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Aim: to establish the relative efficacy of personal and ambulatory devices to detect movement and precursors, particularly in aged patients, that may indicate a likely fall, with the aim of providing intervention to prevent the actual fall.

Personal Ambulatory Monitoring

Factors such as ageing population, rising health costs and the increasing incidence of long-term chronic disease are generating healthcare challenges of an unprecedented scale. These issues are driving a trend towards increasing levels of care in the home, with early discharge from hospitals, or 'ageing in place' initiatives, in which the elderly are encouraged to maintain independent living for as long as possible.

As part of the program of ambulatory monitoring of stroke and elderly patients, a Smart-State initiative of the Queensland Government, the e-Health Research Centre conducted clinical trials to establish the relative efficacy of personal and ambulatory devices to detect movement and precursors, particularly in aged patients, that may indicate a likely fall, with the aim of providing intervention to prevent the actual fall.

In addition to movement monitoring, the e-Health Research Centre evaluated systems capable of continuously monitoring and recording patient vital signs information, such as heart rate. While the trials were primarily focused on patients in clinical settings, it is anticipated that similar approaches could be extended to the home environment.

Background

Falls in the aged community have been a significant problem for many years and often result in major injury leading to disability or death. In Queensland alone, around 300 deaths and 16,000 hospital admissions per year are attributed to falls in older people [1].

In particular, falls in older people with stroke, who's conditions are often managed with medications such as vasodilators, anti-arrhythmics and diuretics are a concern. Many of these drugs result in a significant lowering of blood pressure and can lead to orthostatic or cardiac arrhythmia syncope, conditions that result in markedly increased rates of mortality and sudden death.

In responding to the needs of this group of vulnerable people, aged care clinicians and nursing staff would be significantly assisted by the use of personal and ambulatory monitoring devices to monitor patient vital signs and activity. The ability to monitor vital signs remotely would also facilitate the remote management of medications.

Devices that detect human movement are available on the market and are gaining acceptance in non-clinical environments such as sports medicine.

Benefits

The continuous personal monitoring of patients may provide a number of advantages:

Early detection & intervention Events such as heart arrhythmias, falls and stumbles are detected, alarmed and recorded as they occur allowing clinicians, nursing staff or carers to intervene quickly.
Analysis & interpretation Clinicians can draw upon accurate data for analysis and interpretation.
Efficiency Personal monitoring reduces the burden placed on already over-extended clinical staff and carers.
Independence Patients receiving in-home care are able to maintain a degree of independence in surroundings that are familiar to them.
Remote living Patients living in geographically remote communities who require medical monitoring without the need for hospitalisation can be monitored.
Affordability The cost of providing continuous personal monitoring is lower than the costs of transporting and accommodating patients.

Technology

Two categories of monitors were trialed:

  • Motion Sensors to record movement, measure long-term trends in activity level, and provide the means to detect falls quickly and accurately.
  • Vital Signs Sensors to detect vital signs such as ECG, heart rate, respiration rate become necessary for patients under critical conditions and enhance the quality of personal monitoring systems. These signs can also provide important information on precursors leading to falls.

Communications Systems Options

Personal monitoring technology can use standard wireless transmission of data to a PC/Laptop/PDA when indoors or via mobile phone/conventional phone when outdoors/home. Devices can also record data to an internal memory card in situations where wireless protocol cannot be used.

Data System Possibilities

Information recorded could be accessed by carers using a standard Web browser. In an emergency, the system software could have the ability to send text messages to alert family, physicians, or other carers or emergency services directly.

Options for Applications

Use of personal monitoring systems with wireless technology will enable real-time, remote monitoring while the patient can continue with normal daily activities. Patient information can be stored in a secure database allowing access by clinicians or carers.

Last Updated on Thursday, 20 October 2011 08:59

 
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Dr Mohan Karunanithi

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