Persons Found Helpless in Their Homes

N Engl J Med 1996; 335:1612-1613November 21, 1996

Article

To the Editor:

Both the article by Gurley et al.1 and the editorial by Campion2 (June 27 issue) address the fear expressed by those living alone — that after an emergency, they may be incapacitated for a long time before being found. Of the 367 persons studied by Gurley et al. who lived alone and were “found down” by San Francisco paramedics, only 1 had a commercially available device used to summon help.1 Had the others had alerting devices, the long periods before they were found might have been substantially reduced.

There is some literature on “personal emergency response systems.”3 Their users usually live alone, wear a pendant-type transmitter around their necks or a wristwatch-type device, and pay $25 to $30 per month for a service that ties their residential phone lines to a response center in a local emergency department or a national response center. Studies we conducted4 show that not only do subscribers to such services have fewer hospital admissions and shorter stays after they subscribe than they did before (P = 0.01), but the elapsed time from the subscriber-initiated alert to the time help arrives is well under one hour.

Campion accurately describes the problem facing those at risk of being “found down.” One third of the almost 33 million Americans over the age of 65 live alone. They carry a risk of 3.2 percent per year of being found helpless or dead.5 This amounts to about 300,000 older persons each year who have crises at home of the types described by Gurley et al.1 Health care providers should be informed about preventive measures such as personal emergency response systems, and controlled studies are needed. If clear benefits can be proved, then perhaps such systems, along with other assisted-living arrangements, may be indicated for specific people at high risk, especially older Americans living alone.

Robert E. Roush, Ed.D., M.P.H.
Thomas A. Teasdale, Dr.P.H.
Baylor College of Medicine, Houston, TX 77030

5 References

1
Gurley RJ, Lum N, Sande M, Lo B, Katz MH. Persons found in their homes helpless or dead. N Engl J Med 1996;334:1710-1716
Full Text | Web of Science | Medline

2
Campion EW. Home alone, and in danger. N Engl J Med 1996;334:1738-1739
Full Text | Web of Science | Medline

3
Montgomery C. Personal response systems in the United States. Home Health Care Serv Q 1992;13:201-222
CrossRef | Medline

4
Roush RE, Teasdale TA, Murphy JN, Kirk MS. Impact of a personal emergency response system on hospital utilization by community-residing elders. South Med J 1995;88:917-922
CrossRef | Web of Science | Medline

5
National Center for Health Statistics, Cohen RA, Van Nostrand JF. Trends in the health of older Americans: United States, 1994. Vital and health statistics. Series 3. No. 30. Washington, D.C.: Government Printing Office, 1995. (DHHS publication no. (PHS) 95-1414.)

To the Editor:

In my home community of Morton Grove, Illinois, the “Are You O.K.?” program allows the local police to provide home monitoring to elderly or disabled citizens in the independence-preserving, noncoercive, nonintrusive manner advocated by Gurley et al. The program involves a telephone system that automatically makes a call to a subscriber's home each day at a time the subscriber chooses. If the subscriber is well, he or she simply hangs up after hearing a prerecorded message. If the subscriber does not answer or the line is busy, three more attempts are made before the system alerts the police. Dispatchers then either contact a neighbor who has previously agreed to assist in the event of an emergency or send the police to check on the subscriber.

The system is an outgrowth of a recently installed “911” system. No new police employees were hired, yet approximately 100 calls can go out hourly whether or not there are police emergencies in progress. Police visit interested citizens at home to enroll them in the program. This model deserves further study.

Stuart Oserman, M.D.
Lutheran General Hospital–Advocate, Park Ridge, IL 60068-1174

Author/Editor Response

The authors reply:

To the Editor: Roush and Teasdale and Oserman cite two types of electronic monitoring (personal emergency response systems and automatic-dialing systems) as means communities can use to show concern for people who might otherwise become helpless or die in their homes. Electronic monitoring takes many forms, but the common thread is that a patient is equipped with a device that can inform a central system when a potentially adverse event happens. Several limitations of electronic monitoring have already been mentioned, including the ongoing expense and the need for patients to wear portable devices continuously.1 Another limitation of these systems is that those at risk must be identified appropriately in order to benefit from the systems.

The types of events we described result from complex sociological conditions that isolate elderly people within their communities. Many elderly people have no source of help when an adverse event occurs in the home. Those at highest risk are, by definition, very isolated. Effective intervention means identifying patients, counseling and educating them, becoming involved with the patients' communities, and seeing that there is an effective community response. Without these steps, the patients at highest risk may not be identified appropriately; resources may be directed disproportionately to a low-risk group; acceptance and compliance by patients will be poor; and the community response will be inadequate. Further studies of the effectiveness and cost effectiveness of monitoring systems are needed before they can be recommended widely. Electronic monitoring may be one creative way a community can respond to this complicated need. Friendship would be another.

We must add that there was an error in our calculations of the Glasgow coma scale. The last paragraph on page 1711 should have read as follows: “Ratings on the Glasgow coma scale were available for 295 of the 297 patients found alive (99 percent). Forty-six patients (16 percent) had moderately to severely depressed scores (1 through 12). Forty-three patients (15 percent) had scores of 13 or 14, with 84 percent of this group exhibiting “confused verbal response.” The remaining 205 patients (69 percent) had a normal score (15).” We apologize for the error.

R. Jan Gurley, M.D.
Mitchell Katz, M.D.
San Francisco Department of Public Health, San Francisco, CA 94102

1 References