Strong demand for state-of-the-art pendants and sensors stems from a need to improve emergency response time and survival rate.
By Eric Taub
Afflicted with Parkinson’s disease, a Minnesota woman in her 80s was falling regularly. The resultant injuries placed her in and out of nursing homes and severely degraded her quality of life.
Fortunately, she was under the care of Knute Nelson Homecare, a nonprofit organization serving over 5,000 elderly and ill individuals. Knute Nelson equipped her Minnesota home with room sensors and a fall detection floor pad. Now her husband knows when his wife rises from the bed, and he can reach her in time to help her get to the bathroom safely.
The result has been a dramatic change in her health. For the past year, she has neither fallen nor required hospitalization. “The administrator told me that she can’t believe that she’s not had to come back to her nursing facility,” says Cadi Breun, Knute Nelson’s clinical technology manager. “We bought her another year living at home.”
Alarming statistics
For the elderly and infirm, falling is one of the most serious events that can dramatically reduce the quality and length of life. Falls can lead to fractured hips, broken bones and brain injuries.
Falling also feeds upon itself. The trauma involved with falling often terrifies the elderly, increasing their fear and decreasing their frequency of walking, which leads to muscle deterioration and an increased likelihood of further falls.
“Falls lead to considerable morbidity and mortality, most of which is preventable,” noted the Department of Health and Human Services in a 2012 Report to Congress.
The cost to society is high. More than $19 billion per year is spent on fall-related illnesses in the United States, as patients require additional medical and skilled nursing care. And of the 300,000 hip fractures annually, 55 percent result from a fall.
Falls are common in older adults. Approximately one-third of people 65 years of age and older fall annually. Illnesses from falls can also affect the financial health of an assisted living community.
Seniors who fall often may have to move to a rehabilitation or skilled nursing facility. This premature change of venue can affect an assisted living community’s bottom line and increase its vacancy rate.
A wide range of factors cause falls, ranging from the physical to the environmental. They include drug side effects, strokes, diabetes, arthritis, decreased visual acuity, inner-ear balance issues and a lack of exercise leading to decreased muscle mass. External factors such as slippery, wet and uneven floors and rugs multiply the risk of falling in older individuals.
The more one falls, the more likely one is to fall, as injuries lead to reduced exercise, then muscle mass deterioration, resulting in less support to the exoskeleton, increasing the tendency to sway and lose one’s balance.
An individual who will be prone to falling is often easy to detect. “The best predictor of the likelihood of a fall is one’s average walking velocity,” notes Majd Alwan, executive director of the Leading Age Center for Aging Services Technologies, a nonprofit organization, and the author of the DHS report to Congress. “Slowing down and taking shorter steps contribute to an increased fall risk.”
Injuries due to falls also increase the longer a fallen individual goes unnoticed. In private homes, those who live alone and fall often do not receive help for as long as 72 hours. Those who fall in assisted living communities typically fare much better, as regular staff check-ins minimize the time one spends on the floor without help.
This may be why sales of personal emergency response systems (PERS) are on the rise, according to a 2012 report from San Antonio-based consulting firm Frost & Sullivan. In North America, the PERS market grew to $963.9 million in 2010, a 15.2 percent increase over 2009. The report predicts that number will rise at a compound annual growth rate of 10.4 percent each year to reach $1.86 billion in 2017.
Pros and cons of detection devices
Whether one is still aging in place or living in an acute or chronic care facility, falls can be detected using various technology products, allowing help to arrive sooner than if someone waits to be discovered by a caregiver or family member.
Fall detection technologies can be either passive or active. Active products require some action on the part of the user. They include GPS devices kept on the body and pendants typically worn around the neck, such as Philips’ Lifeline product. A user may need to push a button to summon help, or the device may automatically detect the fall. Passive devices require no activity on the part of the user, using room sensors to detect potential falls.
“Fall detection technologies definitely make a difference as they shorten the time for help and thereby increase the rate of survival,” says Majd Alwan.
Both passive and active technologies have their drawbacks. Placing sensors in a room may feel “Big Brother-like” to a resident who wants privacy, not constant monitoring of all their activities. What’s more, devices that look for inactivity may trigger a large number of false alarms. An individual may simply be taking an unexpected nap, but that inactivity could be mistakenly classified as a fall.
In a residential community, room sensors may work well when the resident is inside, but if that person falls in an empty hallway, an additional body device will be needed to detect a fall.
Active devices, such as pendants, may require an individual to take action, such as pushing a button to summon help. But that person may be too injured or embarrassed to do so, rationalizing that their fall doesn’t warrant help.
Those with declining faculties may at first remember how to push the button, but then forget a few weeks later as their symptoms worsen. And even those pendants that detect falls automatically still need to be worn.
Meeting resistance
Users often don’t want to wear the pendants because they don’t like to be seen as dependent; they may think the pendant is unattractive, or they don’t need to wear it when they’re sleeping. If they then get up in the middle of the night to use the bathroom and fall, they will have no way to sound an alert.
Even when worn, it is common for users to not activate their pendant. According to a 2008 study published in the British Medical Journal, 80 percent of individuals studied who were over 90 years old failed to use their emergency pendant or pull an emergency cord. For those who lay on the floor for more than one hour, 97 percent did not use their emergency call system.
“Auto alert devices are great if you wear them,” notes Mike Dempsey, a researcher in fall detection technologies at the Boston-based Center for the Integration of Medicine and Integrative Technology.
Still, Philips Healthcare, the largest deployer of active fall detection systems, believes that its automatic detection products save lives. “We capture 95 percent of all falls,” says Nick Padula, vice president of home monitoring sales for Philips. “And within 22 seconds of detecting a fall, we contact the user.”
Philips has 300,000 seniors using its automatic fall detection devices. That includes its Lifeline home unit, a pendant system that communicates with a base station that in turn is connected to a phone line, and its GoSave product, which uses cellular-assisted GPS signals to triangulate a user’s location when they’re out of the home.
Pendant offers peace of mind
For assisted living and other residential communities, Philips integrates its fall detection pendant into its CarePoint suite of residential services, which also includes passive sensors. It’s the system that Retirement Community Management chose to implement across its 13 independent living, assisted living and memory care properties in Texas and Oklahoma.
The majority of its 1,200 residents use the Philips automatic fall detection pendant. When a fall is detected, multiple wireless receivers placed throughout the property triangulate a resident’s location, a message is automatically sent to the front desk, alerts go out to all caregivers, and help arrives typically within five minutes, says Danny Merchant, the company’s head of information technology.
“This gives residents and their family members peace of mind,” says Merchant. While residents still have to decide to wear their pendants in order for them to be useful, Merchant says that reluctance to use them has decreased as the pendants have shrunk in size. “Now they’re little bigger than a quarter.”
Alternative approach
GrandCare Systems, the technology supplier to Knute Nelson Homecare, believes that room sensors often provide better outcomes than bodily-worn devices. The company can equip an individual’s room or home with a range of sensors that detect motion or the lack of it.
Using parameters defined by the caregiver, alerts are sent out to family members or medical personnel once those are broached. For example, if an elderly individual typically never gets up at night, an alert can be defined to be whenever that person walks around outside of predefined hours.
In the case of falls, GrandCare creates “excessive motion rules” to its software, sending alerts within 15 minutes that some sort of movement is detected, says Jerry Furness, the company’s chief operating officer.
The company eschews the use of pendants. “They’re too institutional looking,” observes Furness. “A pendant says you’re old and institutionalized.”
Keys to fall prevention
While a range of technologies exists to detect falls, the best solution is to prevent falls from happening in the first place. In addition to treating illnesses that cause unsteadiness and eliminating environmental factors, building muscle strength is important.
Majd Alwan supports the use of various low-impact exercises to increase strength and stability, including Tai Chi and the Silver Sneakers fitness program offered throughout the country through participating health insurance companies.
Columbus, Ohio-based Status Solutions takes a hybrid approach. Rather than simply monitor falls, the company looks to eradicate underlying conditions that, left unattended, could cause them.
For example, if an elderly person is regularly fainting, is that caused by a high fever, which in turn is caused by a urinary tract infection? If so, then the infection, not the fainting, should be treated.
“We go back to an early point in the chain,” says Mike MacLeod, company president. The company has developed its “situational awareness engine” software and uses its own and third-party hardware to monitor physical conditions, creating rules that trigger alerts to care providers. With a combination of floor and wall vibration detectors as well as wearable devices, “we turn motion into meaningful information,” says MacLeod.
For example, watching the change in the speed of gait, or an increase in bathroom use, may indicate an underlying physical ailment. In the case of UTIs, a simple regimen of cranberry juice may eliminate the problem that could ultimately lead to a fever, and eventually a fall.
What’s next?
Dempsey, the researcher at the Center for the Integration of Medicine and Integrative Technology, believes that technological advances in fall detection will come with passive systems, those that require the individual to do or wear nothing in order to work.
Early attempts at passive fall detection included the use of video cameras to monitor changes in motion. But thanks to the “creepiness” factor, their deployment has not fared well. Dempsey, through his healthcare startup called Secora Technology, hopes to change that. Secora is developing a system that uses a camera of such low resolution that it can’t image the actual person.
Deploying a camera similar to the one used in an optical computer mouse, the device can detect motion without actually seeing the individual, eliminating privacy concerns. The addition of an optical range finder helps place the individual at a particular distance.
“We look at shapes,” says Dempsey. “Is it tall enough to be a human, is it the right shape? We look at the change in speed, and whether someone is flopping or falling onto a bed.”
Whether Secora’s technology will ultimately work is still unknown. “Falls are so significant that no comprehensive solution can be offered without fall detection,” says Dempsey. “And passive fall detection is the linchpin.”