Fall Service Models -Lessions learned from the FARSEEING project

Jorunn L Helbostad Research group on Geriatrics, Movement and Stroke Department of Neuroscience, Faculty of Medicine,

Norwegian University of Science and Technology, Trondheim Norway, and St. Olav University Hospital, Trondheim Norway,

Acknowledgements

• NTNU – Ather Nawaz – Espen Ihlen – Alan Bourke – Per Bendik Wik – Arnhild Jenssen Nygård

• Municipality of Trondheim

– Kirsti Fossland Brørs – Klara Borgen – Lise Høiberg Knipeberg

• Sintef – Babak Farshchian – Yngve Dahl – Thomas Vilarinho

• University of Bologna

– Lorenzo Chiari – Sabato Mellone

• Rest of the FARSEEING

consortium

• Technology

• Service model – a description of a service

and the components required to deliver that service

• Service

– Implementation of the service model in practice

Service model

Technology

4

Health enabling technology and services

• The tools must be reliable

• The services must be reliable

• The services must meet the requirements for real life use

• New systems should build on the existing health care systems, health information systems, and information management systems

– Ludwig et al. 2012

5

Factors complicating implementation of falls service models in practice

• The technology is still immature or not feasible for older persons

• Lack of agreements and standards for technological platforms

• Failure to take into account the interests of important stakeholders – Patients, care providers, health care organizations, health care

personnel, policy makers, next of kin, government, suppliers

Falls and falls prevention

7

The FARSEEING telemedicine service models

• Fall detection and management – Give immediate and qualified help to older people

following a fall

• Fall risk assessment (proof of concept) – Detect fall risk earlier – Improve decision making for clinicians

• Exercice guidance (proof of concept)

– Increase uptake of interventions – Empower older people to mange own health and

function

Falls and falls prevention

9

Why fall detection and management services?

• Nearly half of those who fall need help

to get up from the floor – Not being able to get up after a fall

increases fear of falling

• 10 % stay on the ground >1 hour • poor prognosis if >12 hours on the

ground

Norway • Low population density

• 2050

– 20% of the population will be >67 years of age

• 2060

– Decrease in number of empolyees per retired person from 5 to 2.5

• Home care services constitute 1/3

of the municipal activity and costs Proportion of people living i areas with low and high population density

TRONDHEIM, NORWAY

• 172 000 inhabitants – 10% >67 years of age

• Public health care system

• Low population density

• Well developed primary

health care system – Home nursing – Public safety alarm service

12

Users of safety alarm services in Norway

Sintef report, 2012

0

20

40

60

80

100

50-66 yrs 67-79 yrs 80-89 yrs 90 yrs and older

Percentage

Reasons for using alarm services • Increased fall risk • Anxiety • Heart disease

13

Today’s safety alarm service in Trondheim

• 3780 safety alarm users

• 83 employees in the safety alarm service

• Use of push button-activated alarms

• ~12 000 activated alarms every month

• ~ 10% of the activated alarms lead to a physical visit

Today’s safety alarm service Trondheim, Norway

Push-button pendent safety alarm systems and services Pro • Robust technology • Established service • Same service for different

needs

Cons • The alarm only works

indoor • Alarm buttons are not

always worn • The users do not activate

the alarm • Requires a conscious

decision by the user • Dependent on analogue

telephone lines

Existing fall alarm service (Trondheim)

IO1: The user fails to activate the alarm IO2: The user fails to provide status about his condition after activating the alarm IO3: Response time

17

The FARSEEING automatic fall detection system and service model • User centered design

• Take important stakeholders into account

• Develop reliable algorithms for fall detection

• Develop/use technological platforms that can be reused and that can interoperate with other platforms

18

The FARSEEING fall detection and management service model

19

The FARSEEING service model adapted to a residential care setting

The FARSEEING automatic fall detection system

21

Field testing of the FARSEEING service model Aim: Assess experiences with implementing the model Sample • 20 end-users

– Age: 28-103 yrs, mean: 82.5 yrs – Living in residential care facilities – 8 had fallen the past year – All were considered to be at risk of falling – All were users of the today’s alarm service

• 10 care-providers

Assessment • Log books and logs from the server • Weekly follow-up meetings • Focus interviews with care-providers and end-users • Number of elicited alarms

23

Number of falls and triggered alarms • 20 people monitored over 4 weeks

– ~500 monitored days

• 7 falls by 4 people

– 0.42 fall per monitoring month

• Activated alarms

– 1 true positive – 6 falls not detected – 3 false alarms

24

Results Form factor and ergonomics – End-users

• Wearability • Aestetics • Self management

– Care-providers

• Devises that are strapped on are preferable (e.g. watch)

• Devises should be visible

25

Results System feedback and user control • End-users

– Want confirmation that the alarm has been received – Need a system that works in- and outdoor – Want to have the possibility to stop the alarm – Feasibility is more important than safety

• Care-providers – Inappropriate feedback increases anxiety for the end-user – Feedback to end-users should be individualised – False alarms are burdensome for carers and end-users – The end-user’s safety is most important

26

Lessions learned…… • ICT enables moving interventions closer to the users

– Empowering people to take care of own health requires new services

• User privacy – Sharing of data collected in free-living situations raise new challenges

• Introduction of new services raise new ethical questions

• Technology usability and form factors – Feasible to wear over 24 hours a day – Easy to use – Reliable!

• Holistic models vs. fragmented technologies and services – Same technologies and platforms for different purposes – Services than can be used by the same users over time

http://farseeingresearch.eu/ http://profound.eu.com/

Falling can be risky!

Thank you for the attention!

The user centred design process

ISO standard 9241-210