Falling Forward

When addressing senior lifestyle, comfort and safety, you can’t ignore the issue of falls. Falling is a big deal and it’s getting bigger. One out of every three seniors will fall at some point this year. One of the reasons falls are becoming a bigger issue is because there are more seniors every day. We are in the early stages of what some call the silver tsunami, describing the group of 35 million Americans above the age of 65, which is growing at a rate of 10,000 a day in the United States. Out of that large group, 10 million live alone. According to the American Association of Retired Persons (AARP), 89 percent of all seniors prefer to stay at home. That home may be one that they own, it may mean living with a friend or family member or it may be the independent living wing of a retirement facility. But the key is that they want to maintain their independence. The term ‘‘aging in place’’ correctly frames this trend of living in the residence of choice independently, and for as long as they are able, while having access to services they might need over time as needs change.

For these seniors living independently, it is almost certain that a fall will occur at some point—and for some, multiple falls. We know that despite this scary scenario, most seniors will do nothing about a fall because they either don’t know what to do or they don’t want to be inconvenienced or inform caregivers that they’ve had a fall. An alarming statistic is the cost associated with a fall, which pinpoints the hospitalization number at around $17,500. We are in the midst of transitioning away from traditional safety products that are well intentioned but becoming more outdated, and moving toward more modern products that can utilize technology to better solve the problem. Two veteran approaches to the problem of senior falls are generically referred to as nurse call and personal emergency response systems (PERS). Nurse call is primarily used in senior living facilities and consists of an intercom-like device mounted on the wall. This device has a button and a pull cord that can be used to create an alert to notify a caregiver that a senior has fallen. The problem is, for this device to work, the senior has to fall directly beside the call station. Confining this safe zone to such a small area does not give seniors an opportunity to move out of one specific area. As such, nurse call has really been rendered ineffective for the vast majority of falls. PERS avoid the above problem altogether, by placing the device on the user instead of on the wall. PERS stands for personal emergency response system and is often known by the catch phrase “I’ve fallen and I can’t get up.” Most people have seen the commercials—it’s a push-button device that is typically worn on a lanyard or sometimes on the wrist. The user simply presses the button when he/she falls, and help is on its way. However, what happens if the user can’t press the button? Or chooses not to press the button? It turns out that both of these scenarios are extremely likely. A recent industry study showed that 83 percent of PERS users failed to press the button after a fall. Although a small portion of those were unable to press the button due to unconsciousness, disorientation or falling too far away from the PERS (some falls occur at night when the patient is going to the rest room and leaves the PERS on their nightstand), a larger portion chose not to press the button, figuring that they would be able to get up eventually and because they did not want anyone to discover that they had fallen. Because multiple falls tend to get more serious with each incident, identification of even a small fall can be critically important. The key is to detect all falls small or large, in the hope that the bigger, critical falls can be prevented altogether. We can greatly enhance our chance to offer timely interventions if we collect data on the habits of the senior and allow analytics to guide us to an understanding of what trends might be good predictors of a fall. Technology plays an important part in identification of these predictors. Accelerometers are the first piece of technology that can help with fall detection. Although an accelerometer may not be recognizable by its name, you are undoubtedly familiar with it, as they are found in all smart phones and tablets. Accelerometers sense motion, activity, acceleration and direction. It’s how your smartphone knows if it’s oriented vertically or horizontally. By using a tri-axial accelerometer inside of a PERS pendant, the device can tell if a fall has occurred and sends an alert without the user having to press a button. These smarter devices are often called active PERS and serve as a reliable way to detect falls. Of course, fall prevention is better than fall detection. The best in the active PERS option takes a step toward fall prevention with the help of technology that transmits not only alerts, but also data on the general movement and activity of the senior. This data can be analyzed with the help of complicated algorithms that spot trends that indicate the higher likelihood of a fall. The data can also indicate that the pendant is not being used at all, and an automatic alert can be sent to remind the senior to wear it. The preeminent answer for fall detection and prevention is the use of a remote monitoring system. Similar to home security, these systems consist of sensors, such as motion detectors, door contacts and bed pressure pads, placed throughout the home to gauge normal life patterns. When a condition is outside of normal patterns—gathered from the continuous data feeds of the patient’s activities—notifications can be sent via web, text or e-mail so caregivers both near and far can respond. The encouraging development here is that many of these systems today are passive and don’t require any interaction on the senior’s part. The sensors integrate into the senior’s lifestyle and work quietly in the background. If there is an issue or threat to the senior’s health or safety, some systems will automatically alert family members or caregivers so they can respond. The best of these systems will run intensive data analytics on the information provided, even detecting falls and emergencies through the data rather than through a pendant. The combination of an active PERS pendant and a remote monitoring system gives the user total coverage, 24 hours a day, 7 days a week, that can provide peace of mind for the patient and family members or caregivers. Fall safety is evolving from fall notification to fall prevention. Fall prevention is important, whether it requires daily in-home visits or monitoring from outside of the home through PERS. Today’s seniors and caregivers are expecting better solutions to allow them to age-in-place and remain independent. And the application of new technologies is quickly making that possible.