|Care Advocate Newsletter|
|Past Issues | Download PDF||February/March 2013|
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:
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:
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.
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|Resources & Events|
“Rethinking the Use of Position Change Alarms”
Case Study, “Reducing Falls by Eliminating Resident Alarms at the Jewish Rehabilitation Center for the North Shore.”