Impact of An Emergency Response System on Anxiety and Health-Care Use - Full Text View

Purpose

What to do after an elderly patient falls but is not seriously injured can be a very challenging decisions for the patient and the Emergency Physician. Unfortunately, homecare support is often unavailable for weeks. The patient and physician must then choose between discharge home without support, or hospitalization. An emergency response service (ERS) allows the patient to summon assistance from anywhere in their home, and may provide another option.

Objectives: To see how an ERS affects patients’ anxiety, fear of falling, and use of the health-care system after discharge. We will study patients over 70 years of age who have fallen but do not need to be hospitalized. Our belief is that the ERS will improve patient anxiety, and may prevent return visits to the Emergency or episodes of prolonged immobilization after a fall.

Methods: Patients agreeing to participate in the study will be assigned by chance to receive either current standard discharge care, or standard care plus the use of the emergency response system. Patients will be interviewed one month after discharge to compare the impact of the ERS. This study is a first step in deciding whether the ERS is a useful new technology.

Condition	Intervention
Anxiety Falls Fear of Falling	Device: Emergency Response System (Device)

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Single Group Assignment Masking: Single Blind Primary Purpose: Treatment
Official Title:	A Randomized Clinical Trial To Asses The Impact of An Emergency Response System on Anxiety and Health-Care Use Among Older Emergency Patients After A Fall

Resource links provided by NLM:

MedlinePlus related topics: Anxiety

U.S. FDA Resources

Further study details as provided by Sunnybrook Health Sciences Centre:

Primary Outcome Measures:

Anxiety measured with the Hospital Anxiety and Depression Scale, at 1 month

Secondary Outcome Measures:

Fear of Falling, using Falls Efficacy Scale at 1 month
Proportion who Returned to the Emergency Department by 2 months
Proportion who are Hospitalized by 2 months
Length of Stay by 2 months, in Days.

Estimated Enrollment:	80
Study Start Date:	November 2002
Estimated Study Completion Date:	June 2004

Show Detailed Description

Eligibility

Ages Eligible for Study:	70 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Age greater than or equal to 70 years.
Primary complaint of a fall and discharged home directly from the Emergency Department -

Exclusion Criteria:

Admitted to hospital
Not independently living
No Phone Line
Unable to give informed consent
Living outside geographic catchment area -

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00330720

Locations

Canada, Ontario
Sunnybrook Health Sciences Center
Toronto, Ontario, Canada, M4S 3M5

Sponsors and Collaborators

Sunnybrook Health Sciences Centre

The Physicians' Services Incorporated Foundation

Lifeline

Investigators

Principal Investigator:

Jacques S. Lee, MD

Sunnybrook Health Sciences Center

More Information

Publications:

Burt CW, Fingerhut LA. Injury visits to hospital emergency departments: United States, 1992-95. Vital Health Stat 13. 1998 Jan;(131):1-76.

Tinetti ME, Speechley M. Prevention of falls among the elderly. N Engl J Med. 1989 Apr 20;320(16):1055-9. Review. No abstract available.

Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA. 1989 May 12;261(18):2663-8.

Vellas B, Cayla F, Bocquet H, de Pemille F, Albarede JL. Prospective study of restriction of activity in old people after falls. Age Ageing. 1987 May;16(3):189-93.

Walker JE, Howland J. Falls and fear of falling among elderly persons living in the community: occupational therapy interventions. Am J Occup Ther. 1991 Feb;45(2):119-22.

Howland J, Lachman ME, Peterson EW, Cote J, Kasten L, Jette A. Covariates of fear of falling and associated activity curtailment. Gerontologist. 1998 Oct;38(5):549-55.

Howland J, Peterson EW, Levin WC, Fried L, Pordon D, Bak S. Fear of falling among the community-dwelling elderly. J Aging Health. 1993 May;5(2):229-43.

Arfken CL, Lach HW, Birge SJ, Miller JP. The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health. 1994 Apr;84(4):565-70.

Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI. Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. J Gerontol. 1994 May;49(3):M140-7.

Dibner AS. A method for reducing anxiety in the home-bound elderly. J Geriatr Psychiatry. 1981;14(1):111-3. No abstract available.

Roush RE, Teasdale TA, Murphy JN, Kirk MS. Impact of a personal emergency response system on hospital utilization by community-residing elders. South Med J. 1995 Sep;88(9):917-22.

Koch WJ. Emergency response system assists in discharge planning. Dimens Health Serv. 1984 Nov;61(11):30-1. No abstract available.

Dibner A. Personal emergency response systems: comunication technology aids eldery and their family. J Appl Gerontol. 1990;9:504-510.

Dibner AS. Personal response services present and future. Home Health Care Serv Q. 1992;13(3-4):239-43. No abstract available.

Hyer K, Rudick L. The effectiveness of personal emergency response systems in meeting the safety monitoring needs of home care clients. J Nurs Adm. 1994 Jun;24(6):39-44.

Bernstein M. "Low-tech" personal emergency response systems reduce costs and improve outcomes. Manag Care Q. 2000 Winter;8(1):38-43.

Ford JD, Trestman RL, Steinberg K, Tennen H, Allen S. Prospective association of anxiety, depressive, and addictive disorders with high utilization of primary, specialty and emergency medical care. Soc Sci Med. 2004 Jun;58(11):2145-8.

Ford JD, Trestman RL, Tennen H, Allen S. Relationship of anxiety, depression and alcohol use disorders to persistent high utilization and potentially problematic under-utilization of primary medical care. Soc Sci Med. 2005 Oct;61(7):1618-25. Epub 2005 Apr 26.

Grief CL. Patterns of ED use and perceptions of the elderly regarding their emergency care: a synthesis of recent research. J Emerg Nurs. 2003 Apr;29(2):122-6.

ClinicalTrials.gov Identifier:	NCT00330720 History of Changes
Other Study ID Numbers:	205-2002, PSIF Grant #02-13
Study First Received:	May 26, 2006
Last Updated:	May 26, 2006
Health Authority:	Canada: Ethics Review Committee

Keywords provided by Sunnybrook Health Sciences Centre:

Personal Emergency Response System
Anxiety
Fear of Falling
RCT

Additional relevant MeSH terms:

Anxiety Disorders
Emergencies
Mental Disorders
Disease Attributes
Pathologic Processes

ClinicalTrials.gov processed this record on May 21, 2013