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FALLS, CALLS AND TELECARE

Theresa Atkinson, PhD Student (ESRC), Lancaster UniversityPresentation to Town and Gown Event

Thursday 27th September 2018

TELECARE CONTEXT – FIRST AND SECOND GENERATION2

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POLICY CONTEXT

➢ Followed implementation re-designed telecare service

➢ Uncertainties in the evidence base - but “leap of faith” - charge free for those eligible under the Care Act (2014)

➢ Ambition - promote independence, keep people safe at home, integrating telecare into social care practice, roll out large scale, achieve cost savings

➢ Unclear whether the cost savings materialised

➢ Telecare grew substantially, multiple service users prescribed wearable falls detectors in addition to the red button alarm and/or other devices

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RED BUTTON ➢Red button active - required component - welcomed for ‘peace of mind’.

➢ Some attached, others maintain distance, ‘at hand’- in tray of walking aid – or bedside cabinet, never worn, never used, but better with than without it?

➢Red button not always used after a fall (Fleming and Brayne 2008) - not wearing it, didn’t think about it; couldn’t activate; chose not to, manage own fall

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MARGARET

➢Margaret chose not to press her red button when she fell again at home. She didn’t want the monitoring centre to contact her son, nor the ambulance service, and she managed with some considerable effort to crawl and shuffle on her back from room to room, eventually manoeuvring herself off the floor (FN100 :11/17)

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FALLS AND RESPONSE➢ Red-button preferred choice - multiple people prescribed a wearable falls detector - ? who is at

most risk/which device is most appropriate?

➢ Falls devices had own and sensitivities - promote sense of security, but can create demand, dependency - sometimes false sense of security

➢ Monitoring centre staff operate in high-risk situations - mobilise support from multiple others, including families, carers, blue light services, emergency home response and falls lifting service (for some)

➢ Day to day tele-care-work - negotiate complex care boundaries managing/preventing/reducing falls risks - lifting from the floor, from the chair, into bed, off the toilet but with this physical and emotional work mostly rendered ‘invisible’

➢ Majority of alarm calls, including through falls monitoring, for non-emergency use. Everyday activities entangled with real-time emergencies - multiple calls required to create and maintain the system.

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FALSE CALLS/FALSE ALARMS

➢ ? “intelligent/automatic” - over or under sensitive - picking up certain types of falls, multitude of calls, many false calls (how do they get categorised as such).

I realised like if I did something – and say you were in the kitchen and I dropped a spoon it would go off so I stopped wearing that and I keep it by the locker – but I wear this all the time (red button alarm) (FN51 : 07/16:1)

➢ False alarms can lead to rejection of falls detection (Igual 2013) - privacy invaded; fuelling anxieties enhancing vulnerability and fragility

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EVERYDAY ENCOUNTERS

… don’t know why it’s gone off; I just dropped it; Yes I’m ok - I’m just on the toilet;It went off - I just touched it; are you tilting it… are you on the floor; … the carer’scoming; it’s going off all the time - he’s taken it off; are you sitting on it?; she justwants her dinner; I’m hungry; I’m cold - it’s freezing in here (FN88 : 05/15; FN94:06/7; FN95 : 07/17 – Monitoring Centre Observations)

… she closed her eyes, crossed her arms over her chest, as the installer reminded her about her potential vulnerabilities, the risks of falling, in particular, but also risk from fire and from poisonous gases as the installer checked the other devices - even though she had the ability to raise an alarm herself (FN66 : 02/17 – Installation Observation)

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TRUST AND TELECARE

➢ Difficulty demonstrating/simulating fall; dropped on carpet or lid of a cardboard box better - hard surface

➢ Confusion about the manual and automatic function; envisaged when introduced might replace the 1.7 million red button alarms (BBM 2013)

➢ Some wore both devices - which one to press if fails to alert. Confusing, stigmatising, objectifying, ? lack of trust in automatic device

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EVERYDAY ENCOUNTERS

➢But Margaret struggled to press the button on her second issue falls detector. She said it went off late at night for no reason and she thought someone was loitering outside, but it was the monitoring centre staff talking to her on the system – so despite her falls risk, she leaves them both on her bedside cabinet (FN 100 : 11/07).

➢Reg described how he’d pulled a chest of drawers on top of himself, falling over in the process, but his ‘intelligent’ falls device failed to trigger an alert and he was told he should have pressed the button. Reg said that his device went off frequently, but not when he fell, but the ‘false’ calls gave him reassurance that ‘someone’ was there and he had regular unscheduled contact with the monitoring centre staff albeit via falsely activated calls (FN : 05/17)

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CONCLUSION

➢ Partial picture – diversity/multiplicity/unpredictability – but valued by some - many placing trust in falls detection through telecare

➢ ? whether falls detection yielded to the new technological age (Doris 2014)

➢ For the right candidate - there are no downsides to using falls detection, despite the false alerts (Schoonover 2014)

➢ Cautious and reflective approach – review ‘fit’, shouldn’t be the only tool to manage ‘falls’ risks

➢ Better in digital generation? The clunky, noisy, bleepy, analogue dial up system left behind in 1990s – to be replaced by a seamless, silent, integrated ‘always on’ version of telecare.

➢ Some may resist ‘always on’, preferring something, or someone, to be there just in case

ReferencesBBH (Building Better Healthcare) 1 May 2013 https://www.buildingbetterhealthcare.co.uk/news/article_page/Tunstall_launches_fall_detection_alarm/88127

Doris T (2014) http://telecareaware.com/accelerometers-false-positivesnegatives-and-fall-detection

Fleming J and Brayne C (2008). Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90. BMJ. 2008;337:a2227.[PMC free article] [PubMed]

Igual R, Medrano C and Plaza I (2013) Challenges, issues and trends in fall detection systems. Biomed Eng Online 12 : 66 doi: 10.1186/1475-925X-12-66

Schoonover A (2014) http://telecareaware.com/a-five-point-rebuttal-to-accelerometers-false-positivesnegatives-and-fall-detection/#more-18059

http://telecareaware.com/who-what-when-the-history-project/

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