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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
References
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
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
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