Older Patients and Those with Dementia or Delirium are Major Consumers of Hospitals: It is well documented that older patients and those with dementia or delirium are at increased risk of falling. In a retrospective observational study by AI Hill of a 323-bed acute care tertiary hospital, Dementia (B63Z) and Delirium (B64Z) were the Diagnostic Related Groups (DRGs) with the highest proportion of fallers, with up to 24% of patients admitted with those DRGs experiencing a fall in acute care. This same study also demonstrated that falls were most common in the oldest (i.e. age >80 years)1. Older people are major consumers of healthcare. Even though people aged 65 years and older make up only 15% of the population in South Australia, they account for 38% of hospital separations and 51% of all inpatient days (SA Health Policy for Older People-2010-2016). A recent unpublished audit (CI Visvanathan) of in hospital fallers within the Division of Medicine at the Queen Elizabeth Hospital in Adelaide confirms that 68% of falls occurred in those aged 75 years and over and almost half of these patients falling had dementia or delirium.
Where do People Fall in Hospital?: In hospital, falls commonly occur around the patients’ beds, in the corridor, bathroom and/or the toilet. A study of an older persons unit revealed that 66% of falls occurred in the bedroom with 80% of these falls occurring around the bed. Many falls occur at night when nurse staffing levels are lowest and patient confusion occur. In one study, over 54% of the bedroom falls in an older person’s assessment, treatment and rehabilitation unit were un-witnessed. Similarly, in our hospital audit, 54% of falls were un-witnessed. 71% occurred in the bedroom and 17% in the bathroom. 35% were whilst ambulating and 25% were related to sitting or standing.
What we are doing about it?: There is a definite need for effective, evidence based interventions in hospitals, especially for older patients and those with cognitive impairment as highlighted in a recent systematic review and meta-analysis.
Therefore primary aim of this study is to determine the feasibility of a movement sensor alarm intervention using radio-frequency identification (RFID) technology to alert staff to a falls risk within a hospital geriatric unit. Feasibility aspects studied include: a) the acceptability of the intervention to consumers (including carers and patients with dementia) and clinicians; b) safety of the system to patients with dementia; c) adherence to the intervention as evidenced by activation of the system and response to the alarm by clinicians; and d) participation (i.e. proportion participating) of eligible patients in the trial, barriers to participation and reasons for withdrawal. Secondary aims include: a) Acquiring local data to enable accurate sample size calculations to inform the design of a definitive cluster randomized control trial; and b) refining the technological system based on feedback from consumers and clinicians ensuring that the system is prepared for a definitive trial.