Policy Proposals for Scaling Up the Development of Emergency Medical Service Systems for Community-Dwelling Older Adults with Long-Term Dependency Using Emergency Notification Technology

Abstract

This research and development study aimed to develop policy proposals for an emergency medical service system for community-dwelling older adults with long-term dependency using emergency notification technology. The study was conducted in three phases: 1) analyzing the situation and factors associated with medical emergencies; 2) testing a prototype emergency medical service system using emergency notification technology; and 3) developing policy proposals for scaling up the system. The participants included 1,396 older adults receiving care at an emergency department, 279 older adults with long-term dependency, and 140 stakeholders. Research instruments included medical record forms, an emergency medical event prevention outcome assessment, an activities of daily living assessment, an emergency notification technology acceptance assessment, and guidelines for in-depth interviews, focus group discussions, and stakeholder consultations. Quantitative data were analyzed using descriptive statistics, multiple logistic regression, paired t-test, and McNemar’s test, while qualitative data were analyzed using content and thematic analysis.

The findings showed that 88.4% of older adults presenting to the emergency department had illnesses or chronic diseases, and 23.42% experienced medical emergencies. Factors significantly associated with medical emergencies, in descending order, were loss of consciousness, asthma or emphysema, heart disease or chest pain, pneumonia, and age. After three months of prototype implementation, acceptance of emergency notification technology significantly increased (p-value < 0.001). Blood pressure (p-value = 0.018) and blood glucose levels (p-value = 0.039) improved, and patients with hypertension demonstrated improved blood pressure control (p-value = 0.049). Clinical outcomes also improved, including emergency department visits (p-value = 0.004), hospital readmissions (p-value = 0.045), and the incidence of stroke and falls (p-value = 0.003). At the local level, policy proposals included integrating an emergency medical event prevention program and emergency notification technology into individualized care plans for older adults with long-term dependency and chronic diseases within the long-term care system. At the national level, policies should promote the development of care standards for community-dwelling older adults with long-term dependency and improve access to emergency notification technology.