Patients Hospitalised in Geriatrics Clinical Trial
Official title:
Usability Study of PARADE CONNECT Shoes, a Device to Detect Falls in Old People
This study evaluates the usability of a new remote warning system for fall in old people. This system is integrated in a shoe. Patients hospitalized in a geriatric ward but also their informal and professional caregivers will assess the usability of the device using a structured survey.
Falls are a major health concerned because of their frequency and severity. It is estimated
that 30% of people over 65 years old and 50% of those over 85 years old fall at least once a
year. Falls are also one of the main factors of morbidity, mortality and early
institutionalization for old people.
Preventive measures have been implemented to limit the recurrence of falls. Most of these
preventive measures are secondary and tertiary prevention programs, such as MultiFactorial
Interventions (MFIs). Home-based programs are under evaluation, but evidences of their
effectiveness are currently controversial. Effects of prevention programs for in and
outpatients remain modest. The objectives of these interventions are to decrease the
frequency of falls but also to decrease the severity of falls.
The severity of falls is due to their physical complications (found in 50 to 55% of cases),
their psychological complications (40%) but it is also reflected by the subsequent
hospitalizations (20%), the acceleration of dependency (50%) and the institutionalizations
(40%). Falls are complicated by death in 5% of cases.
In addition, the literature on fall complications is profuse. One of these complications is
the hip fracture. Hip fracture is the main cause of mortality and loss of autonomy due to
falls. However, in a previous study conducted by Bloch et al. in 2009 at Cochin Hospital,
several indirect evidences tended to show that mortality from falls was related to the
metabolic disorders linked to the extended stay on the ground, rather than to immediate
traumatic consequences. As metabolic disorders reflects the time needed to be rescued, this
article highlights the importance of using early warning systems to reduce the occurrence of
such complications in old frail patients living alone, and unable to get up alone from the
ground.
The most commonly used warning tools are remote assistance systems (necklace or bracelet)
with a button to push in case of a fall. In the study conducted by Flemming et al. in 2008,
when these systems are activated, the great majority of fallers are back on their feet within
one hour after the alert. Nevertheless, of 143 old people living alone and unable to get up
alone from the ground, only 28 were using a warning system. The reasons for non-use are as
follows: the person does not have a warning remote assistance systems, the person owns a
warning remote assistance systems but was not wearing it at the time of the fall, the person
was wearing a warning remote assistance systems but was forgetting (or was in difficulty) to
use it.
Many research projects on fall warning and detection systems have been initiated. In the 2018
meta-analysis by Nguyen et al., fall detection systems are divided into 2 groups: a pre and a
post-fall group. In the latter group, the detection systems were mainly using 3D
accelerators, gyroscopes, magnetometers or smartphones with the above-mentioned devices.
However, to date, there is no reliable detection system on the market because some obstacles
remain. These obstacles are concerning technology but also usability. Concerning
technological issue, one of the problems remains the ability of devices to detect low kinetic
falls, which is common in the elderly. Concerning usability, questions are for example the
problem of the voluntary activation by the user of the most common devices, or the absence of
wearing the device during numerous falls.
PARADE CONNECT would remove some of the usability obstacle typically associated with remote
warning systems. Indeed, the system is activated independently of the will, cognitive state
and consciousness of its user. The warning system is integrated into a shoe usually worn by
the old people, with probably a less stigmatizing character of aging and loss of
independence. This is why it seems important to us, as a first step, to evaluate its
acceptability and usability by patients.
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