Falls, Tech

Spotlight on Falls – Harnessing technology and AI for a safer future

 


Falls are one of the most feared health emergencies for older people and their families. In our three-part series, we are shining a spotlight on falls, the changes we aspire to make and the impact these will have in reducing falls. We finish this series by looking at the possibilities for future falls detection and prevention.

We know that falls are something our residents and their families dread, as we explored in our first blog that looked at the impact and implications when a person has a fall and our second blog where we heard from our residents, relatives and staff

How we support our residents to reduce their risk of falls and ensure that any falls that do occur are detected very quickly is extremely important to us. We are supported in this mission by the numerous healthcare professionals who visit us to support our residents, including Gemma from The Caring Physio, whose work we featured in our blog ‘Personalised, at-home physiotherapy for our residents’.

Specifically thinking about the role of technology in falls prevention, Gemma told us:

I believe that there is so much scope for digital technology improving and reducing falls, both in a preventative element and an analytical element. The biggest way to reduce falls is by getting close to really understanding why people fall, how they fall and how we can reduce it, so if technology can do this I think it would be really good.

 

Technology we are considering at Peverel Court Care

We are in discussions with various supplies, including Sensio and Ally Cares, two companies who specialise in cutting-edge falls detection and prevention technology.

To share more about their work, we spoke to Sven Seljom, UK Country Manager for Sensio who produce a product called RoomMate, and Thomas Tredinnick, Co-founder and CEO of Ally Cares who produce an acoustic monitoring system, to share more about these breakthrough technologies.

 

Sensio’s Roommate

RoomMate is a prevention, detection and digital monitoring device. We asked Sven what the benefits are to implementing this type of technology for our residents: 

The obvious benefit is that we are able to detect movements and incidents in the room. We can detect falls, even low impact falls, very reliably thanks to our 3D vision sensor without needing the resident to remember to wear anything. 

When it comes to falls prevention, there are so many things that actually lead up to a fall that we can help with. For example, the sensor can pick up if a resident sits up in bed during the night. Staff can be warned about that on their handheld devices, and then act on it before the resident potentially ends up falling because they are tired or the room doesn’t have enough light. 

The system also enables staff to look into the resident without actually going into the room. They can do this through an anonymised view of the room, which means that they can see a figure in the room that represents the resident and they can check if they’re ok. If there has been an alert, they can also assess whether it’s a false alert or not. The purpose of this is to try and keep staff out of the room unless they are needed. This improves the privacy of the residents, and also increases their sleep quality. If residents sleep better, they are more rested and have fewer falls during the day. Night staff are also more relaxed; they can concentrate on the residents who need attention and leave residents who are happily asleep to enjoy that rest.

 

Ally Cares Acoustic Monitoring System

Ally Cares produce a resident monitoring system that uses sound and inferred motion to understand when a resident is alone in their room and may need assistance. It alerts staff to enable them to provide assistance if it’s needed. If it isn’t, they can hear why the alert was generated and leave the resident to enjoy privacy to continue with their activities, safe in the knowledge that that staff will be alerted if assistance is needed.

Thomas explains more about the benefits of what he and his co-founder, Zach, have set out to achieve with their technology after having personal experiences of the challenges their ageing relatives faced:

The main benefit to our technology is to being able to absolutely know when a resident needs assistance, and more broadly to gain insights into their health and wellbeing by being able to see trends and changes that you originally would not have been able to observe.

By connecting with care record systems, we can support residents to have better sleep which should reduce falls’ risk. Better sleep means a person may be able to do more for themselves safely, enabling staff teams to provide targeted, insightful care for residents who need it the most. 

One of the managers we worked with early on when we were developing the system put it really well. She said she wasn’t really anticipating the level of insight you get from the products when you’re using sounds. She also wasn’t anticipating seeing how much more connected her night team felt to her day team. How much more knowledgeable they were and the conversations that flowed because of this. That was a benefit that we hadn’t anticipated because we were so focused on how to deliver the safest possible care for residents.

 

Integrating falls detection and prevention technology into our digital care records

Across Peverel Court Care homes we moved to digital care records in 2020, with Nourish as our chosen supplier. We spoke to Steve Lawrence, Head of Product at Nourish, to find out his view on how Nourish see sensor based technology linking to what they offer:

The fact that you don’t have to wear a device or press any button to interact with acoustic systems is one of the key positives around this technology. With wearables, sometimes the person isn’t wearing the device, or the person isn’t able to raise a warning using it. Or the person is wearing it but they don’t want to make a fuss; they sit there suffering rather than actually getting the response that they need.

To know that the system is monitoring all the time, mostly generating non-urgent alerts which give passive information, means you have rich data that you wouldn’t have otherwise. For example, with night-time behavioural monitoring with acoustics. This works really well because as humans we are generally creatures of habit, so if we’re going to get up to use the bathroom we’ll do that consistently most nights. When there is something wrong, that’s when that pattern changes, and we can start to monitor that activity and use algorithms to determine changes to behaviour that can link to changes to someone’s condition. This could be due to a number of different factors, including an underlying condition that perhaps the person hasn’t been able to verbalise themselves. 

Through machine learning, we’re able to determine that these things are beginning to occur and to enable staff to have that early insight and take action sooner. We’ve seen that in practice, to a level where you can analyse that data and use it in predictive and preventative ways.

 

The current and future for falls detection and prevention – Ally Care’s view

We asked Thomas about how Ally Care will look to develop their acoustic monitoring technology further, particularly by supporting staff knowledge and decision making:

At the moment we have an insight tool using a machine learning algorithm to say whether or not a resident needs assistance. We use a different machine learning algorithm to chart how much rest a resident has had, how much care they might need, and picking up on things like whether they’ve been coughing more than usual.

We deliver that in a little handover tool and an insights tool that lets the night team very quickly and succinctly handover information to the day team about residents that they really need to handover. This means you go from the night team not really feeling like they can understand what’s happened for that resident (because multiple people have been going in and providing care as part of the regular safety checks), to us giving you a simple prompt that this resident has been awake more than usual, received more care than usual or been coughing more than usual. We measure this both on individual nights and also a trend over multiple nights. 

This means that the day team can be more cognizant of the care that they need to provide during their shift. If a resident has, over the last three nights, been much more restless you can start to join the dots. If this same resident is a high risk for a UTI, is this perhaps the precursor to them developing a UTI and we can do a dipstick test. 

For another resident you might see that over the last month on every Wednesday they are much more restless during the night. What is that to do with? Is it the fact that they’ve started a new activity on that day? Is there a regular visitor that day? Do they take a new weekly medication on that day?

These insights are then like an assessment tool that prompts staff. Is what they are seeing a generic trend over the month or something that’s just happened over the last few nights? This prompts the day team and the managers to review what they’re doing and be more dynamic in their support.

We want to develop this to make it more insightful for staff, so that they are prompted with what they need to look at or do and how they need to do it. In an ideal world you’d want to see the top three or four reasons as to what might be happening for the resident, and I think that’s probably the area we want to develop to create more holistic data sharing.

 

The future for falls detection and prevention – Sensio’s view

We asked Sven about how Sensio will look to develop their RoomMate technology further, particularly by utilising data that’s been collected as a result of their technology. This could be used to support clinicians to reduce an individual’s risk of falls by, for example, linking Sensio’s data to multifactorial patterns like a person’s medical needs, nutritional and hydration input:

We could analyse many aspects from our data and produce useful outputs, for example measuring gait speed and how people move around their room. Are they confused? Are they going straight to the bathroom or are they going out in the hallway and then trying to find the bathroom? With UTI’s, how many times does the person visit the toilet? How is a person moving in bed? Compare that data with their medication regime – What types of medication are they having and how does that affect how they sleep? How much time do they spend in bed? How much time do you spend in a chair?

There are so many things we would like to do to improve our systems. It’s just a question of resources to do this work, always keeping the privacy of people using RoomMate in mind.

 

The future for falls detection and prevention – Nourish’s view

We asked Steve how Nourish foresees using data in the future:

There are good practice examples out there that can be utilised to be able to support staff to do the right things at the right time. It’s not just about research-based ways of doing things, there are common practice examples within our Nourish community where we are learning from providers like Peverel Court Care. We see it as our role to help to share information to support care teams to be able to do things in a more prompted way, to ensure that important aspects aren’t missed and that good care is provided by having the right sort of processes in place. 

There’s a big element around the protocols and workflows. I think there’s a lot around the predictive analysis too, the cause and effect of certain events that take place, and using that information intelligently. You know, we have a lot of insights in our system and we have the ability to start looking at things that happen perhaps before an event to know if there was a fall.

 

What’s next? 

At Peverel Court Care we will continue to work with our partners in falls prevention and monitor the latest news and developments, like the use of artificial intelligence (AI) to prevent falls. We want to be – and remain – at the cutting edge of reducing falls for our residents. 

To conclude with Gemma’s thoughts:

I’m really pleased that you’re looking into this because I think it’s a sadly under-researched area. With the digital evolution that’s going on at the moment, if we can take some of that genius and apply it to something as important as falls – which have such a huge effect on this population’s life – that’s brilliant. 

No pressure, but I think you’ll make big waves if you can break through and make some sort of improvement. Older people deserve this, they deserve to have some tech to help them.

 

Further reading

Peverel Court Care’s Associate Director, Preet Shergill’s Topol Fellowship (that focuses on falls) continues. Preet’s Topol Fellowship includes close working with the NHS, and he wrote about this in his blog for the Department for Health and Social Care

 

About Peverel Court Care

Peverel Court Care is a group of one residential and two nursing homes, located in Buckinghamshire and Oxfordshire. Bartlett’s Residential Care Home and Stone House Nursing Home in Aylesbury, and Merryfield House Nursing Home in Witney. We are a long-standing family business. Providing exceptional, personalised care, delivered by talented and compassionate people, in exclusive and idyllic settings.

With happiness at the heart of our homes, we recognise and respect the contribution made by our residents to society during their lifetimes. Valued by residents and their families; our reputation, investment in each property, and approach to appointing and developing our staff makes each home unique and the benchmark in premium care.

Falls, Tech

Spotlight on Falls – The voices of lived experience

 

 

Falls are one of the most feared health emergencies for older people and their families. In our three-part series, we are shining a spotlight on falls, the changes we aspire to make and the impact these will have in reducing falls. We continue this series by hearing from our residents, relatives and staff about their personal and professional experiences of falls.

We know that falls are something our residents and their families dread – and with good reason – as we looked at in our first blog in this series that detailed the impact and implications when a person has a fall.

It’s very important to us, as we explore the latest technology around falls detection and prevention, that we understand first-hand about our residents’ and relatives’ experiences of falls and how they feel about the technological solutions we are considering.

 

What our residents and relatives say about their experiences of falls

Don lives with us at Bartlett’s and told us:

I was a runner, I enjoyed running. I’ve always been willing to test myself, going a little further is always important for me, pushing boundaries, and that’s still there in walking.

My balance over the last year has been deteriorating. I started off by denying I needed a walking stick, then realised it was probably advisable to carry one. So, I carry a stick and try not to use it. I go out for a walk and carry it. I start with leaning on the stick, realise my balance is ok, then I pick the stick up and walk with it.

I have some consciousness of my vulnerability to falls. The most alarming is falling backwards. That doesn’t happen often… It’s when I get tired that my vulnerability to falls is raised. Yesterday I wanted to sit down on the edge of the bed and I missed it. I didn’t hurt myself; I fell on my backside, picked myself up and carried on. But it was a warning to be careful.

Andrea told us about her experiences of caring for her dad before he moved to Bartlett’s:

Dad had multiple falls, both in the house and out of the house, and I had no idea how to deal with that other than call 999. 

Dad calls falls ‘a slow sit down to the floor’. He doesn’t call them falls at all. He gets so tired that he can’t support his weight any more and falls. I don’t think he trips. One time on the drive at his house he fell and crawled on his hands and knees to his car to pull himself up.

I couldn’t be there 24/7 for him, and I would rely on him to either call me to tell me he’s fallen or dad’s pendant alarm company to ring me. But that’s obviously after the event, it’s not helping to prevent the fall.

Heather lives with us at Stone House and told us:

I don’t think of falling, I continue with life, then the beastly falls happen. Recently, I went across the room to take my phone off charge, I didn’t rush, I went quite slowly, but on the way I fell, got my foot trapped and I couldn’t get up. Two nurses who happened to be next door came and got me standing.

I’m not expecting to fall, but unfortunately I do. I lose my balance. I don’t think of it until I go down bang, which is pretty stupid. (Laughs)

Lynn’s mum lives with us at Bartlett’s and told us:

Mum has been getting increasingly unstable and we’ve had two reports now of mum being found on the floor. She’s been fine, but there hasn’t been anybody to witness that (the falls). I don’t think she remembers it, so she can’t report it herself.

Mum used to be somebody who played tennis and badminton and did keep-fit and dog walked two or three times a day. To see her with this frailty and worry about the thought of her lying or sitting on the floor… I feel for her vulnerability and her safety.

Following her mum’s falls, Lynn told us:

Mum’s gait has changed. She definitely needs an arm to lean on, and has a general sense of imbalance and isn’t confident on her feet anymore.

 

What our staff say about how falls impact our residents

Connie is an Administrator at Bartlett’s and told us:

People don’t deliberately fall. You don’t necessarily have that reaction time to think ‘I’ll grab something’. I’ve been on reception, heard a commotion and later found out that it was someone who had a fall in the corridor. It’s quite hard knowing that’s what I heard and later discovering they had an injury, that’s quite tough. Then seeing the knock in their confidence in the coming days. It’s not nice to experience.

Naturally I think some of the residents who are less mobile are more cautious when they are walking. One resident who recently had a fall and was found on the floor, in the coming days she was a lot more hesitant and wary with her steps. Whether she remembered the fall, and on some level emotionally she did, you see that within her. She was almost looking for extra support from staff and had that uncertainty about what to do next.

 

Falls in a person’s own home

As part of our work into falls detection and prevention, we are looking at many different environments – not just those within our Peverel Court Care homes – to understand the challenges for all older people who are vulnerable to falls.

Ruth supports her mum who lives in her own home. Ruth’s mum has had a series of falls, and Ruth recounted her feelings about her mum’s first fall to us:

I was pretty shocked, there was a lot of blood. The hearth was marble, so mum had fallen down on something very hard….. the unsteadiness, there was a trip involved as well… I was very frightened for her. I think we all know that head injuries can result in life changing events and a risk to life, and because of the amount of blood that was there, I felt very shaky… I felt a bit all over the place if I’m honest.

Following her mum’s first fall, Ruth told us:

We felt that mum’s memory had declined. She was finding it quite difficult to recall dates and facts about things. She lost confidence, she didn’t want to leave the house… she didn’t really want to walk. Emotionally, mum is a very strong woman… but what I did notice 6 months later is that mum couldn’t remember having a fall.

 

How can we support older people with earlier detection of falls risks?

Ideally we’d like to be able to prevent every fall, but experts agree that such aims are unrealistic. The focus of current technological solutions is around detecting falls risks, particularly when someone starts to move around, for example by getting out of bed at night. 

Sensor monitoring in resident’s bedrooms is one solution we are considering for Peverel Court Care homes. Sensor monitoring detects changes in noise, picking up when someone starts to move, which could be particularly helpful at night in reducing the number of night-time checks staff do that can disturb residents. We asked our residents and relatives who participated in our research interviews on falls what they thought of this technology.

Don said:

So long as it’s not obtrusive, I won’t notice it. I’m trusting the technology to help me.

Andrea, Don’s daughter, told us:

I wouldn’t want it (sensor monitoring) to totally replace any human checks, but if it could reduce the number of checks staff make that would be useful. It’s not a mistrust of the technology, it’s just nice to see someone in the night if you’re unsure and you’ve woken up. Sometimes dad gets a bit disorientated.

I remember my grandmother, she had a fall and broke her hip, and that was life changing for her. So anything that helps to prevent falls is good.

Lynn echoed Don and Andrea’s views. She said: 

It just seems a real benefit to have some sort of monitoring that is there… overnight in rooms, because who knows when somebody gets out of bed and decides they want to wander around the room or go to the toilet. To have that constantly monitored has got to be a good thing. I know staff pop in every now and again, but things happen in between visits so I think that can only lead to a better outcome.

 

What are the key considerations when introducing new falls detection technology?

Whilst we are keen to explore new falls technology, we know there are many considerations to implementing this to ensure our core values of providing the highest standards of care and support for our residents are upheld.

We explored this topic with Connie who told us:

When we’re looking at the sensor* technology we definitely need to keep the level of privacy, making sure that it’s non-intrusive. 

I think for residents especially, they need to know that there are no trip hazards. For instance, the mats that go on the floor (that we currently use to detect movement), they are potentially a trip hazard. I’ve always wondered why they are used, because I don’t think they’re that effective in preventing falls, which they are designed to alert (us to) if they are on the floor. 

I think with the sensor* monitoring, keeping the autonomy of the resident is really important, that’s one that the residents would say themselves. 

Removing the need for nighttime hourly checks would be really beneficial for residents, especially those with dementia. Sleep is incredibly important, it has an effect on their day-to-day moods, their balance, their lives. I think that would be the main benefit.

 

What’s next?

In our third and final blog of this series, we will look at the future of falls prevention and how different digital solutions and advancing technology can assist us at Peverel Court Care.

 

About Peverel Court Care

Peverel Court Care is a group of one residential and two nursing homes, located in Buckinghamshire and Oxfordshire. Bartlett’s Residential Care Home and Stone House Nursing Home in Aylesbury, and Merryfield House Nursing Home in Witney. We are a long-standing family business. Providing exceptional, personalised care, delivered by talented and compassionate people, in exclusive and idyllic settings.

With happiness at the heart of our homes, we recognise and respect the contribution made by our residents to society during their lifetimes. Valued by residents and their families; our reputation, investment in each property, and approach to appointing and developing our staff makes each home unique and the benchmark in premium care.

 

*Sensor monitoring/technology is also referenced as acoustic monitoring/technology by some of our interviewees.

Falls, Tech

Spotlight on Falls

 

 

Falls are one of the most feared health emergencies for older people and their families. In our three-part series, we will be shining a spotlight on falls, the changes we aspire to make and the impact these will have in reducing falls. We begin by looking at how falls impact older people and the implications for a person when they fall.

The potential to have a fall is something many older people and their families dread. Whether the person lives at home, is in hospital or in a care home, having a fall can have significant and far-reaching consequences. It’s something many health and social care staff also fear and often find difficult to mitigate against and manage. 

 

What do we know about falls?

The 2018 ‘NICE impact report on falls and fragility fractures’ said:

Older people are more likely to fall. They are also more likely to suffer significant consequences, such as a loss of independence and confidence, leading to physical and mental deterioration and frailty. This increases the risk of a person experiencing multimorbidity, which is when a person has 2 or more long-term health conditions. It can also increase their risk of further falls and fractures.

In 2015/16, NHS Improvement reported that 204,269 inpatient falls were voluntarily reported by acute trusts, with a fall rate of 2.8 falls per 100 patients. However, many falls occur at home and go unreported, so the true incidence of all falls is unknown. It is estimated that approximately 30% of people older than 65 fall at least once a year; this is around 3 million people in England.

The 2022 Age and Ageing Journal published the first ‘World guidelines for falls prevention and management for older adults’ that said: 

Falls occur at all ages and are an inevitable part of a bipedal gait and physical activity. They occur in 30% of adults aged over 65 years annually, for whom the consequences are more serious, despite concerted efforts of researchers and clinicians to understand, assess and manage their risks and causes. In addition to personal distress, falls and fall-related injuries are a serious health care problem because of their association with subsequent morbidity, disability, hospitalisation, institutionalisation and mortality.

In Europe, total deaths and disability-adjusted life years due to falls have increased steadily since 1990. The Global Burden of Disease study reported nearly 17 million years of life lost from falls in 2017. Related societal and economic consequences are substantial. In high-income countries, approximately 1% of health care costs are fall-related expenditures.

Note: NICE (National Institute for Health and Care Excellence) are currently updating their guidance on Falls and their new recommendations will be published in August 2024.

 

Falls and care homes

With these statistics in mind our Associate Director, Preet Shergill, has made falls the subject of his NHS Digital Academy TOPOL Fellowship (TOPOL Fellowships were borne out of the 2019 Review conducted by Eric Topol MD entitled ‘Preparing the healthcare workforce to deliver the digital future’). In his first blog for the NHS Digital Academy about his fellowship entitled ‘Empowering social care through digital innovation: My Topol Digital Fellowship journey’ Preet said:

The public health data highlights the urgent need for falls prevention strategies, given the impending exponential growth in the 85+ age group. In my local county of Buckinghamshire, the number of people over 85 is projected to rise by 78% over the next 12 years. The total annual cost of fragility fractures to the UK, including social care, is estimated at £4.4 billion.

 

What are the current challenges around falls?

As we go into the autumn and winter seasons, falls join flu, Covid and many other seasonal challenges making NHS-related headlines every year. Falls outside are more likely in cold and icy conditions, and falls inside become more common when people are unwell with infections and more confused, tired or struggling with their balance.

Once a person has a fall, shock and distress are highly likely, making the psychological impact immediate. The physical consequences can, at worst, mean broken bones – hip fractures are especially common and often life-changing or life-shortening – and, if the person has hit their head, potentially the consequences can be fatal. 

Even if these worst-case scenarios are avoided, a fall often means going to hospital for a precautionary scan and tests, an in-patient stay may be needed, pain may be difficult to assess and control, and bruising and any cuts can take a long time to heal. 

With extended waiting times for ambulances, overstretched A and E departments, shortages of beds on wards, and the difficulties for an older person or a person with dementia when they are in an unfamiliar environment (that can often lead to further falls, loss of independence, weight loss and incontinence), going to hospital alone can be a traumatic experience.

Even if a person’s physical injuries heal, the physiological ones often remain. The person may repeatedly think about how they fell and what the cause was. They may become fearful of walking, or lose confidence in maintaining aspects of their independence that they feel may have either led to their fall or could lead to another fall. It then becomes a vicious circle of reduced mobility, with the physical consequences of pressure ulcer risks and greater chances of infections like UTI’s, and greater dependence, which can often erode feelings of self-worth and self-esteem.

 

Falls matter to everyone

Because falls have such a massive impact on the lives of people who fall and their families, we believe they are a vital issue for us to understand more about. We need to find innovative ways to prevent falls and, should a fall still occur, manage a person’s recovery as effectively as possible through modern rehabilitation techniques – like our personalised, at-home physio service – to ensure the best quality of life for our residents.

We will never be able to prevent every fall, or indeed the physical and psychological effects a person may be living with from a fall prior to moving into a Peverel Court Care Home. What we can do, however, is change the narrative and our approaches to find new solutions and ways of thinking.

 

What’s next?

In our second blog of this series, we will hear from some of our residents, families, staff and other healthcare professionals about their personal and professional experiences of falls. We will also discuss how digital transformation can lead to a positive impact in reducing falls.

 

About Peverel Court Care

Peverel Court Care is a group of one residential and two nursing homes, located in Buckinghamshire and Oxfordshire. Bartlett’s Residential Care Home and Stone House Nursing Home in Aylesbury, and Merryfield House Nursing Home in Witney. We are a long-standing family business. Providing exceptional, personalised care, delivered by talented and compassionate people, in exclusive and idyllic settings.

With happiness at the heart of our homes, we recognise and respect the contribution made by our residents to society during their lifetimes. Valued by residents and their families; our reputation, investment in each property, and approach to appointing and developing our staff makes each home unique and the benchmark in premium care.

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