Falling Forward - Technology is moving today's senior care industry from fall notification to fall prevention

When addressing senior lifestyle, comfort and safety, you can’t ignore the issue of falls. Falling is a big deal and it’s getting bigger. One out of every three seniors will fall at some point this year. One of the reasons falls are becoming a bigger issue is because there are more seniors every day. We are in the early stages of what some call the silver tsunami, describing the group of 35 million Americans above the age of 65, which is growing at a rate of 10,000 a day in the United States. Out of that large group, 10 million live alone. 

According to the American Association of Retired Persons (AARP), 89 percent of all seniors prefer to stay at home. That home may be one that they own, it may mean living with a friend or family member or it may be the independent living wing of a retirement facility. But the key is that they want to maintain their independence. The term ‘‘aging in place’’ correctly frames this trend of living in the residence of choice independently, and for as long as they are able, while having access to services they might need over time as needs change.

For these seniors living independently, it is almost certain that a fall will occur at some point—and for some, multiple falls. We know that despite this scary scenario, most seniors will do nothing about a fall because they either don’t know what to do or they don’t want to be inconvenienced or inform caregivers that they've had a fall. An alarming statistic is the cost associated with a fall, which pinpoints the hospitalization number at around $17,500.

We are in the midst of transitioning away from traditional safety products that are well intentioned but becoming more outdated, and moving toward more modern products that can utilize technology to better solve the problem. Two veteran approaches to the problem of senior falls are generically referred to as nurse call and personal emergency response systems (PERS). 

Nurse call is primarily used in senior living facilities and consists of an intercom-like device mounted on the wall. This device has a button and a pull cord that can be used to create an alert to notify a caregiver that a senior has fallen. The problem is, for this device to work, the senior has to fall directly beside the call station. Confining this safe zone to such a small area does not give seniors an opportunity to move out of one specific area. As such, nurse call has really been rendered ineffective for the vast majority of falls.

PERS avoid the above problem altogether, by placing the device on the user instead of on the wall. PERS stands for personal emergency response system and is often known by the catch phrase “I’ve fallen and I can’t get up.” Most people have seen the commercials—it’s a push-button device that is typically worn on a lanyard or sometimes on the wrist. The user simply presses the button when he/she falls, and help is on its way. However, what happens if the user can’t press the button? Or chooses not to press the button?

It turns out that both of these scenarios are extremely likely. A recent industry study showed that 83 percent of PERS users failed to press the button after a fall. Although a small portion of those were unable to press the button due to unconsciousness, disorientation or falling too far away from the PERS (some falls occur at night when the patient is going to the rest room and leaves the PERS on their nightstand), a larger portion chose not to press the button, figuring that they would be able to get up eventually and because they did not want anyone to discover that they had fallen. Because multiple falls tend to get more serious with each incident, identification of even a small fall can be critically important.

The key is to detect all falls small or large, in the hope that the bigger, critical falls can be prevented altogether. We can greatly enhance our chance to offer timely interventions if we collect data on the habits of the senior and allow analytics to guide us to an understanding of what trends might be good predictors of a fall. Technology plays an important part in identification of these predictors. 

Accelerometers are the first piece of technology that can help with fall detection. Although an accelerometer may not be recognizable by its name, you are undoubtedly familiar with it, as they are found in all smart phones and tablets. Accelerometers sense motion, activity, acceleration and direction. It’s how your smartphone knows if it’s oriented vertically or horizontally. By using a tri-axial accelerometer inside of a PERS pendant, the device can tell if a fall has occurred and sends an alert without the user having to press a button. These smarter devices are often called active PERS and serve as a reliable way to detect falls.

Of course, fall prevention is better than fall detection. The best in the active PERS option takes a step toward fall prevention with the help of technology that transmits not only alerts, but also data on the general movement and activity of the senior. This data can be analyzed with the help of complicated algorithms that spot trends that indicate the higher likelihood of a fall. The data can also indicate that the pendant is not being used at all, and an automatic alert can be sent to remind the senior to wear it. 

The preeminent answer for fall detection and prevention is the use of a remote monitoring system. Similar to home security, these systems consist of sensors, such as motion detectors, door contacts and bed pressure pads, placed throughout the home to gauge normal life patterns. When a condition is outside of normal patterns—gathered from the continuous data feeds of the patient’s activities—notifications can be sent via web, text or e-mail so caregivers both near and far can respond.

The encouraging development here is that many of these systems today are passive and don't require any interaction on the senior’s part. The sensors integrate into the senior’s lifestyle and work quietly in the background. If there is an issue or threat to the senior’s health or safety, some systems will automatically alert family members or caregivers so they can respond.

The best of these systems will run intensive data analytics on the information provided, even detecting falls and emergencies through the data rather than through a pendant. The combination of an active PERS pendant and a remote monitoring system gives the user total coverage, 24 hours a day, 7 days a week, that can provide peace of mind for the patient and family members or caregivers.

Fall safety is evolving from fall notification to fall prevention. Fall prevention is important, whether it requires daily in-home visits or monitoring from outside of the home through PERS. Today’s seniors and caregivers are expecting better solutions to allow them to age-in-place and remain independent. And the application of new technologies is quickly making that possible.

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Article adapted from Home Care magazine. Author: Jim Anderson

Addressing Seating and Mobility for the Geriatric Population - Senior mobility goals include safety, independence and proper support.

Older wheelchair users can face additional challenges due to the effects of aging, which include neurological, musculoskeletal, gastrointestinal, cardiopulmonary, skin, urological and cognitive changes. All of these can contribute to seating and mobility issues, especially if there is an underlying disease or injury. 

One goal for the geriatric population is to maintain safe and independent mobility for as long as possible. Although decreases in strength, endurance, joint health, cardiopulmonary function and balance may prohibit safe and functional ambulation, many older individuals could functionally self-propel a manual wheelchair with the appropriate features. Unfortunately, it is not unusual to see them struggling to propel basic standard wheelchairs, which are heavy and have few options and adjustments. These wheelchairs require much effort to propel and may be uncomfortable, ill-fitting, and promote poor posture with prolonged sitting. It is time we look beyond this standard equipment to alternatives that have the features necessary to allow independent mobility for this often fragile population. 

The weight of the wheelchair is a critical feature for anyone trying to propel since self-propulsion involves using the smaller arm muscles to move the wheelchair weight plus the individual’s body weight. Although weight seems to be a primary consideration for our younger population, it is often ignored with older individuals, despite the fact that they may have even less strength and endurance.

Another important factor is how well the wheelchair supports/facilitates proper positioning to prevent deformity and facilitate function, respiration, swallowing, skin protection and efficient propulsion (access to the hand rim). Unfortunately, many elderly individuals have trouble maintaining good posture due to weakness and fatigue. For some, there is a tendency to slide into a slouched position, while others are already fixed in this curved posture. The tendency to slide is compounded by the fact that the 90-degree angle between the seat rails and the back posts of most wheelchairs does not match their rounded anatomical shape. The difficulty in maintaining an upright position may also be due to the vertical orientation of the wheelchair itself. Adjusting the back posts to create a small amount of recline in the back support could help to accommodate the individual’s shape, while adding a small degree of tilt in the frame could decrease the effort required to sit upright—both of which could have a significant impact on posture, physiological function and propulsion. 

Seat and back dimensions can also affect propulsion and posture. For the smaller individual, a back height that is too tall and/or a seat that is too wide can interfere with sufficient access to the hand rim for efficient (easy) propulsion. A seat that is too wide can also allow the individual to lean/move into asymmetric postures. For the taller individual, a seat that is not long enough will provide insufficient support to the pelvis and legs, causing poor positioning and increased pressure.

For individuals who propel with one or both feet, efficient propulsion is possible only if the heel(s) can be placed flat on the ground. If the seat-to-floor-height (STFH) of the wheelchair is too high, the individual must slide down in the seat, which creates poor posture, or propel with the toes, which is slow and energy-consuming. 

In summary, to increase mobility, reduce fatigue, promote good posture, protect joint health and prevent pain for our older manual wheelchair users, we should provide products with: (1) the lightest weight possible, (2) optimal hand rim access, (3) proper seat back and STFH dimensions, and (4) appropriate adjustments.  Standard wheelchairs should only be used for short time periods over very short distances or for temporary use. 

Power of Mobility

The benefits of independent mobility include increased time out of bed, improved skin integrity, improved cardiopulmonary health, decreased attendant care, increased socialization and motivation and improved quality of life. At some point however, many older adults struggle or are unable to ambulate or propel any wheelchair. To keep them as independently mobile for as long as possible, power mobility should be considered.

Unfortunately despite the benefits, power is frequently overlooked for this population. In some cases, this is due to lack of a proper clinical evaluation and assessment of need. In other cases the individual, caregivers and/or facility staff are reluctant due to unfounded safety concerns and/or lack of familiarity with available options and technology. However, today’s power wheelchairs can be programmed and configured to allow safe and independent mobility for nearly anyone, from the very young to the very old, as long as they possess sufficient cognition, judgment, vision and motivation, as well as a functional body part to operate the control.

To choose the most appropriate power wheelchair, we must consider postural needs, activity level and daily environments of the individual. As with manual mobility, we should look beyond standard equipment when appropriate, particularly when choosing between standard captain’s seating vs. rehab seating. Captain’s seating is appropriate only for individuals who can fit in standard seat sizes, are at little to no risk of skin breakdown and are able to maintain good upright posture with minimal support and contour. For more complex requirements for posture, function or skin protection, rehab seating should be considered.

Dependent Mobility

Typical mobility choices for those who are dependent include armchair recliners or “geri-chairs.” We must consider, however, that these options provide no specific postural support or skin protection, cannot accommodate postural deformities, allow minimal weight shifts and fit average body dimensions. Unfortunately, there are many older individuals relegated to this type of seating despite their more complex needs/risks. In some cases, these needs might be better met by one of the manual wheelchairs described above with appropriate sizing, options and adjustments. For others, a manual recliner or tilt-in-space might be needed to provide weight shifts and a resting position for skin protection, comfort and reduction of fatigue. In these cases a tilt-in-space is often preferred, since recliners are less effective in maintaining posture, cannot accommodate hip/knee joint limitations and can cause shearing with recline and return.

Our equipment goals for the elderly are to provide the simplest, most cost-effective solution that will optimize the person’s posture, function, skin integrity and mobility. This means looking beyond standard-issue non-adjustable equipment so older adults have the technology necessary for the best outcomes of comfort, health and quality of life.

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Article adapted from Home Care magazine.

Maximize Your Bed Possibilities - Proper bed selection can address concerns while giving you better rest.

The public’s focus on safety for everyday activities such as driving, medications and even walking has grown significantly over the past three decades. Keeping people safe has become a slogan for companies who do business in most markets or industries. We see daily public service announcements about seatbelt safety, texting and driving—even ads about eating your vegetables. Very rarely is anything communicated about sleeping safety. After all, sleeping is part of our nature. It’s instinctual. Getting to sleep is difficult for some, and sleeping disorders like sleep apnea affect millions. Sleep is not always an easy activity for the majority of Americans. 

How can you parlay safety into sleeping? First, we need to understand that the average 65-year-old spends almost nine hours a day in bed (Bureau of Labor Statistics, 2011). This number rises depending on medical conditions and activity levels. It is the most time spent on one activity in the average 65-year-old’s daily routine. Bed safety starts with comparison to the national average. The more time a person spends doing something, the greater the risk of an accident or injury. 

We then address the kind of bed a user is sleeping in. Most seniors are sleeping in traditional beds with box springs and a pillow-top mattress. Many have found solace sleeping in adjustable beds, while some have been provided with medical or hospital beds due to an illness or positioning needs. The different style beds present different challenges. Compounding those challenges are personal traits and capabilities, medical diagnosis, strength and cognitive ability. Deciding which bed is best for you can be simple and should ultimately be discussed with your doctor.

Whichever bed you use, it should be a benefit to your life, not just a fixture in your life. The top of your mattress should be at a height that allows you to comfortably get in and out. If you are at risk of falling out of your bed, keep in mind that a lower bed helps reduce the severity of injuries, but can be very difficult to get out of when transferring.  Beds that you or your caregiver can simply adjust in height to make transfers easy are a good choice.  Pay particular attention to the mattress you are using, especially if your medical condition is one that results in fragile skin or poor circulation.  Long periods of time resting on a basic mattress can lead to skin breakdown and pressure ulcers. If you are using a hospital bed, consult with your provider about different options for your mattress.

There are a multitude of optional accessories for a bed that, when used properly, can make your bed experience more comfortable and more practical. The most prominent of accessories, and one that is typically used with a hospital bed, is a set of side rails. The most basic and common use of the rails is to keep you from rolling out of the bed and falling. Rails come in all shapes and sizes and perform different functions. It is imperative to understand this simple fact—if accidentally rolling out of the bed is not a concern, then you may not need rails on your bed. Again consult your doctor and Savon Medimart to decide if rails are right for you.

The US Food and Drug Administration and the Consumer Product Safety Commission issued warning as early as 1995 and as recent as 2012 about the risks associated with bed rails. In 2006, the FDA published voluntary guidelines that detail different measurements of the rails. These measurements only pertain to entire bed systems which include the bed, rails, and mattress. If you have a hospital type bed, it is critical to research where your bed system is from and if it meets these guidelines. The components of the bed system should all come from the same manufacturer. Rails that are marketed as universal and for use with any type of bed may be harmful if not mounted properly. Carefully follow the installation instructions and read all warnings in the owner’s manual. More information on bed rail entrapment can be found at www.fda.gov or invacare.com/bed safety.

Bed wedges have grown in popularity as an alternative to using a hospital bed. These foam wedges are easy to slide behind your torso, so the wedge elevates your head. These wedge pillows can be used in any type of bed, and, by propping up your head and torso; you can breathe easier, simplify eating in bed, and comfortably watch television.  Bed wedges also alleviate fatigue while sitting up to talk with others in the room.

Fall mats have traditionally only been found in places like nursing homes and hospitals. Today, designer mats for home use can be placed next your bed as a mode of decor. These mats provide functionality, cushioning from a fall while adding style to the room. A low height bed used in conjunction with a fall mat may reduce the need for side rails.

Over the bed tables have a base that rolls under your bed, while the top makes it easier to grab a bite to eat, hold the telephone and television remote, as well as your favorite book or computer tablet.  Keeping these items within reach reduces fidgeting and unnecessary transfers.  If you need help with transfers or repositioning, trapezes can be installed to offer the user a convenient handle bar within reach. Positioning with a trapeze employs the assistance of your upper body strength.

Using the proper bed, the proper mattress and the proper accessories can help minimize the risk of injury, but there are a few other best practices to form safe habits in your life. Know if you need help transferring in and out of bed. If you cannot transfer on your own, build schedules around toileting, bathing and eating so someone can be there when you have to get out of bed. Look for obstacles on the floor. Power cords, telephone wires, shoes, even side tables or over bed tables. The walkway to the kitchen, bathroom or front door should be clear to prevent falls. If you need a mobility device such as a walker or cane, keep it close to the bed so you can use it as a transfer aid. If you are still independent, build a network of caregivers, friends and family who can develop a monitoring program that includes daily visits and frequent phone calls. Finally, if your condition should change at any time, consult your doctor about your sleeping habits and the bed system you may need to use. 

If your bed is electric—which includes most beds that have adjustable heights—have someone periodically assess the condition of the power cord. Frayed or damaged cords—mostly from vacuum cleaners or patient lifters—can lead to risk of shock or fire. Check for any missing, damaged or non-functioning parts.  Refer to the owner manual instructions, warnings and cleaning tips.

While it’s unlikely that we will ever see a Super Bowl commercial concerning bed safety, we all have a responsibility to acknowledge the dangers, understand the causes and do our best to minimize the risks. Awareness begins with the individual user, who knows the best possible environment surrounding their own bed and bed safety practices. Consult your doctor, physical therapist, caregiver or Savon Medimart for the proper solutions. Select the right type of bed to fit your individual needs and diagnosis. If you are using a hospital type bed system, confirm that it meets FDA guidelines. Look to simple accessories to enhance your experience, and be cognizant of falls. All of these components can help create a pleasant and functional bedtime experience where users can be capable of enjoying their rest.

Article re-printed from Home Care magazine.  Author - Phil Cunningham, Invacare

The Importance of Senior Hygiene Care - Begin a conversation on bathing needs with your loved one.

Beginning a discussion about good bathing practices helps ensure that new technological developments provide the necessary assistance seniors require to remain self-sufficient or regain independence. As the largest organ in the body, the skin performs regulatory functions including temperature maintenance, expulsion of toxins through sweat and prevention of dehydration, and skin is part of the body’s defense system against infection. Thus, skin maintenance becomes even more critical as we age. 

The fragile state of skin in many individuals who face bathing disabilities compounds the necessity to be sure we are actively cleaning and taking care of the skin while also protecting and enhancing its integrity. Removing dead skin cells and body waste from the skin’s surface is important to our health but ironically, many of the activities we undertake (soaps, warm water, astringents) remove protective oils and decrease the inherent protective nature of skin. 

The cost of wound management for fragile skin becomes significant because wounds are a primary source of allowing infection into the body, which can have a significant impact on the quality of daily life. Ensuring bathing routines and rituals promote healthy skin requires an individualized approach to bathing to account for the needs of the skin as well as our social needs. 

Hygiene is an issue that can be particularly difficult to discuss with the people we are closest with. However, hygiene issues can contribute significantly to the cost of health care, long-term care and the ability to stay independent. 

It remains unclear exactly what causes urinary tract infections (UTI), particularly in the elderly, and a wide variety of organisms are responsible. However, 70 percent of UTIs in non-catheterized patients are caused by E. coli. In patients with a catheter, E. coli is responsible for roughly 40 percent of UTI diagnoses. Attention to hygiene can significantly reduce the impact of E. coli transfer and colonization. Meticulous personal hygiene and appropriate incontinent care are crucial in the elimination of re-infection UTIs. In a study of non-catheterized, elderly, long term care residents, results showed a significant reduction in UTI risk factors when correct hygiene protocols were followed by caregivers.

As we age, we face more difficulty with the activities of daily living. Bathing disability is one of those critical activities that can take away independence. Bathing disability is defined as the inability to wash and dry one’s whole body without personal assistance. A number of studies and personal experiences tell us that when a person experiences bathing disability, it is associated with long-term nursing home admission. 

The strong relationship between bathing disability and nursing home admission exists even when there are other disabilities impacting daily activities. When studied in adults age 70 and older, the onset of a bathing disability increased the likelihood of developing a disability in the other activities in the following month by five times. It’s important to note that a bathing disability can be a transient disability. In a 2006 study, researchers found that approximately one-third of the participants had multiple episodes of bathing disability, with the duration of each episode averaging about six months. Bathing disability is not commonly proceeded by other disabilities, and it strongly predicts subsequent disabilities, so the ability to prevent the onset of bathing disability becomes critical to being able to age in place. 

Technological developments in the bathing environment in the form of chairs, benches, mats, grab bars, hand held showers, etc. are personal. The ADA provides us with guidelines about how to make environments accessible, but the ADA doesn’t account for the specific disabilities of a person and the type of assistance they need. 

Technology doesn't have to mean a device with a screen, wires or electricity. Technology is defined as the application of scientific knowledge for practical purposes. The goal is to understand, and apply what we understand, to the problems that need solving. More specifically, assistive technology refers to any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.

In a series of interviews in Connecticut in 2010 with adults age 70 and older living at home, researchers found most pieces of assistive technology in use in bathrooms were not selected because of the resident’s specific bathing disability, but because the resident had seen an advertisement for the piece of technology. The sources for information did not include a professional needs assessment at all. 

Take a critical eye to bathing and talk about the problems that exist. Ask how we can help you solve those problems. Talk about hygiene. Discuss how your loved one is currently bathing. Will a grab bar or tub-cut really address the bathing disability your loved one is experiencing? Does a handheld shower head really allow the bather to address all their hygiene needs? Or is a bidet or seated shower more appropriate? There are a plethora of options to address bathing disabilities today. Take time to address the benefits of bathing and find an appropriate piece of bathing technology for your loved one.
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Article adapted from Home Care magazine.