Assessment of an automated tele vigilance system on serious falls prevention in a dementia specialized care unit: The URCC

Background: Aging is often related to autonomy loss problems. Falls are a major issue that leads to autonomy loss. Falls incidence is particularly high in dementia (increased risk by 2 or 3 times compared to the general elderly population). Falls are also responsible for high morbi-mortality rates themselves responsible for high socio- economical costs. Seriousness of falls is related to traumas and high length of stay on the floor. Since many falls in geriatric units do not have any witness, it is important to detect them as soon as possible in order to decrease aggregative factors. In France, special Alzheimer's units called URCC were recently (2008: French political plan to fight Alzheimer) created for functional and cognitive decompensated patients. Automated televigilance system could be both a solution to falls early detection and a preventive tool for the caring staff. Since high length of stay on the floor will be avoided with the televigilance system and that physicians and or nurses would be able to identify causes of the falls, this system could decrease serious falls rates for elderly people hospitalized in URCC. It could also be able to decrease falls rates as well as fall risk of cognitively impaired patients and dementia related behavioral disorders. Methods: GET-BETTER is an opened prospective, randomized into 2 parallel groups study ran from april 2012 to april 2013. 2 units in the Limousin region (France) are equipped with the automated televigilance system. One group will have cameras installed and the other will not and will act as a comparison group. 350 subjects are expected to enter the study. Patients will be assessed twice during the study, at admission in (inclusion visit) and at outcome from the URCC (end of study visit). Each assessment implies a standard geriatric assessment, and a fall questionnaire. Every fall will be considered as adverse events and will therefore be listed along the study and characterized in types and number. The primary outcome is to compare the impact of the automated televigilance system on the incidence rate of falls with serious outcomes between the two groups during their hospitalization in URCC. Rooms of the patient of the “intervention group” will be equipped with cameras. These cameras can either work in visible or infrared range. They are physically linked to a server that will store encrypted video and analyze images data in real-time. The server works 24h/24 and 7d/7 and will send an alert to the care staff via their computers and personal pagers if it detects a fall. Physician can also watch images in order to determine the cause of the incident and then act preventively and induce treatment / care strategies. Patient in the “non-equipped” group will have usual care. Statistical analysis that will be performed includes paired t tests comparison or de MannWhitney test for quantitative variables, Chi2 tests or Fisher test for qualitative variables with significant alpha risk 0.05. Expected results: - A decrease in serious falls in the intervention group; - A slower functional decline; - Fewer behavioral disorders; - A decrease in deceases; - A fast identification of individual falls risks factors. Conclusion: Real time falls detection will allow physicians to introduce individual secondary prevention program of functional decline. It could also help to manage adverse events in dementia specific units.