number of patients who fell , injurious fall rates , or the number of patients physically restrained on intervention units compared with control units . LIMITATION The study was conducted at a single site and was slightly underpowered compared with the initial design . CONCLUSION An intervention design ed to increase bed alarm use in an urban hospital increased alarm use but had no statistically or clinical ly significant effect on fall-related events or physical restraint use . PRIMARY FUNDING SOURCE National Institute on Aging
AIMS To analyse the evidence on the effectiveness , usability and acceptability of health technology in falls detection and prevention among older adults .
There is a lack of research into the efficacy of and staff attitudes towards health technology in falls detection and prevention .