The Apple Watch, ECG and fall detection–a trend too far?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/10/apple-watch-series-4-elektrokardiogram.jpg” thumb_width=”125″ /]Mid-September’s Apple Fans kvelled about the Apple Watch Series 4 debut. Much was made in the health tech press of Apple’s rapid FDA clearance and the symbolism of their further moves into medical devices with the Series 4 addition of a built-in atrial fibrillation-detecting algorithm and an ECG, along with fall detection via the new accelerometer and gyroscope.

This latter feature is significant to our Readers, but judging from Apple’s marketing and the press, hardly an appealing Unique Selling Proposition to the Apple FanBoys’n’Girls who tend to be about 35 or wannabe. The website touts the ECG as a performance feature, a ‘guardian and guru’ topping all the activity, working out, and kickboxing you’re doing. It positions the fall detection and Emergency SOS in the context of safety during or after hard working out or an accident. It then calls 911 (cellular), notifies your emergency contacts, sends your current location, and displays your Medical ID badge on the screen for emergency personnel, which may not endear its users to fire and police departments. 

Laurie Orlov in her latest Age In Place Tech article points out the disconnect between the fall risk population of those aged 70+ and the disabled versus the actual propensity (and fisc) to buy an Apple Gizmo at $400+. PewInternet’s survey found that 46 percent of those over 65 actually own a smartphone, though this Editor believes that 1) much less than 50 percent are Apple and 2) most smartphone features beyond the basic remain a mystery to many. (Where store helpers, children, and grandchildren come in!)

Selling to older adults is obviously not the way that Apple is going, but there may be a subset of ‘young affluent old’ who want to sport an Apple Watch and also cover themselves for their cardiac or fall risk. (Or have children who buy it.) This is likely a sliver of a subset of the mobile PERS market, which is surprisingly small–only 20 percent of the total PERS market. But monitoring centers–doubtful, despite it being lucrative for GreatCall.

Hip-protective airbags get another entrant from France. And fall prediction steps forward.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/01/Studio-CAP-PHOTO-HELITE-1002-logo.png” thumb_width=”150″ /][grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/01/thumbs_Studio-CAP-PHOTO-HELITE-1010-logo.png” thumb_width=”150″ /]CES served as the US debut (the first was at November’s Medica fair in Dusseldorf) for Fontaine-lès-Dijon, France-based Hip’Air. Hip’Air by Helite is a soft belt with hip-positioned airbags that triggers upon fall detection but before ground impact. It is designed to be worn outside the body (unlike conventional pads), is reusable, claims a 90 percent reduction in fall impact, with a battery charge that lasts for over one week. According to their website, it will debut in Europe this spring after testing in nursing homes for €650 (US$800, UK£570). Video on their website above and on CNet.

Our Readers are well acquainted with the toxic statistics around falls and hip fractures. The US CDC found that 95 percent of hip fractures are caused by falls, usually sideways, they disproportionately affect women, and in the US they amount to about 300,000 per year. Hip’Air quotes their sources as 65,000 per year in France alone. NIH’s 2010 study found a 21 percent mortality rate after one year. Surgery/recuperation cost is around $30,000. Here is a largely avoidable cost.

In that context, it’s encouraging that Fort Washington, Pennsylvania-based ActiveProtective, which we profiled a year ago and received numerous Reader and company founder comments [TTA 10 Jan 17], is testing its belt-worn approach with Eskaton Village, an assisted living residence, in Carmichael near Sacramento California, and nearing a commercial debut. It is also based on sensors (3D) that sense a fall and deploy before impact in what they call ‘fall disambiguation’ and claims a comparable 90 percent impact reduction. It gained $4.7 million in Series A funding in December [TTA 19 Dec 17]. CBS 13 video. While Hip’Air is direct competition, albeit in Europe, more than one provider serves to convince funders and customer markets that the concept is valid.

Fall prediction is also stepping off the sidelines. Our earlier article covered four tech approaches that help to estimate and proactively act against falls [TTA 10 Jan]. Here’s another one from Spain, the FallSkip, which allows a physician or therapist to measure fall risk in under two minutes and in walking under 10 feet. Developed at Spain’s Universitat Politècnica de València, it consists of an Android-based mobile device Velcro-mounted on the back of a soft waistband for the patient which is worn during the walking test. The custom app provides and interprets motion readings to the doctor. New Atlas  YouTube videoHat tip to Toni Bunting 

To this Editor, advances in estimating fall risk are long overdue. Fall cushioning is too, and the less clunky but effective the better. But strength training is a needed adjunct, per the Dutch program. This physical training helps older adults and the disabled prevent falling and fall better, if they must. So what organizations in the US, UK, and EU are advocating this? There’s plenty of room for tech too. Not sexy or cocktail-party-buzzy at Silicon Valley parties, but a direct way to decrease cost and increase older/disabled quality of life.

Fall prevention: the technology–and Dutch–cures

The ‘Holy Grail’ of fall detection is, of course, fall prevention. The CDC statistics for the US are well known: One in four Americans aged 65+ falls each year. Every 19 minutes, an older adult dies from a fall. Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults–2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths. In 2014, the total cost of fall injuries was $31 billion. In the UK, AgeUK‘s stats are that falls represent the most frequent and serious type of accident in people aged 65 and over, the main cause of disability and the leading cause of death from injury among those aged 75+. 

The technology ‘cures’ as noted in this NextAvenue/Forbes article centers around predicting if and when a person will fall.

  • The ‘overall’ approach, which is constant monitoring of ADLs through activity sensing and modeling/machine learning to detect early signs of decline or health change. Companies in this area are Care Innovations’ QuietCare (sensor arrays) and CarePredict (wrist worn).
  • Gait detection. Relatively small changes in gait and walking speed are an accurate, fast, and straightforward indicator of fall risk. Ten years of research performed at TigerPlace in Missouri showed that people whose gait slowed by 5 centimeters per second within a week had an 86% probability of falling during the next three weeks. Shortening of stride had a 50 percent probability of fall within three weeks.
  • Read the brain. Research at Albert Einstein School of Medicine in NYC indicates that in otherwise high-functioning older people, high levels of frontal brain activity while walking and talking can predict higher long term fall risk, up to 32 percent.
  • Balance impairment. Tests using VR to simulate falling in healthy subjects and tracking their muscular response also could be used to roadmap a person’s balance impairments and future fall risk–along with training and targeted physical rehabilitation.

The Netherlands has taken this last point and gone ‘low tech’ with physical training courses that teach older adults both not to fall and to fall correctly if they do. Students negotiate obstacle courses and uneven surfaces, then learn to fall properly on thick inflated mats. Many of those attending use walkers or canes, but complete the courses which reduce the fear of falling or getting up–and provide both fun and socialization. The courses have become popular enough that they are government rated with insurance often defraying the cost. New York Times

Themes and trends at Aging2.0 OPTIMIZE 2017

Aging2.0 OPTIMIZE, in San Francisco on Tuesday and Wednesday 14-15 November, annually attracts the top thinkers and doers in innovation and aging services. It brings together academia, designers, developers, investors, and senior care executives from all over the world to rethink the aging experience in both immediately practical and long-term visionary ways.

Looking at OPTIMIZE’s agenda, there are major themes that are on point for major industry trends.

Reinventing aging with an AI twist

What will aging be like during the next decades of the 21st Century? What must be done to support quality of life, active lives, and more independence? From nursing homes with more home-like environments (Green House Project) to Bill Thomas’ latest project–‘tiny houses’ that support independent living (Minkas)—there are many developments which will affect the perception and reality of aging.

Designers like Yves Béhar of fuseproject are rethinking home design as a continuum that supports all ages and abilities in what they want and need. Beyond physical design, these new homes are powered by artificial intelligence (AI) and machine learning technology that support wellness, engagement, and safety. Advances that are already here include voice-activated devices such as Amazon Alexa, virtual reality (VR), and IoT-enabled remote care (telehealth and telecare).

For attendees at Aging2.0, there will be substantial discussion on AI’s impact and implications, highlighted at Tuesday afternoon’s general session ‘AI-ging Into the Future’ and in Wednesday’s AI/IoT-related breakouts. AI is powering breakthroughs in social robotics and predictive health, the latter using sensor-based ADL and vital signs information for wellness, fall prevention, and dementia care. Some companies part of this conversation are CarePredict, EarlySense, SafelyYou, and Intuition Robotics.

Thriving, not surviving

Thriving in later age, not simply ‘aging in place’ or compensating for the loss of ability, must engage the community, the individual, and providers. There’s new interest in addressing interrelated social factors such as isolation, life purpose, food, healthcare quality, safety, and transportation. Business models and connected living technologies can combine to redesign post-acute care for better recovery, to prevent unnecessary readmissions, and provide more proactive care for chronic diseases as well as support wellness.

In this area, OPTIMIZE has many sessions on cities and localities reorganizing to support older adults in social determinants of health, transportation innovations, and wearables for passive communications between the older person and caregivers/providers. Some organizations and companies contributing to the conversation are grandPad, Village to Village Network, Lyft, and Milken Institute.

Technology and best practices positively affect the bottom line

How can senior housing and communities put innovation into action today? How can developers make it easier for them to adopt innovation? Innovations that ‘activate’ staff and caregivers create a multiplier for a positive effect on care. Successful rollouts create a positive impact on both the operations and financial health of senior living communities.

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Chubb upgrades fall detector to identify, cancel a false alarm (UK)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/11/Chubb_07112016_Comm-Care-independent-living-image-wrist-fall-2.jpg” thumb_width=”150″ /]Chubb Community Care on Monday announced an upgraded fall detector which can both identify and if appropriate, cancel a fall alert alarm. “During the first 20 seconds of an incident, cutting-edge algorithms perform silent analysis of the situation, recognising if an individual is back on their feet,” according to David Hammond, general manager, in describing how the system differentiates a fall from a false alarm.

The self-cancellation software has been improved to help differentiate between types of movement, for example if the person is moving on the floor where help is needed, which may apply to epileptics having seizures, versus standing up and mobile. The wrist-worn device also has a standard button alert to summon help. If an alarm happens, it has a confirmation feature that indicates that help has been called by flashing a red light and vibrating for 20 seconds. The user at that point can manually cancel the activation or let it continue. According to Chubb, the product is presently in-market.  Release.

81 percent interested in tech for older adult fall detection: Carnegie-Mellon

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/03/fall.png” thumb_width=”150″ /]Carnegie-Mellon University-College of Engineering recently conducted a survey of 1,900 US adults on care for their aging parents, as background for a project in fall prevention.

  • 81 percent are interested in sensor technology to prevent falls, particularly among their aging parents
  • 54 percent worry about an elderly parent falling
  • 70 percent of this group have this fear at least once a week, if not daily; regardless of whether the parent lives alone or not

Checking in with parents is a ‘top of mind’ anxiety for most of those surveyed, with most taking a team approach:

  • 44 percent personally or have a sibling check in on their parent daily;  33 percent check in weekly; 12 percent stop by as needed
  • 56 percent have neighbors or staff physically check on their parent daily

Not coincidentally, a team of engineers from Carnegie-Mellon are also researching active sensor technologies that gauge gait stability, dizziness and fatigue to predict and prevent falling–what at a former company we called the ‘Holy Grail’ of fall detection that can keep older adults active and well. No mention though of technology aids for ‘check in’ (see 3rings and also the original notion of QuietCare‘s behavioral telemonitoring.) MedCityNews, Carnegie-Mellon release

A trip back in time to telecare, circa 2009–and maybe the future

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/08/Cape-May-Point-fade-to-dark.jpg” thumb_width=”150″ /]As the season winds down, our thoughts turn backwards. Your Editor remembers Jersey Shore vacations, travel, great airshows, collector car shows, old friends and good times. She also remembers When Telecare Was New (2006-9) with Living Independently Group (now Care Innovations), helping to pioneer the QuietCare system in senior housing. At that time, universities like Virginia and Florida were on the cutting edge in developing smart homes and pioneering systems for monitoring health in older adults and the disabled. Those smart homes and research initiatives vanished years ago, replaced by incubators, accelerators, the size of your funding round, Big Data, wearables, IoT….

Sigh. Your Editor is in Error. The University of Missouri is still at it 12 years later with its sensor-based behavioral/activity/proactive care system in the Tiger Place assisted living community near Columbia. And it seems much the same: bed and residential motion sensors, fall detection tracked by a variety of sensors, gait analysis and analysis of activity changes (changes in behavior=changes in health, which still doesn’t excite those in senior care the way it should) . You have to admire the persistence of vision the founders/researchers have had (Marilyn Rantz, professor emeritus with the School of Nursing, and Marjorie Skubic, a professor with MU’s College of Engineering). Their research model has now spread to 13 communities and hospitals in Missouri, and they are commercializing it with a former student, George Chronis, with Foresite Healthcare to convert it into a reliable, robust assisted living/hospital monitoring/care transition system with a simpler, affordable ‘health at home’ version. Besides the nostalgia and supporting fellow ‘true believers’, what they have designed is still needed AND not achieved by RFID (a big fizzle) or ancient PERS. We can all wish them luck in a competitive and much changed market. MU researchers taking sensor system from lab to marketplace (Columbia Daily Tribune)

Previously in TTA: Quantifying early detection capabilities of telecare (July 2012) and Editor Steve’s first look in October 2009 at ‘magic carpet falls’.

Tunstall Americas gets active with QMedic

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Tunstall Americas’ monitoring providers will have something new to distribute: the QMedic activity tracker. The QMedic bracelet (alternatively pendant) has an alert button and a base station like a conventional PERS, but also tracks sleep quality and activity levels. It has two way monitoring and also generates alerts and texts to loved ones if the bracelet isn’t worn or no wake-up is detected, plus recurring wellness reports on activity, sleep, and safety in the home. Fall detection presumably is inferred Tunstall’s reseller agreement includes all its local healthcare service providers. This Editor also observes that after a very long period of quiet, Tunstall in the US is demonstrating its own activity. Release. Earlier in TTA: Tunstall Goes Hawaiian with Kupuna Monitoring acquisition

Redesign of Kinect to detect, prevent Parkinson’s freezing of gait (UK)

Two researchers at London’s Brunel University have repurposed a common Microsoft Kinect game controller to detect and help prevent the freezing of gait (FOG) that is a common result of Parkinson’s disease. FOG strikes without warning–the muscles freeze and the sufferer generally falls. To both detect falls and help prevent them, the Brunel researchers mounted a laser projector on the ceiling controlled by the Kinect. If a fall happens, it initiates a video conference call to assist the person. The prevention comes in with projecting visual cues–lines ahead on the floor, which has been found to help unfreeze the muscles. According to the Brunel release, it has passed proof of concept stage and is moving to patient trials. The further proof will be if this can scale. Brunel University News

A telecare device that may solve the ‘soft fall’ and unconscious problems (UK)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/04/MonitorGO-cropped-small-232×300.jpg” thumb_width=”150″ /]Guy Dewsbury of the eponymous Gdewsbury independent research consultancy brought to this Editor’s attention his recent commission for West Yorkshire-based MonitorGo in evaluating their new smartphone-based personal alarm. He analyzed the device’s features here in a comparison chart and writeup, versus what is commonly available in the market. If it reliably does what it says it does (our normal caveat), it could be a big step beyond the Ur-Pendant, addressing our (and Neil Versel’s) concerns earlier this week on the persistence of ‘ancient history’ PERS [TTA 31 Mar].

It goes well beyond common mPERS as well. There are 12 features, including GPS location, hard fall detection and 24/7 third-party help line monitoring (via Medvivo), but the key differentiating features are the soft fall detector, unconsciousness/inactivity detection and false alert detection/response–as well as usability as a simplified smartphone with unlimited calls to UK landlines and 250 mobile-to-mobile minutes. (more…)

The traditional PERS as ‘ancient history’

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/03/Fallen-woman.jpg” thumb_width=”150″ /]Something to think about. How many families and older adults are aware that the traditional PERS emergency pendant, which has been around for at least 40 years, is sadly outdated and in fact inadequate for those at greatest risk? While major advertisers on US media such as Life Alert, Life Call, ADT and Philips Lifeline present crisis situations where the older person is on the floor and is rescued after pressing the pendant button, they barely advertise their other available products that incorporate passive fall detection and cellular, even if somewhat inadequate for soft falls or unconsciousness. Families unwisely feel ‘protected’ when paying for traditional PERS, not realizing that more advanced technology is readily available and not that much more expensive. Moreover, and only mentioned in the context of his grandmother’s fall while in senior housing, there is a distinct recalcitrance of senior housing executives to rid their apartments of the (cheap) old pendants and replace them with (pricier) passive/cellular assistance systems, much less more advanced wearables/RFID systems or mobile/watch combinations. This Editor also notes that the major drugstore chains also sell PERS; while they trumpet wellness in their advertising, they are as behind the curve in this area as senior housing. Neil Versel in MedCityNews.

For our Readers: can we compare/contrast how the UK, EU and US are still wedded to traditional PERS after 40 years, and if more advanced forms are starting to take hold? Click on the headline to see comments, including this Editor’s opining on traditional PERS as ‘cash cow’.

An alert watch for older adults that responds to voice commands

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/02/UnaliWear_Images_r6_c4.jpg” thumb_width=”150″ /]This Editor has been in Watch Overload (see Apple Watch) for months, but this may be an exception. The UnaliWear Kanega watch (in development) is for the sizable market of older adults who would wear a well-designed watch or band for safety assistance, but not one that screams Old Person With Plastic PERS, an objective shared with the latest edition of buddi [TTA 16 Dec 14]. Their prototype looks like a fairly techno steel watch, a little on the chunky side, but it packs in a lot: a 9-axis accelerometer for fall detection, a GPS locator, Bluetooth LE, cellular/Wi-Fi connectivity and a digital analog display with time and date. What’s unique: no buttons, smartphone or other tether. It works via speech recognition and ‘talks with’ the wearer (via mechanical voice, messaging on the display and a feed to a BLE hearing aid if worn.) (more…)

Looking back over Telehealth & Telecare Aware’s predictions for 2014, part II

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/01/magic-8-ball.jpg” thumb_width=”150″ /]Editor Charles has treated you to a look back on his 2014 predictions, daring Editor Donna to look back on hers. Were they ‘Decidedly so’, ‘Yes’, ‘Reply hazy, try again’ or ‘My sources say no’? Read on…

On New Year’s Day 2014, it looked like “the year of reckoning for the ‘better mousetraps’”? But the reckoning wasn’t quite as dramatic as this Editor thought.

We are whipping past the 2012-13 Peak of Inflated Expectations in health tech, diving into the Trough of Disillusionment in 2014.

There surely were companies which turned up ‘Insolvent with a great idea’ in Joe Hage’s (LinkedIn’s huge Medical Devices Group) terms, but it was more a year of Big Ideas Going Sideways than Crash and Burns.

Some formerly Great Ideas may have a future, just not the one originally envisioned. (more…)

buddi wins £20 million in contracts, signs up with Care Innovations in US

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/12/lavender_set_34.jpg-buddi.jpg” thumb_width=”150″ /]buddi, a well-known UK personal tracker/tagger company, announced over the weekend that they have signed two contracts worth £20 million ($25.1 million). The first and most of interest is with Intel-GE Care Innovations for their new, quite attractive wrist-worn fall detector/two-way emergency alert/activity monitor. According to the Telegraph, it was designed by Sebastian Conran (left) and was ‘fully certified by the US government in recent weeks’ which may mean that it gained FDA clearance. The second was for their ‘Smart Tag’ used in criminal tracking with the New South Wales, Australia government. Care Innovations adds another consumer-facing device to the Lively activity tracker and iHealth fitness and telehealth devices. Timing for availability is not disclosed. (more…)

Life expectancy up, but so is death from falls (US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”175″ /]The Gimlet Eye falls outside the box, and is writing this from recovery. Our companion in curmudgeonliness, Laurie Orlov, whacks us upside the head with first the good news then the bad. US life expectancy is up: if you are 65 today, on average you will live to 83 (men) and 86 (women), even with the rise in chronic conditions that affect quality of life, such as diabetes and heart disease. But the bad is that death from falls is also up. This is despite all the systems and gizmos the Digital Health Industry has concocted to detect falls beyond 1970s PERS technology. Once upon a rose-colored Telecare Time we thought we could infer falls purely by sensors detecting lack of activity (the basis of QuietCare, GrandCare, Healthsense, the late WellAWARE). Then with accelerometers, fall detection would be automatic, (more…)

Telecare Soapbox: Falling outside the box

[Editor Donna’s note: Even if you have already read this great article by Steve, read on to the first comment as to ‘what happened’.]

Before you read the rest of this item, read or re-read the following two popular recent falls-related articles:

Accelerometers, false positives/negatives and fall detection (Tom Doris)

A five-point rebuttal to ‘Accelerometers, false positives/negatives and fall detection’ (Andy Schoonover)

The acceptability of false positive fall alerts and the risk of false negatives has dogged fall detection ever since the first detector was invented. It is great to see this fundamental matter still being debated on this website by experienced practitioners!

However, given that calibration of devices has, as Tom Doris points out, inherent problems however sophisticated they become, I see no one putting their finger on what I consider to be the ‘real’ issue. That is: where in the system is the intelligence that judges whether a fall is problematic or not?

Current systems place the intelligence either with (more…)