Monday, May 9, 2016

Is elderly fall prevention a cost, or a benefit for nursing home?

"Fall causes 1,800 death and US$34 billions each year"

According to U.S. Centers for Disease Control and Prevention (CDC), about 1,800 older adults living in nursing homes die each year from fall-related injuries and those who survive frequently sustain injuries that result in permanent disability and reduced quality of life, not including people living at home or other forms of nursing facilities. Each year, nursing home with 100 beds reports 100 to 200 falls. 35% fall inquiries occur among resident who cannot walk.

The number does not include people who were injured and hospitalized from these fall accidents. CDC reported that US$34 billion costs are incurred relating to direct medical cost, not including the costs for long term care such as disability, emotional health and reduction of productivity from their family caregiver.

Same statistics are shown in "Later Life in the United Kingdom", pointing out that 1/3 of people aged over 65 falls each year in UK. 3,653 death caused by fall were recorded in 2013. Around 70,000-75,000 hip fractures occur each year, mainly caused by fall accidents, costing for GBP 2 billion (~USD 2.88 billion) each year. 1 in 12 people died in 1 month after a fall while only half would return home. 50% of patients never regained the pre-accident mobility level.

The main cause of fall is muscle weakness due to lack of exercises, which accounts for 24% of falls. It could also be environmental factors such as poor lighting, tripping hazards and wet floors in bathrooms. Overuse of antipsychotics medication such as anti-anxiety drugs for patients with mental health issues could lead to adverse side effects in their central nervous system.

In fact, fall management measures can exist in different stages of elderly care. Therapists can estimate fall risk by conducting activities of daily living assessment and simple timed up and go test. Body motions can be monitored to detect fall risks in advance with motion alarm system, given in a skilled nursing facility or elderly home with a live-in caregiver. Panic buttons or mobile application with gyroscope are designed for immediate notification to caregivers for people who have just fallen.

While technology seems to be available, the trend of fall among elderly people does not seem to be improving. In the U.S., each full-time nurse has to look after approx. 1.75 beds with elderly care recipients. The number sounds reasonable for avoiding most of the accidents in nursing homes, but it is obviously not what is happening. How can the industry do better?

Turning from hospitalization to fall prevention

According to CDC, the average cost of hospitalization due to fall injury is over USD35,000. There is a great monetary initiative for nursing home owners to enhance their fall management capability. By stopping residents from being hospitalized, nursing homes could extend the period of stay for their residents, and possibly charge a premium for better elderly protection at the beginning during admission.

The key is to collect 24 x 7 behavioral data from residents through wireless sensing technology, with motion sensors in living areas, pressure sensors in bed, chair and toilet. Data such as the number of times a panic button is pressed during the day, or a resident get up from bed at night, or the duration of activity (or inactivity). Further analysis can be conducted and compared by long term care professional based on residents' health and medication records. As long as abnormal behavioral patterns can be spotted from residents who have changed in their daily activities, more attention and resources can be shifted to prevent them from falling. For example, nursing homes may separate residents with abnormal behavior into an environment with intensive care.

Data tells no lies.

For elderly people who appears to have signs of dementia, it is sometimes difficult for doctors or caregivers to find out the real problem as they tend to ignore or deny about their worsening health condition. With actual behavioral data available, nurse and family members can better understand the health status of the elderly residents, while doctors can prescribe more accurate accordingly.

Acceptance is the key

The key to deploy sensors successfully in nursing homes and on the elderlies is acceptance. Most elderlies are reluctant to move from their familiar living environment, into nursing homes, not to mention wearing panic buttons or tracking sensors on their body. Therefore, designers and manufacturers of elderly care devices have to put much greater effort to "hide" the sensor device in normal home settings. Wearable device can be personalized and turned into a warm gift that everyone (elderly, nurse, family) uses and loves.

"Later Life in United Kingdom", by, Feb 2016


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