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The Apple Watch and Fall Detection – What’s it Mean?

When Apple speaks, a puzzled market listens. When Apple announces, industries crane their necks to hear. Last week they announced two features of a new watch, ECG monitoring and fall detection. In July, Tim Cook apparently did not want to get into the world of FDA regulation. Well, that was then – or he just wasn’t saying. In this new watch, both the ECG feature and fall detection have received FDA clearance within 30 days of applying, startling some observers who noted that closer to 150 days was more typical for a medical device.  Healthcare observers are concerned that false positives from ECG readings could propel people unnecessarily to already-overloaded Emergency Rooms. To date, the Apple Watch may have been of greatest interest to 40 year old males. Interestingly, 70% of cases of atrial fibrillation are among the 65+ population.  Does Apple really want the 65+ population to buy an Apple watch?

Let’s talk about fall detection.  This was the option less discussed – and maybe for the target Apple audience, less relevant. But consider: according to Pew, half (or more) of the 50 million 65+ population owns a smartphone, and let’s assume nearly 50% of those are iPhone owners. Would they be interested in a fall detection feature? Would they need one – or would a family member encourage it? This feature too is also set to alert ‘emergency services’ if the user requests it (911, most likely) or if the wearer is non-responsive. There are a few standalone fall detectors on the market – here’s an example list with more on the way – but most connect the user to a call center.

Is there a need to speak to someone? Perhaps, as with mobile PERS devices, an intermediate option speaking with the person who fell (like a call center) could save fire departments and the watch wearer from non-emergency trips – and just wanting to chat with someone. Assuming the population most likely to fall are older adults in the older age range, call me crazy, but I am betting they are not iPhone owners.  For those with other types of fall risks, maybe it makes sense to have a device that contacts family or others who have agreed to be contacted; or an app that contacts a call center, like FallCall; or a watch linked to a PERS call center.

Why Apple? So we know that Apple wants to get into 'healthcare' and we know healthcare is often used as a euphemism for aging – which apparently is an investment killer. But Apple is a trendsetter, not an investor – and investors wearing Apple watches follow the company with near-religious fervor – promoting and buying their stock, no matter how underwhelming the new phones might be. Whether the ECG offering is a breathless game-changer for Apple in the medical device market or comes with caveats, remains to be seen. As for its role as a mobile PERS device, Parks Associates expressed hope (PERS vendors may start selling) and caution about upfront price of $400 (too high). So let’s assume that mobile PERS is 20% of the total PERS market. Parks thinks the total PERS market comprises 4 million users; that seems low. But okay. If a user (or a reseller) wants to appear cool and has customers who are already Apple-cool and may be aging into fall risk and who can afford the device and will tolerate the small screen-size --  then maybe this is a viable sub-category of PERS. Apple then partners with a few monitoring centers, not just fire departments, when that happens. Count me as doubtful. 


Agree with you. This is a classic case of 20 something designing for 80 something. The younger seniors don't need this help and older can't use such a small screen. There are cheaper options available to help a person after fall.

Pleased you wrote this. I read something on Lori L.’s LinkedIn page on Friday and intended to write a “please don’t buy based on the demo” warning. I think that in time these wearable IoT devices will be ready (and battery life long enough) to really make a difference. Some, specifically the static-passive IoT devices are already proving themselves. Fall prevention, via ML and data analytics, will be a important (or more important) than fall detection. Sadly, until then, an uninformed market will buy and try and become disillusioned. Sad that marketing has to push so hard to try to get the consumer’s head in the tent. Smaller companies will prove things out as they are more nimble then the larger companies will scale the proven tech per usual. I am hopeful for the future and a bit skeptical of the present...


I could be wrong, but I really don't think that fall detection is intended for the 80-something group.  I think it's more targeted at the 20 to 30-something adventure seeker... "go ahead and climb that mountain alone, if something should happen your watch has got your back". If some 80-somethings also buy that's fine with Apple I'm sure, but I don't think that is the market segment they were looking at when they added the feature.

If this is true then I see a flaw in the thinking, as an outdoor enthusiast (climber and mountain hiker) I am off grid when “climbing that mountain alone” additionally there just aren’t enough of us (who do extreme kind of activities) to warrant an Apple watch not to mention how crushed it would get in one day. I think that Apple and Samsung are spending time and money “dipping their toe” into all of these “solutions” and they have deep enough pockets to do so. For Senior Care, I believe one of the smaller startups will make it happen first and prove the solution (battery life is a huge issue to this market). Once the solution is proved out, the aforementioned players will step in with an acquisition of the smaller player or just out muscle them (scale faster). The good news is that wearable IoT will make a huge difference. So far, I have only seen one player in the Senior Care Market who can do this.

The biggest issue is that they only detect 'hard' falls because those have a hard impact that can be detected by the wrist-based IMU sensor. Elderly often don't fall 'hard', they fall in a quite atypical way, their loose balance and fall in stages. But they do break bones and get hurt by these 'soft' falls. So this is again Apple looking for a medical problem to solve with its Swiss army knife while we need surgical precision. The same problem with the aFib tech having a PPV of 50%. I even read 5%.

As PERS is not a new market, Apple would surely have known that genuinely usable fall detection (ie: few false positives) is notoriously difficult and unreliable from the wrist, which is why stigmatizing pendants are still the market standard. I'm sure this announcement made some shareholders happy, that seems to be the point in Cupertino these days. 

That must have been an interesting decision-making meeting.

Fall detection default is off for younger users, automatically set on for 65+


A falls sensor is a good first function for health on a platform that has an IMU. I wonder how well the ecg function works on older individuals. 

Perfect? Likely not, depending on what audience you are assigning to the watch. But brilliant in a way, nonetheless, in its universal design/appeal. Remember, these are just 2 of many many apps. Is this for aging adults? No. Is the watch for 40 something "most likelies" to AFib? Not necessarily. For millennials? Yes, and... Could anybody find benefit from the offering? Of course. It introduces the idea of PERS health IoT to an entire population with an absurdly large following! A rising tide for sure. It also de-stigmatizes wearables to agers prone to avoid such traditional aging lifestage indicators. I see more upside than downside. 

I am very excited by the Apple Watch. And would love a less expensive alternative that wasn't a watch (I have not worn a watch since the early-1970s, and don't want to, I would prefer a small pendant, or something like that).

I should say right off - I did tech support for Mac database and server software for a number of years. I run my own web server - Apache on a Mac Mini. I am an Apple fan, but I have also used many non-Apple tech options over the years (heck, I used mainframes way back when, and first did email from home in the mid-1980s using a dumb terminal).

I have looked at other options for fall detection.

I am 64 years old, but I have an autoimmune connective tissue disease that makes me very stiff and it causes muscle weakness. If I fall, I often cannot get up without help, but I'm not injured (except a bruise or two). I don't want 911 called! From watching a very frail friend, I know what happens - an ambulance ride, ER visit and huge bills - all of which, in my case, would almost certainly be unnecessary.

So far, in the 8 falls I have had in the past 5 years, all but one were in my own home. But I was only injured once (a sprained wrist didn't require an ER visit - I drove myself to urgent care later.)

I used to backpack. I still hike - with a walker and always a companion.

But I live alone, and really want fall detection to call to a local friend who can come over and help, not a call to 911.


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