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Chan HYL, Ho FKY, Chui KCM, Wong BPS, Chui MYP, Zhao Y, Yang C, Kwok TCY. Evaluation of a multicomponent restraint reduction intervention in care homes. Collegian 2022. [DOI: 10.1016/j.colegn.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cheung JCW, Tam EWC, Mak AHY, Chan TTC, Zheng YP. A Night-Time Monitoring System (eNightLog) to Prevent Elderly Wandering in Hostels: A Three-Month Field Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042103. [PMID: 35206290 PMCID: PMC8872318 DOI: 10.3390/ijerph19042103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/02/2022]
Abstract
Older people are increasingly dependent on others to support their daily activities due to geriatric symptoms such as dementia. Some of them stay in long-term care facilities. Elderly people with night wandering behaviour may lose their way, leading to a significant risk of injuries. The eNightLog system was developed to monitor the night-time bedside activities of older people in order to help them cope with this issue. It comprises a 3D time-of-flight near-infrared sensor and an ultra-wideband sensor for detecting human presence and to determine postures without a video camera. A threshold-based algorithm was developed to classify different activities, such as leaving the bed. The system is able to send alarm messages to caregivers if an elderly user performs undesirable activities. In this study, 17 sets of eNightLog systems were installed in an elderly hostel with 17 beds in 9 bedrooms. During the three-month field test, 26 older people with different periods of stay were included in the study. The accuracy, sensitivity and specificity of detecting non-assisted bed-leaving events was 99.8%, 100%, and 99.6%, respectively. There were only three false alarms out of 2762 bed-exiting events. Our results demonstrated that the eNightLog system is sufficiently accurate to be applied in the hostel environment. Machine learning with instance segmentation and online learning will enable the system to be used for widely different environments and people, with improvements to be made in future studies.
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Affiliation(s)
- James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 999077, China
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.)
- Correspondence: ; Tel.: +852-2766-7673
| | - Eric Wing-Cheung Tam
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.)
| | - Alex Hing-Yin Mak
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.)
| | - Tim Tin-Chun Chan
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.)
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 999077, China
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.)
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Cheung JCW, Tam EWC, Mak AHY, Chan TTC, Lai WPY, Zheng YP. Night-Time Monitoring System (eNightLog) for Elderly Wandering Behavior. SENSORS 2021; 21:s21030704. [PMID: 33498590 PMCID: PMC7864330 DOI: 10.3390/s21030704] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/09/2021] [Accepted: 01/16/2021] [Indexed: 12/13/2022]
Abstract
Wandering is a common behavioral disorder in the community-dwelling elderly. More than two-thirds of caregivers believe that wandering would cause falls. While physical restraint is a common measure to address wandering, it could trigger challenging behavior in approximately 80% of the elderly with dementia. This study aims to develop a virtual restraint using a night monitoring system (eNightLog) to provide a safe environment for the elderly and mitigate the caregiver burden. The eNightLog system consisted of remote sensors, including a near infra-red 3D time-of-flight sensor and ultrawideband sensors. An alarm system was controlled by customized software and algorithm based on the respiration rate and body posture of the elderly. The performance of the eNightLog system was evaluated in both single and double bed settings by comparing to that of a pressure mat and an infrared fence system, under simulated bed-exiting scenarios. The accuracy and precision for the three systems were 99.0%, 98.8%, 85.9% and 99.2%, 97.8%, 78.6%, respectively. With higher accuracy, precision, and a lower false alarm rate, eNightLog demonstrated its potential as an alternative to physical restraint to remedy the workload of the caregivers and the psychological impact of the elderly.
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Affiliation(s)
- James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.); (W.P.-Y.L.)
- Correspondence: ; Tel.: +852-2766-7673
| | - Eric Wing-Cheong Tam
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.); (W.P.-Y.L.)
| | - Alex Hing-Yin Mak
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.); (W.P.-Y.L.)
| | - Tim Tin-Chun Chan
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.); (W.P.-Y.L.)
| | - Will Po-Yan Lai
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.); (W.P.-Y.L.)
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Jockey Club Smart Ageing Hub, Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China; (E.W.-C.T.); (A.H.-Y.M.); (T.T.-C.C.); (W.P.-Y.L.)
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Law W, Kwok TCY. Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: A feasibility pilot study. Int J Geriatr Psychiatry 2019; 34:1765-1775. [PMID: 31390090 DOI: 10.1002/gps.5191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/05/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The objectives of this study are to explore the feasibility of a multicomponent intervention programme and to evaluate its impacts on behavioural and psychological symptoms of dementia (BPSD) and psychological health of caregivers. METHODS Fifty-six community-dwelling people with dementia (PWD) and knee osteoarthritis (OA) and their caregivers were recruited and randomized into the intervention group (IG) or comparison group (CG). Each participant in both groups received an individual physiotherapy session (personalized home exercises and care education) and underwent 8 weeks of a 1-hour-structured group exercise session weekly at a day care centre. They were instructed to follow the prescribed home exercise. The IG received a multicomponent programme, combining knee OA-specific therapeutic exercise with self-management support, while the CG attended the routine group exercise programme. The attendance rate and reasons for non-attendance were recorded for evaluating the feasibility. The Chinese versions of the Revised Scale for Caregiving Self-Efficacy (RSCSE) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) were measured at the baseline and postintervention. RESULTS Fifty-four dyads completed the programme with high attendance rate (94.4%). Compared with the CG, caregivers in the IG significantly improved in three domains of RSCSE scores (P ≤ .005) and caregivers' distress (P = .004) after the intervention. However, no effects were observed in terms of BPSD severity in PWD. No adverse events or falls were reported. CONCLUSION This multicomponent programme is feasible and safe for dementia caregivers and older people with mild-to-moderate dementia and knee OA. The programme has beneficial effects on caregiving self-efficacy and distress of dementia caregivers.
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Affiliation(s)
- Waiyan Law
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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Lan SH, Lu LC, Lan SJ, Chen JC, Wu WJ, Chang SP, Lin LY. Educational intervention on physical restraint use in long-term care facilities - Systematic review and meta-analysis. Kaohsiung J Med Sci 2017; 33:411-421. [PMID: 28811011 DOI: 10.1016/j.kjms.2017.05.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/26/2017] [Accepted: 05/08/2017] [Indexed: 11/26/2022] Open
Abstract
"Physical restraint" formerly used as a measure of protection for psychiatric patients is now widely used. However, existing studies showed that physical restraint not only has inadequate effect of protection but also has negative effects on residents. To analyzes the impact of educational program on the physical restraint use in long-term care facilities. DESIGN A systematic review with meta-analysis and meta-regression. Eight databases, including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, Ovid Medline and Physiotherapy Evidence Database (PEDro), were searched up to January 2017. Eligible studies were classified by intervention and accessed for quality using the Quality Assessment Tool for quantitative studies. Sixteen research articles were eligible in the final review; 10 randomize control trail studies were included in the analysis. The meta-analysis revealed that the use of physical restraint was significantly less often in the experimental (education) group (OR = 0.55, 95% CI: 0.39 to 0.78, p < 0.001) compared to the control group. Meta-regression revealed the period of post education would have decreased the effect of the restraint educational program (β: 0.08, p = 0.002); instead, the longer education period and more times of education would have a stronger effect of reducing the use of physical restraint (β: -0.07, p < 0.001; β: -0.04, p = 0.056). The educational program had an effect on the reduced use of physical restraint. The results of meta-regression suggest that long-term care facilities should provide a continuous education program of physical restraint for caregivers.
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Affiliation(s)
- Shao-Huan Lan
- Institute of Medicine, Chung Shan Medical University, Taiwan
| | - Li-Chin Lu
- Department of Information Management, National Yunlin University of Science and Technology, Taiwan
| | - Shou-Jen Lan
- Healthcare Administration, Asia University Department, Taiwan
| | - Jong-Chen Chen
- Department of Information Management, National Yunlin University of Science and Technology, Taiwan
| | - Wen-Jun Wu
- Institute of Medicine, Chung Shan Medical University, Taiwan
| | - Shen-Peng Chang
- Department of Pharmacy, Chi Mei Medical Center, Liouying, Taiwan
| | - Long-Yau Lin
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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Bai X, Kwok TCY, Ip IN, Woo J, Chui MYP, Ho FKY. Physical restraint use and older patients' length of hospital stay. Health Psychol Behav Med 2014; 2:160-170. [PMID: 25750775 PMCID: PMC4346038 DOI: 10.1080/21642850.2014.881258] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022] Open
Abstract
In both acute care and residential care settings, physical restraints are frequently used in the management of patients, older people in particular. Recently, the negative outcomes of physical restraint use have often been reported, but very limited research effort has been made to examine whether such nursing practice have any adverse effects on patients' length of stay (LOS) in hospitals. The aim of this study was to examine the association between physical restraint use on older patients during hospitalization and their LOS. Medical records of 910 older patients aged 60 years and above admitted to one of the Hong Kong public hospitals in 2007 were randomly selected and recorded during July to September 2011. The recorded items included patients' general health status, physical and cognitive function, the use of physical restraints, and patients' LOS. Hierarchical regression analysis was conducted to analyze the data. The results indicated that older patients' general health status, physical, and cognitive function were important factors affecting their LOS. Independent of these factors, the physical restraint use was still significantly predictive of longer LOS, and these two blocks of variables together served as an effective model in predicting older patients' LOS in the hospital. Since physical restraint use has been found to be predictive of longer hospital stay, physical restraints should be used with more caution and the use of it should be reduced on older patients in the hospital caring setting. All relevant health care staff should be aware of the negative effects of physical restraint use and should reduce the use of it in hospital caring and nursing home settings.
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Affiliation(s)
- Xue Bai
- Department of Applied Social Sciences, The Hong Kong Polytechnic University , Hung Hom , Kowloon , Hong Kong, People's Republic of China ; Jockey Club Centre for Positive Ageing , Shatin , New Territories , Hong Kong SAR, People's Republic of China
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong , Shatin , New Territories , Hong Kong SAR, People's Republic of China
| | - Isaac N Ip
- Jockey Club Centre for Positive Ageing , Shatin , New Territories , Hong Kong SAR, People's Republic of China
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong , Shatin , New Territories , Hong Kong SAR, People's Republic of China
| | - Maria Y P Chui
- Shatin Hospital & Bradbury Hospice , Shatin , New Territories , Hong Kong SAR, People's Republic of China
| | - Florence K Y Ho
- Jockey Club Centre for Positive Ageing , Shatin , New Territories , Hong Kong SAR, People's Republic of China
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Kwok T, Bai X, Chui MYP, Lai CKY, Ho DWH, Ho FKY, Woo J. Effect of physical restraint reduction on older patients' hospital length of stay. J Am Med Dir Assoc 2012; 13:645-50. [PMID: 22763142 DOI: 10.1016/j.jamda.2012.05.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 05/24/2012] [Accepted: 05/29/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Physical restraints are often used to prevent falls and to secure medical devices in older people in hospitals. Restraint reduction has been advocated on the grounds that physical restraints have negative psychological effects and are not effective in preventing falls. The potential effect of restraint reduction on length of hospital stay (LOS) has not been investigated. This study was undertaken to compare the average length of stay of older patients in a convalescent medical ward setting before and after a restraint reduction program. DESIGN This is a retrospective study. SETTING A convalescent hospital in Hong Kong. PARTICIPANTS This study included 2000 patient episodes. MEASUREMENTS The use of physical restraint, LOS, and clinical outcomes of randomly selected patient episodes in the year before and after the implementation of a restraint reduction program were compared. The clinical outcomes included Modified Functional Ambulatory Categories and modified Barthel index. Subgroup analysis was performed on those with confusion as defined by dementia diagnosis, low abbreviated mental test score, or abnormal mental domain of Norton Score. RESULTS A total of 958 and 988 patient episodes admitted to 10 medical wards in a convalescent hospital in 2007 and 2009 were examined. There were no significant differences in the baseline characteristics of patients in the 2 years. With the implementation of the restraint reduction scheme, the rate of physical restraint use declined significantly from 13.3% in 2007 to 4.1% in 2009 for all patients. The average LOS of patients was significantly lower in the year after the implementation of restraint reduction (19.5 ± 20.7 versus 16.8 ± 13.4 days in 2007 and 2009 respectively, P < .001). On subgroup analysis, the reduction in LOS was significant in the cognitively impaired patients (23.0 ± 26.5 to 17.8 ± 15.0 days in 2007 and 2009 respectively, P < .001), but not in the cognitively normal patients. There were no significant differences between the 2 years in the incidence of fall, mobility, and activities of daily living on discharge. CONCLUSION Physical restraint reduction was associated with significant reduction in average length of stay in convalescent medical wards, especially in the cognitively impaired patients.
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Affiliation(s)
- Timothy Kwok
- Jockey Club Centre for Positive Ageing, Hong Kong; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
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The effect of a restraint reduction program on physical restraint rates in rehabilitation settings in Hong Kong. Rehabil Res Pract 2011; 2011:284604. [PMID: 22110972 PMCID: PMC3195393 DOI: 10.1155/2011/284604] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 07/04/2011] [Accepted: 07/05/2011] [Indexed: 11/18/2022] Open
Abstract
Background. In view of the adverse effects of using restraints, studies examining the use of restraint reduction programs (RRPs) are needed. Objectives. To investigate the effect of an RRP on the reduction of physical restraint rates in rehabilitation hospitals. Methods. A prospective quasi-experimental clinical trial was conducted. Demographic data, medical and health-related information on recruited patients from two rehabilitation hospitals, as well as facility data on restraint rates were collected. Results. The increase in the restraint rate in the control site was 4.3 times greater than that in the intervention site. Changes in the restraint mode, from continuous to intermittent, and the type of restraint used were found between the pre- and postintervention periods in both the control site and the intervention site. Discussion. Compared with that in the control site, the RRP in the intervention site helped arrest any increase in the restraint rate although it had no effect on physical restraint reduction. The shift of restraint mode from continuous to intermittent in the intervention site was one of the positive outcomes of the RRP.
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