One of our most popular articles ever on TTA has been Tom Doris’ analysis of accelerometers in fall detection. His point of view is as a developer in digital health technology. For your consideration, we are posting this extended response from an executive experienced in deployment of both traditional PERS and now PERS with accelerometer-based fall detection in older adult populations.
Andy Schoonover is President of VRI, a leading provider of PERS, MPERS, and telehealth monitoring services founded in 1989. VRI currently actively monitors approximately 110,000 clients in the US–and a long-time TTA reader.
Tom Doris wrote a post on September 17th, laying out the problems with the use of accelerometers and fall detection devices especially in regards to PERS. After reading Tom’s post I felt compelled to respond with the following five points on why it’s important to continue to promote fall detection within PERS and MPERS.
1) In the 1 out of 100 case that my grandma falls and can’t physically press a button (sudden fainting due to hypoglycemia for example) would I prefer she have a regular PERS, which definitely won’t indicate a fall, or a PERS with fall detector which will more than likely indicate a fall? If it were my grandma I’d go with the “more than likely” option.
2) If my grandma had too many false positives then I’d ask her: you can use regular PERS with no fall detection or you can use PERS with fall detection where you will get called a couple more times per month. Which would you prefer? Hint: she’ll say fall detection. About 5 percent of our customers are annoyed by the false positives. Most love-love-love the interaction with our Care Center. It makes them feel special.
3) We tell every client that regardless of whether or not they have a fall detector they should press the button. They know they have to press the button because during install and the set-up call, we have them push the button multiple times. When it comes to the woman in Massachusetts, I’d ask Lifeline what’s included their on boarding protocols. The #1 reason why people don’t press their button is because they are afraid EMS will show up at their door which happens without a Call Center intermediary. 90 percent of the time a person presses their button, it’s for a non-emergency.
4) False Sense of Security: If people feel more secure they will go out more often, socialize more, and generally be happier and healthier. How many of us who have elderly parents or grandparents wish they would be more active? From what I’ve seen researchers overwhelmingly agree that people who are more mobile and active fall less, not more. If you are afraid you are going to fall, you aren’t going to be active. If you aren’t active, your muscles deteriorate. If your muscles deteriorate, you tend to fall more often.
5) For the first time ever we actually know how many times seniors fall. Do you think that seniors will tell someone that they fell if they got back up and are OK? Most of the time they don’t because it’s embarrassing and the perception is that things will have to be done that will limit their independence. 89 percent of the time people fall, they stand back up (meaning they don’t need help). How incredibly valuable is it to have this data? Hint: very. [Editor Note: What if you could intervene with those older adults or disabled when there is an observed pattern of non-injury falls, but before the injury fall? That could be critical to maintaining independence and even life.]
Bottom line is that there are really no downsides of using fall detection. On the contrary, fall detection for the right candidate is extremely valuable.
Managing and responding to falls is a complex area involving many components to improve outcomes. Falls detectors have some problems around false alarms but at least allows a monitoring centre to make contact to determine whether a response is required which may be a carer, responder service or some emergency response. Quite often false alerts come when the user has sat down, the TV is on loud and they are unable to hear the Lifeline telephone and then a decision has to made how to react.
As Andy mentions, having the information on frequency provides invaluable data which can be used to improve falls outcomes. It may be that the user could be referred to some agency to provide suitable excercise to improve their muscle strength, it may be that their home could be better laid out to reduce potential obstacles, it may be reassurance to the user that there is support to enable them to have the confidence to remain within their own home or maybe the contrary, it may provide opportunity to explain how the service and system is working, and it does provide a social contact call to ease social isolation.
The response to a fall is very important. For one County that I undertook work for, they had some 4,700 callouts in 1 year by a fully equipped and crewed ambulance which did not require the faller going to hospital but needed a little assistance to get up. At a cost of some £225 to send an ambulance, this amounts to a considerable annual cost which could be re-invested into a social care response service offering injury assessment, helping the person if required to their feet and a cup of tea and reassurance among over help. The ambulance would also be available for more higher priority emergency calls.