Assistive technologies

Abstract Content - Introduction Falls are the leading cause of preventable death in older adults and can also lead to psychological consequences, including concerns about future falls. Although literature traditionally focuses on those over 65 yrs, recent research shows adults as young as 50 yrs could be at risk. Most falls occur at home and are often due to environmental hazards. Despite evidence supporting a 38% reduction in falls through home modifications, their efficacy in not fully understood. Exploring barriers and facilitators to home modifications aimed at reducing falls and concerns about falling, could better inform future interventions. Methods As part of a mixed-methods systematic review, six electronic databases were searched on February 4th 2024: Scopus, PubMed, CINAHL, MEDLINE, SportsDiscus and Psycinfo. The search explored studies on home modifications for adults over 50 living at home, without residential health or rehabilitation services, specifically aimed at reducing falls incidences and concerns about falling. Barriers and facilitators to home modifications were explored from the perspectives of fallers, those at risk of falling, families, caregivers and key stakeholders. Results Thirteen of the 31 papers included in the full systematic review were focused on barriers and facilitators to home modifications. For barriers, five themes were identified: cost; stigma associated with ageing and disability; lack of awareness; fear of change and professional incompetence and inconsistency. Five themes were identified for facilitators: support from family and caregivers; early planning; involvement in decision making professional collaboration and enhanced caregiver well-being. Conclusion These findings underscore the need for multi-faceted approaches to home modifications, addressing both practical and psychological issues. Only three studies included adults 50+ yrs, with little known about the barriers and facilitators for this age onwards. Future interventions should encompass a person-centered approach, focus on increasing affordability, raising early awareness, fostering supportive networks, and ensuring high-quality professional services.

Introduction

The ongoing rise in prostate cancer rates and consequent prostatectomy have led to an increase in rates of male stress urinary incontinence. ATOMS is an adjustable sling requiring no manual input and suitable for frailer patients. We investigated the long term efficacy of the ATOMs in managing SUI and performed a subanalysis within the geriatric population (aged 75+).

Method

69 men (mean: 70.2, range 50-81) underwent an ATOMS insertion between 2015-2019. Follow up data for up to 9 years were analysed (mean: 5.8, range 5-9 years). Out of the 69 men in the original cohort, 19 were aged 75+ (mean: 76.5, range: 75-81). 17 had SUI post radical prostatectomy, 1 post TURP and 1 post AP resection.

Results

Out of the 19 men, 14 (74%) were dry post ATOMs implant insertion (ie using maximum one pad per day for reassurance). This rate is lower compared with the original cohort (79.7%). The average number of top ups to achieve dryness was 3 (same as the initial cohort). Out of the 14 men who remained incontinent in the initial cohort, 5 were 75+. Of these, 2 reported a significant improvement in their incontinence without meeting the ‘dry’ criteria. 1 had his ATOMs device removed due to infection. 1 was switched to an artificial urinary sphincter. 1 remains incontinent and is being managed with botox injections. There were no cases of mechanical failure.

Conclusions

ATOMS appears to be an efficacious and safe procedure in the geriatric population, with only marginal difference in dry rates compared to the non-geriatric cohort. The main benefit over an artificial sphincter is that it exerts a passive effect to prevent incontinence and requires no patient input for every void. This is especially prudent as geriatric patients may lose hand dexterity or cognitive ability over time.