When it comes to protecting older people from falls, it can take a long time to figure out what helps and sometimes an even longer time to take action against things that were supposed to help but don’t.
A case in point: the so-called safety rails on hospital and nursing home beds. Their hazards, as The New Old Age reported more than two years ago, are well documented. They are intended to keep sick, drugged or confused people from climbing or falling out of bed. What they actually do is make falls more dangerous; they also trap patients between the rails and the mattress until they asphyxiate, causing hundreds of deaths annually.
The Consumer Product Safety Commission is finally investigating these hazards, with findings due soon.
Alarms — sensors that alert aides or nurses when someone at risk of falling attempts to get out of bed or up from a chair or toilet — sound better, right? Lots of health care facilities thought so.
Use of these alarms has increased “over the past 10 or 15 years as the problems of physical restraints and bed rails became better known,” said Ronald Shorr, who directs geriatric research at the V.A. Medical Center in Gainesville, Fla. “This was the next wave in fall prevention.”
The trouble is, hospital bed alarms don’t appear to reduce falls, according to the study that Dr. Shorr just published in The Annals of Internal Medicine.
Lots of patients, of all ages, fall in hospitals, and about a quarter of those falls cause injuries. They also cost hospitals money, because Medicare will no longer reimburse facilities for treating injuries from falls that in theory shouldn’t have happened.
Though there aren’t statistics on the number of systems, it is rare these days to find a large hospital that doesn’t use alarms, in some cases built right into the beds.
Yet “their efficacy hadn’t been established,” Dr. Shorr told me in an interview. The few studies that reported reduced falls from alarms were small, lacked control groups, or didn’t continue for very long. Dr. Shorr and his colleagues set out to remedy those shortcomings.
Over 18 months, they documented falls among patients in 16 medical and surgical units, with a combined 349 beds, at Methodist Healthcare-University Hospital in Memphis, Tenn. Half those units were randomly designated “usual care.” In the other eight, the “intervention” units, Dr. Shorr and study coordinator Michelle Chandler held repeated education sessions to explain the alarms — in this case, flexible pads made by Bed-Ex and widely-used — and demonstrate their use in beds and on chairs and commode seats.
Ms. Chandler visited the intervention units daily — the staff started calling her “Mrs. Falls” — and even brought fresh alarm pads and help set them up to encourage their use.
The intervention worked, in that those units used the alarms far more often. But when the researchers tallied up the falls among the 27,672 patients (half of them over age 63) in these units — controlling for many variables, including not only demographic factors but staffing levels and psychotropic drug regimens — they found the alarms had no significant effect.
Patients in the units that used alarms more heavily fell just as often as patients in the control units that used alarms much less frequently. (The numbers: 5.62 falls per 1,000 patient-days, a measure of how many people spent how long in the hospital, versus 4.56 falls in the control units, not a statistically significant difference.)
There were no fewer injuries in the more-alarmed units, nor any less use of physical restraints.
There were likely higher costs, though. A Bed-Ex monitor and cables cost about $350 at the time, and each disposable sensor pad cost $23.
Why didn’t the alarms help? Dr. Shorr hypothesized that the staff developed what he called alarm fatigue. “How many times a week do you hear a car alarm go off?” he asked. “You become desensitized.”
But it is also possible, he said, that when the alarms sounded and the nurses scampered, “the patients who weren’t alarmed fell more often.”
My own 2 cents: If an alarm sounds when someone stirs, is any hospital or nursing home so well-staffed that someone can materialize within seconds? Does a staff become less vigilant when patients have alarms and are presumed – wrongly, it seems – to be safer?
Nursing homes also frequently use alarms, and while this hospital data might not apply in another setting, Dr. Shorr said his findings made him skeptical about their effectiveness there, too.
So we probably shouldn’t feel reassured about our elders’ safety when they are in a hospital, alarms or no alarms. Even younger people, recovering from surgery and feeling the effects of anesthesia or sedatives, can and do fall.
“The more eyes on your loved one, the better,” said Dr. Shorr. “And it’s best if they’re your eyes.”
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
