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Fall detection -- a look back -- much innovation but little impact

First the good news -- life expectancy is up.  So as boomers cross the 65-year-marker at 8000 per day, 10,000 per day, or whatever, they just received some good news, for a change, from the CDC.  Life expectancy has inched up. A woman who is 65 today can expect to live an average of 21 more years (to age 86), and a man at 65 has an average life expectancy of 18 more years (to age 83). Note that these are averages and that the averages include those with chronic diseases. That average includes the nearly 26% likelihood of diabetes (diagnosed and undiagnosed) -- and that diabetes is the seventh leading cause of death in the US  and that heart disease is the number one cause of death among women and ditto for men.  Thus life expectancy outside of those conditions is most certainly far longer.

Now the bad news -- death from falls is also up.  Okay, that was the good news.  As older adults live lengthier lives, the risk of falling grows. The outcomes for those aged 75 and older? Not good. Death rates are up -- most fractures among older adults are the result of falls.  And many who fall develop a fear of falling that, ironically, limits their activity. Note that in the list of recommendations from the CDC in this article updated in 2014, fall detection technology (in a phone or wearable) was not mentioned. Odd isn't it -- 70% of people who fall do not experience injury (at least for some of the times they fell).  Even the concept of a precursor fall does not seem to be making the top of the search list.

Fall detection technology -- the more things change…  Meanwhile, five years ago when fall detection was new and wearable fall detection was CES-cool, there were researchers who thought it could be in a room and passive. Various of the passive room-based fall detection ideas came and then they went.  In-home (placed) sensor-based monitoring was off-the-ground with GrandCare (2003) and further emerged in 2005 with QuietCare (acquired by GE in 2009). Then sensor monitoring emerged, so to speak, again and again with Intel-GE merged Care Innovations, and along came Healthsense (2009), WellAWARE (2010, gone now), and a few others surfaced here and there, then home-based sensors got a face-lift with myLively in 2013. Wearable fall detection got a boost when Philips announced Lifeline with AutoAlert -- and of course, researchers gotta do research.

Surprise - innovative technology doesn't make everything better. Today, it's a whole new world that would seem to be very exciting -- smartphones have accelerometers and can detect falls! That is unfortunately useless for fall detection or prevention, since the last Pew count showed that only 18% of the 65+ population even has a smartphone, never mind those aged 75+ who are at greater risk of falling. And of course, there are a few fall-related apps that don't work or that nobody uses or this purpose. So with all of the cool apps and even press-the-button PERS apps, there is no improvement in the lives of seniors who risk falling. In fact, the CDC article, updated this past year, doesn't mention any technology as helpful. And seniors don't have the fall detection devices or it may occasionally fail. Medical alerts/aka PERS are still the tech of choice for nervous seniors, most of them worn in the home. Smartphone features are available but not used, inventors of new concepts have arrived and departed, and -- well -- nothing much has changed.


Tarkus Murphy

New Business Development at PlexAN, Inc.

Prediction: With the next stages of 4G / WiFi (multispectral), the need for dedicated gateways, kiosks and PERS will be replaced with devices that support communications separated from sensor, educational and media rich data across the continuum of care. Broadband in patient homes will remain an issue from land / cell sensor data all the way to 3G / 4G action with devices used by caregivers, professionals and patients at the patient's location. Greater mobility in devices (no longer dedicated to specific purposes) will allow patients to bring their communications with them (allowing for much greater mobility from place to place - home, second home, hotel, etc.).


Technology and Healthcare Entrepreneurial Executive

Tilt meters, gps, and accelerometers could be used in wearable smart devices that trigger fall alerts are now feasible. Especially deployed in assisted living or a SNF. The right middleware still hsn't been perfected.

Tarkus Murphy

New Business Development at PlexAN, Inc.

I think that the middleware has been perfected, but I'm looking to put it through its paces via a NYS clinical intranet exercise in the next few months. It should be possible to eliminate dedicated gateways, kiosks, PERS systems and increase the value of in tandem communications. The method of communications has been available for some time at the Center for Future Health (I think the physical site was closed a while ago), but PERS / 2G / landline systems are just the first step in the information loop to be much more useful in fall response.

On the plus side, the system at the Center for Future Health was sped up in frame recognition and is deployed in perimeter protection for the military, security and homeland security.

If genius arrives to early for a market, find another market.

The value of the system (and maybe a return visit) was the reduction of false alarms. there needs to be new approaches for sensor, multisensor and media rich systems.

In addition to better systems, there must be people (caregivers and professionals) who are able to assist in the response to the sensor data to distinguish the response needed to react to the data.

There are some other challenges to, but if you think you got it licked I'd love to talk to you about it. I would have a lot of customers for you

Better than me, but I will be happy to make an introduction to company that inspired me to push the envelope into HD Videoconferencing, patient education and authorized communications (grandkids can't download games and videos off the service, but caregivers and professionals can use BYOD for care appropriate communications). Not a new technology, just an inspired use added to an inspired use to move from a 2G world to a media rich one - without breaming the bank. Send me a LinkedIn request and I will accept.

My dad has lived long enough to fall twice and fracture each hip, have a leg amputated and a pacemaker implanted. he is in his late 80's. My mom can no longer live independently with him and take care of him because of her Alzheimer's. Technology is doing slowing down their deaths so that they are both alive and may live another decade. In the next decade I can expect to see both of them in diapers and only one of them will remember or recognize me and neither will be able to eat of go to the bathroom without help. I know this blog is about technology but as we all work together to achieve super long lives we must remember that our bodies wear out and we were only meant to be living on this earth for a short time. Lets not think of it as longer lives but as longer more agonizing and less dignified deaths.

Thanks for the plug on Lively providing a face lift... IMHO, Lively is re-imagining PERS and Safety with our new Safety Watch... see the new video on our website (www.mylively.com), but we have med reminders, activity tracking/pedometer and the most attractive (another facelift) PERS device on the market today

At the Connected Health Summit recently, it was refreshing to hear enterprises turning up the volume on the topic of prevention and wellness. Let's deliver healthcare to people when they are well and see if we can impact health through prevention. If we applied this to "Falls" in older people, we would be developing programs for balance that enable people to better negotiate their physical world as they age. My mother swears by Yoga, others have special work-outs and a Healthcare VC recently told me she thinks the game of golf may have benefits for developing balance.
This is a market waiting to be disrupted by companies thinking about the earlier root cause of disequilibrium in older adults.

The PERS Systems and Sensors are excellent safety nets and broad adoption of these simple, inexpensive tools may not prevent a fall, but they offer an important sense of confidence that if you need support, you'd receive it quickly. That confidence, I suspect, contributes quantifiably to the wellness of a person who is feeling functional limits for the first time in their life.

Hi Leslie, I agree with your statement that prevention and wellness is the place to start. Hence the patient compliant issue we have upon us today. People in general aren't very proactive. But that's another subject matter completely. Regarding fall detection, simple detection is not enough, but is important to alert someone when it happens. I've done work in identifying fall detection systems able to determine the history of a fall from start to finish. We could record the persons starting position before they started to fall through to how they landed. Complex yes but very usable information. We quickly determined that if we could prevent the fall all together it would be more valuable and accepted in the industry. But it would have to be individualized making each solution configurable to each person. A solution that reduces the outcome of the fall could be a step in the right direction. Technology is moving at light-speed with many breakthrough in MEMS to help solve physical limitations of today's wearable solutions. I am happy to see better awareness for better fall detection solutions I firmly believe that detection or reporting the incident is a piece of the puzzle.

Hi Laurie,

I agree, the industry has been through ups and downs, revolutionizing the way care is brought to our aging loved ones and now with an added emphasis to our discharged patients.

While I think fall detection and crisis management are critical and important, there are several other puzzle pieces that apply. Once fall detection and PERs come into play, the crisis is occurring. This is critical that this person receives help and support. I agree, this is important.

However, I still believe that not enough emphasis is placed on the proactive nature of technology and telehealth solutions.

At GrandCare, we try to combine the most holistic needs of a human being to create a usable and affordable solution while proving reduced readmissions and better chronic disease management. Telehealth monitoring can indicate earlier to a doctor or care provider if vitals fall outside of designated thresholds or if red flag symptoms occur (eg excessive weight gain). It's also helpful that the patient is empowered and better informed to help self manage health. For example, a GrandCare client will have discharge videos, medication prompts and instructions, health assessments, family communications, to do checklists, schedules and one touch secured video chat to providers right at point of care, wherever home is.
This can be so helpful in patient engagement and letting everyone fully circle around the patient.

Thanks again, it's been interesting to watch the reinvention and pivoting as the industry has continued to evolve.

Laura Mitchell
Founding Member, Chief Marketing Officer
GrandCare Systems