C hances are that if you have visited a nursing home or long-term care facility, you have noticed different types of alarms going off from a number of sources—feeding and IV pumps, call lights, staircase doors, etc. One type of alarm you may see on residents is what is known as a personal position change alarm. These are devices designed to emit a warning signal when a person moves in a way perceived to put them at risk, usually for falls. In nursing homes, a common type of personal alarm is a pressure-sensitive pad for chairs, wheelchairs and beds that activates by sounding an alarm when the person moves and there is decreased pressure. Other types of devices might include a cord attached to the person’s clothing with a pin or clip and ending with a magnet or pull-pin that activates when the person exceeds the length of the cord; pressure-sensitive mats for the floor that activate when pressure is increased; or light beams on the bed or door that activate when the person crosses the beam.
You may recall the days of physical restraints which were designed to prevent people from falling or causing harm to themselves. Several years ago, nursing home staff came to understand the harmful effects of restraints and stopped using them because they cause a decline in a person’s physical, mental, and emotional well-being. By keeping people from moving, restraints adversely affect their respiratory, digestive, circulatory, and muscular systems, contribute to depression and isolation, and inhibit sleeping as well as independent eating, drinking, toileting and natural repositioning. Originally, personal alarms were used as temporary measures, to help staff learn more about the resident’s movement patterns. However, as staff began to stop using restraints and changed practice, the use of position change alarms became widespread, and they are now commonly used with residents for indefinite periods of time.
It was thought that they would be helpful, but growing evidence is showing that, just as restraints cause harm by preventing people from moving, so do personal alarms. There is also no evidence to support alarms’ usefulness in preventing falls or injuries. In fact, in most cases, falls continue to occur. From a practical perspective, many residents dislike them and repeatedly hide or remove them, devices malfunction (the cord breaks or detaches, batteries die, alarms fail to go off or are slow to respond), and if too many are in use, the warning sound loses its effectiveness at alerting staff.
For residents, there can be numerous negative consequences to their quality of life and mobility:
- Alarms create noise, fear and confusion for the person and those around them. For example, one gentleman would duck down when he heard the alarm as he was interpreting the sound to mean incoming missiles, bullets from his World War II experience. For people who are cognitively impaired, the alarms can be particularly upsetting: they are disturbed by the noise and have no way of understanding why it is happening
- As the use of the alarm decreases the person’s overall mobility, they may be more at risk for fracture when they fall since the person may have increased weakness and osteoporosis and decreased balance and endurance
- The alarms can be experienced as embarrassing and an infringement of freedom, dignity, and privacy
Skin break-down can occur from being immobilized, and from being afraid to shift position or body weight while sitting for prolonged periods of time, or while lying in bed at night
- Sleep may be interrupted, or even impossible when residents lie still for fear of setting off the alarm if they shift their position, or are awakened by the alarm. Lack of sleep compounds agitation and contributes to loss of appetite and decreased balance and endurance. The medications used to treat agitation and sleeplessness often add to these problems
- Loss of independent bowel and bladder function can occur
One of the reasons alarms don’t work is that they are reactive rather than proactive, because they only indicate to staff that the resident has moved, or has already fallen. But why was the person moving in the first place? It is important to try to identify the real reasons, which may include:
- Sitting or lying too long in one position, getting stiff, restless or bored
- Personal needs/toileting
- Pain, aches
- Inability to reach personal items (glasses, phone, remote, etc.)
As a family member or friend, you can help the staff ensure that the person’s wishes and preferences are addressed, particularly if they suffer from dementia and can’t clearly express their discomfort. Without a doubt, there is a need for an individualized safety plan, based on a thorough assessment of existing risk factors and his/her physical and mental condition. The overall goal, however, should be to encourage movement, balance and endurance and also to engage them in activities that will reduce boredom and agitation, such as listening to soothing music, organizing items in an interest activity box, even cuddling a baby doll or stuffed animal. If they are vision-impaired, consideration should be given to providing contrasting colors in their environment to lessen the risk of falls and clearly marking/color coding important items.
More and more studies of hospital and nursing home patients (including one most recently published in the Annals of Internal Medicine, November 20, 2012), reinforce that the use of bed and personal alarms do not decrease falls and related injuries. As a result, nursing homes are increasingly eliminating their use. Some successful examples include Isabella Geriatric Center in northern Manhattan, Morningside House in the Bronx and the Jewish Rehabilitation Center for the North Shore in Massachusetts. For additional information, you may wish to access the Websites listed in the sidebar.
The bottom line is that personal alarms provide a clear example of an intervention that, by attempting to prevent the risk of falls, may actually increase the possibility of serious injury from falling. In most cases, the best way to prevent this is to promote the person’s overall mobility, engagement and comfort.
Adapted with permission from “Rethinking the Use of Position Change Alarms” by Joanne Rader, Barbara Frank and Cathie Brady.