Falls, injuries due to falls, and the risk of admission to a nursing home. Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator cluster randomised trial Clinical Trial of a Home Safety Toolkit for Alzheimer's Disease A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia Assessment of agitation in Alzheimer's disease: the agitated behavior in dementia scale. Alzheimer's Disease Cooperative Study. Preventing and Managing Indoor Falls with Home-Based Technologies in Mild and Moderate Alzheimer's Disease Patients: Pilot Study in a Community Dwelling
BACKGROUND Falls warrant investigation as a risk factor for nursing home admission because falls are common and are associated with functional disability and because they may be preventable . METHODS We conducted a prospect i ve study of a probability sample of 1103 people over 71 years of age who were living in the community . Data on demographic and medical characteristics , use of health care , and cognitive , functional , psychological , and social functioning were obtained at base line and one year later during assessment s in the participants ' homes . The primary outcome studied was the number of days from the initial assessment to a first long-term admission to a skilled-nursing facility during three years of follow-up . Patients were assigned to four categories during follow-up : those who had no falls , those who had one fall without serious injury , those who had two or more falls without serious injury , and those who had at least one fall causing serious injury . RESULTS A total of 133 participants ( 12.1 percent ) had long-term admissions to nursing homes . In an unadjusted model , the risk of admission increased progressively , as compared with that for the patients with no falls , for those with a single noninjurious fall ( relative risk , 4.9 ; 95 percent confidence interval , 3.2 to 7.5 ) , those with multiple noninjurious falls ( relative risk , 8.5 ; 95 percent confidence interval , 3.4 to 21.2 ) , and those with at least one fall causing serious injury ( relative risk , 19.9 ; 95 percent confidence interval , 12.2 to 32.6 ) . Adjustment for other risk factors lowered these ratios to 3.1 ( 95 percent confidence interval , 1.9 to 4.9 ) for one noninjurious fall , 5.5 ( 95 percent confidence interval , 2.1 to 14.2 ) for two or more noninjurious falls , and 10.2 ( 95 percent confidence interval , 5.8 to 17.9 ) for at least one fall causing serious injury , but the association between falls and admission to a nursing home remained strong and significant . The population attributable risk of long-term admission to a nursing home for these three groups ( the proportion of admissions directly attributable to the three categories of falls ) was 13 percent , 3 percent , and 10 percent , respectively . CONCLUSIONS Among older people living in the community falls are a strong predictor of placement in a skilled-nursing facility ; interventions that prevent falls and their sequelae may therefore delay or reduce the frequency of nursing home admissions Background Assistive technology and telecare ( ATT ) are relatively new ways of delivering care and support to people with social care needs . It is cl aim ed that ATT reduces the need for community care , prevents unnecessary hospital admission , and delays or prevents admission into residential or nursing care . The current economic situation in Engl and has renewed interest in ATT instead of community care packages . However , at present , the evidence base to support cl aims about the impact and effectiveness of ATT is limited , despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers . Method / design ATTILA ( Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia ) is a pragmatic , multi-centre , r and omised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT .  The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded . The study aims to recruit 500 participants , living in community setting s , with dementia or significant cognitive impairment , who have recently been referred to social services . Primary outcome measures are time in days from r and omisation to institutionalisation and cost effectiveness . Secondary outcomes are caregiver burden , health-related quality of life in carers , number and severity of serious adverse events , and data on acceptability , applicability and reliability of ATT intervention packages . Assessment s will be undertaken in weeks 0 ( baseline ) , 12 , 24 , 52 and 104 or until institutionalisation or withdrawal of the participant from the trial . Discussion In a time of financial austerity , CASSRs in Engl and are increasingly turning to ATT in the belief that it will deliver good outcomes for less money . There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare . The ATTILA trial meets a pressing need for robust , generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use . Trial registration Current Controlled TrialsIS RCT Abstract Objective : To determine the effectiveness of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department . Design : R and omised controlled trial . Participants : 274 cognitively impaired older people ( aged 65 or over ) presenting to the accident and emergency department after a fall : 130 were r and omised to assessment and intervention and 144 were r and omised to assessment followed by conventional care ( control group ) .  Setting : Two accident and emergency departments , Newcastle upon Tyne . Main outcome measures : Primary outcome was number of participants who fell in year after intervention . Secondary outcomes were number of falls ( corrected for diary returns ) , time to first fall , injury rates , fall related attendances at accident and emergency department , fall related hospital admissions , and mortality . Results : Intention to treat analysis showed no significant difference between intervention and control groups in proportion of patients who fell during 1 year 's follow up ( 74 % ( 96/130 ) and 80 % ( 115/144 ) , relative risk ratio 0.92 , 95 % confidence interval 0.81 to 1.05 ) . No significant differences were found between groups for secondary outcome measures . Conclusions : Multifactorial intervention was not effective in preventing falls in older people with cognitive impairment and dementia presenting to the accident and emergency department after a fall . What is already known on this topic Multifactorial intervention prevents falls in cognitively normal older people living in the community and in those who present to the accident and emergency department after a fall Fall prevention strategies have not been tested by controlled trials in patients with cognitive impairment and dementia who fall What this study adds No benefit was shown from multifactorial assessment and intervention after a fall in patients with cognitive impairment and dementia presenting to the accident and emergency department The intervention was less effective in these patients than in cognitively normal older Objective : to assess the impact of telecare on the use of social and health care . Part of the evaluation of the Whole Systems Demonstrator trial . Participants and setting : a total of 2,600 people with social care needs were recruited from 217 general practice s in three areas in Engl and . Design : a cluster r and omised trial comparing telecare with usual care , general practice being the unit of r and omisation . Participants were followed up for 12 months and analyses were conducted as intention-to-treat . Data sources : trial data were linked at the person level to administrative data sets on care funded at least in part by local authorities or the National Health Service . Main outcome measures : the proportion of people admitted to hospital within 12 months . Secondary endpoints included mortality , rates of secondary care use ( seven different metrics ) , contacts with general practitioners and practice nurses , proportion of people admitted to permanent residential or nursing care , weeks in domiciliary social care and notional costs . Results : 46.8 % of intervention participants were admitted to hospital , compared with 49.2 % of controls . Unadjusted differences were not statistically significant ( odds ratio : 0.90 , 95 % CI : 0.75–1.07 , P = 0.211 ) . They reached statistical significance after adjusting for baseline covariates , but this was not replicated when adjusting for the predictive risk score . Secondary metrics including impacts on social care use were not statistically significant . Conclusions : telecare as implemented in the Whole Systems Demonstrator trial did not lead to significant reductions in service use , at least in terms of results assessed over 12 months . International St and ard R and omised Controlled Trial Number Register IS RCT N43002091 This r and omized clinical trial tested a new self-directed educational intervention to improve caregiver competence to create a safer home environment for persons with dementia living in the community . The sample included 108 patient/caregiver dyads : the intervention group ( n = 60 ) received the Home Safety Toolkit ( HST ) , including a new booklet based on health literacy principles , and sample safety items to enhance self-efficacy to make home safety modifications . The control group ( n = 48 )  received customary care . Participants completed measures at baseline and at twelve-week follow-up . Multivariate Analysis of Covariance ( MANCOVA ) was used to test for significant group differences . All caregiver outcome variables improved in the intervention group more than in the control . Home safety was significant at P ≤ 0.001 , caregiver strain at P ≤ 0.001 , and caregiver self-efficacy at P = 0.002 . Similarly , the care receiver outcome of risky behaviors and accidents was lower in the intervention group ( P ≤ 0.001 ) . The self-directed use of this Home Safety Toolkit activated the primary family caregiver to make the home safer for the person with dementia of Alzheimer 's type ( DAT ) or related disorder . Improving the competence of informal caregivers is especially important for patients with DAT in light of all stakeholders reliance on their unpaid care Background People with dementia have a disproportionately high rate of falls and fractures and poorer outcomes , yet there is currently no evidence to guide falls prevention in this population . Methods A r and omised trial design was used to test feasibility of study components and acceptability of a home hazard reduction and balance and strength exercise fall prevention program . The program was tailored to participant ’s individual cognitive levels and implemented as a carer-supported intervention .  Feasibility of recruitment , retention and implementation of intervention were recorded through observation and documented in field notes . Adherence , carer burden and use of task simplification strategies were also monitored . Outcome measures , collected at 12 weeks included physiological , fear of falling , cognitive and functional measures . Results Recruitment was achievable but may be more challenging in a multisite trial . Twenty two dyads of persons with mild dementia and their carers were r and omised to intervention or usual care control  group . Of 38 dyads referred to the study , there was a high rate of willingness to participate , with 6 ( 16 % ) declining and 10 ( 26 % ) not meeting inclusion criteria . The intervention was well received by participants and carers and adherence to both program components was very good . All participants implemented some home safety recommendations ( range 19 - 80 % ) with half implementing 50 % or more . At the end of 12 weeks , 72 % of the intervention group were  exercising .  Both the rate of falling and the risk of a fall were lower in the intervention group but these findings were not significant ( RR= 0.50 ( 95 % CI 0.11 - 2.19 ) . There were no differences in physiological outcome measures between the control and intervention groups . However results were influenced by the small study size and incomplete data primarily in the intervention group at follow up . Conclusions The pilot study was feasible and acceptable to people with mild dementia and their carers . The lessons learnt included : recruitment for a larger trial will require multiple approaches ; home safety recommendations should provide a greater emphasis on environmental use compared with behavioural change ; strategies to ensure an adequate dosage of exercise should be further explored . We recommend that intervention delivery incorporate an integrated occupational therapy and physiotherapy approach and that carers be provided with an individualised session to enhance dementia-specific skills in management and communication . A refined intervention should be tested in a r and omised trial with an adequately powered sample size . Trial registration Australia and New Zeal and Clinical Trials Registry OBJECTIVES To develop and evaluate the psychometric properties of a new measure of agitation , the Agitated Behavior in Dementia scale ( ABID ) . The ABID consists of 16 items design ed specifically to evaluate frequency of and caregiver reaction to common agitated behaviors in community-residing dementia patients . DESIGN The ABID was administered at the baseline assessment of a multi-site controlled treatment study to reduce agitation in Alzheimer 's Disease ( AD ) . Reliability was assessed by evaluating internal consistency and test-retest correlations . Validity was assessed by examining correlations with other constructs , including demographics , cognitive status , and overall behavioral disturbance . SETTING Twenty-one sites across the US , comprising the Alzheimer 's Disease Cooperative Study , contributed subjects to the investigation . PARTICIPANTS A total of 148 community-residing AD patients , living with a spouse or adult relative who acted as an informant . Mean age was 75 years , and mean Mini-Mental State Exam ( MMSE ) score was 13 . MEASUREMENTS Cognitive status was assessed using the MMSE . Behavioral disturbance was assessed using the Behavior Rating Scale for Dementia of the Consortium to Establish a Registry for Alzheimer 's Disease , the Revised Memory and Behavior Problems Checklist , and the Cohen-Mansfield Agitation Inventory . RESULTS Reliability of the ABID was excellent , with internal consistency of 0.70 and test-retest reliability of 0.60 to 0.73 . Validity was confirmed by correlations with related measures and lack of correlation with unrelated constructs . CONCLUSIONS The ABID is brief , easy to administer , and provides objective ly anchored observations of problems . It is a promising measure for studies of community-residing AD patients Background : Alzheimer 's disease ( AD ) is known to increase the risk of falls . We aim to determine the effectiveness of home-based technologies coupled with teleassistance service ( HBTec-TS ) in older people with AD . Methods : A study of falls and the HBTec-TS system ( with a light path combined with a teleassistance service ) was conducted in the community . The 96 subjects , drawn from a r and om population of frail elderly people registered as receiving an allocation for lost autonomy from the county , were aged 65 or more and had mild-to-moderate AD with 1 year of follow-up ; 49 were in the intervention group and 47 in the control group . Results : A total of 16 ( 32.7 % ) elderly people fell in the group with HBTec-TS versus 30 ( 63.8 % ) in the group without HBTec-TS . The use of HBTec-TS was significantly associated with a reduction in the number of indoor falls among elderly people with mild-to-moderate AD ( OR = 0.37 , 95 % CI = 0.15 - 0.88 , p = 0.0245 ) . Conclusion : The use of the HBTec-TS significantly reduced the incidence of primary indoor falling needing GP intervention or attendance at an emergency room among elderly people with AD and mild-to-moderate dementia
ABSTRACT Objectives : Assistive technology ( AT ) may enable people with dementia to live safely at home for longer , preventing care home admission .
The review up date s the safety aspect of Fleming and Sum 's 2014 systematic review .