This story was originally published Sept. 20, 2017.
Berkeley resident Janis Bordeaux lost her dad to a fall this summer. John wasn't frail. At 84, he was still the kind of man who never stopped building and making things. The summer before his fall, he was sanding the floor.
But by the following summer, John's health had declined. He was having problems with his heart and his weight, and he was taking 12 medications every day. He had no history of falls, but as Bordeaux watched her dad grow weaker, she became more and more worried that he could stumble or slip and hurt himself.
When her parents, who also live in Berkeley, decided to spend the summer at their second home on the New Jersey shore, John suffered his first fall. He wasn’t seriously injured, but a few days later, he fell again.
“I feel like falls are the thing that will take you out nowadays, because pharmaceuticals are extending your life into what seems like an unnatural range,” Bordeaux reflects. “That could just be someone trying to make peace with their dad dying from something that seemed preventable. But on the other hand, he was getting so weak that a fall was bound to happen.”
It wasn’t the second fall that killed her dad. Or the third. Bordeaux’s dad fell four times that week. The last two falls happened on the same day. He died shortly after.
The saddest part is that, statistically speaking, John's story is so common. More than half of all elderly falls happen in the familiar surroundings of home. There are often warning signs well in advance, such as muscle weakness or gait imbalance. When your muscles are weak, it’s hard to stop yourself mid-fall. And most older adults who have fallen, or feel unsteady on their feet, don’t tell their doctors about it, according to the CDC.
Advice on how to prevent these traumatic falls has not changed much over the years. Experts say seniors who are unstable on their feet should invest in some easy home renovations to minimize slipping or tripping, such as better lighting, fewer rugs and more handrails. It’s important to talk to your doctor about your symptoms and, if needed, have your medications adjusted. The National Council on Aging recommends several evidence-based fall-prevention exercise programs for seniors, including Tai Chi, which is proven to increase balance and strengthen leg muscles.
But that’s pretty much it. As any concerned caregiver who has Googled “how to prevent senior falls” on behalf of a loved one is aware, the preponderance of helpful online resources all cover similar ground – annual physicals, eye exams, eating vitamin-rich foods, exercise and removal of safety hazards.
In spite of these efforts, 29 million Americans over 65 reported falling in 2014, with 7 million of those falls leading to injury, and direct medical costs of $31 billion annually. Falling once makes you twice as likely to fall again. And falls are the leading cause of death by injury for older adults.
Cancer is hard. It’s a hard problem. Preventing falls should be easy. Right?
If it were easy, we would be doing a better job of it, says Sanjay Khurana, Vice President of Caregiving Products and Services at AARP.
“As a society, we recognize that falling has a huge impact on degradation in quality of life," he says. "One in four older adults falls every year, and less than half actually tell their doctors about it.”
The whole world is getting older -– fast. And those demographics are about to make this crisis into a calamity. A 2007 report from the World Health Organization lays it on the line: “The economic and societal burden of falls will increase by epidemic proportions in all parts of the world over the next few decades." If countries, governments and communities don’t develop a coherent strategy to combat senior falls “in the immediate future,” the WHO projects the number of fall-related injuries will be 100 percent higher by 2030.
Old-School Tech No More
The one thing none of the government reports and websites mention is technology. Which is odd, considering senior falls have always been associated with a certain personal medical technology still in widespread use today. It goes by different names, but the iconic brand is LifeCall, whose infamous 1980s TV advertisement -- "I’ve fallen and I can’t get up!”-- has launched a thousand punchlines. Not to mention inspired countless satires, from Urkel to Pokémon.
Here’s how it works: You wear a pendant or a wristband that you push to call an emergency responder when you fall. When they pick up, you can talk to them through a speaker installed in your home (provided you’re close enough for them to hear you, and conscious enough to push the button).
It seemed like a pretty impressive innovation when it was introduced in 1974. But now, we have the technology to do better, says the AARP’s Khurana. Way better.
Khurana has been keeping an eye on wearable and home-based sensors. Some can "see" through walls and discern whether an elderly person may be in distress, or allow you to check in on your parent or grandparent remotely by reporting on where they are and whether they've been having trouble walking lately.
Khurana has made it his mission to persuade industry there's a financial upside to investing in fall prevention. He's confident that when entrepreneurs and investors realize how big the market is –- AARP says $2.9 billion for safety monitoring and fall-prevention tech alone –- the rate of innovation will kick into high gear.
The AARP did its part to goose the market this year with the Fall Prevention Innovation Challenge, a worldwide product search with some serious prize money attached. The first-time partnership with OpenIDEO and UnitedHealthcare attracted 205 design ideas from 90 countries. The competition launched in February and concluded in June.
The $50,000 top prizewinner (which judges dubbed Most Viable Solution) was Luna Lights, an automated lighting system that is activated when someone gets out of bed at night. It wirelessly lights the path along frequently traveled hallways toward, say, the bathroom or the kitchen. When the user gets back into bed, the lights snap off. Over time, cloud-based analytics compile habit data to signal to a caregiver that the elderly user may be spending extra time in the bathroom or wandering the house at night, which could suggest an underlying medical issue.
The competition’s $25,000 Most Promising Idea winner was Path Feel, a smart insole that vibrates in several pressure points when the foot touches the ground. The idea is to help older adults (or people with neuropathy, Parkinson’s or multiple sclerosis) improve their balance in real time by helping them feel their feet on the floor. The company says it's aiming to launch the product in 2018. Its built-in gyroscopes and oscillometers transmit data on gait patterns to an app that physical therapists and caregivers can use to measure progress.
Down the road, all that data could give rise to a new way to map the gait characteristics of, say, a 65-year-old diabetic against a larger dataset of “healthy walkers,” which could eventually help create algorithms for being able to detect certain symptoms and contribute to developing new diagnostic methods.
“As we age, we start changing our walking,” says Lise Pape, founder of Walk With Path, the UK-based company that invented Path Feel. "For instance, we start taking shorter steps. There’s indications in the literature that you can use walking to identify early onset Alzheimer’s and Parkinson’s."
El Camino Hospital in Mountain View, California, is already using predictive technology to reduce falls. A system made by Qventus combines data from patients' electronic health records with call-light and bed-alarm data to alert nurses that the patient is at high risk of a fall. The staff can then implement additional monitoring, including the use of video, and intervene if the patient is going to attempt to stand. In April, Chief Nursing Officer Cheryl Reinking said the hospital saw a 39 percent decrease in falls over the first six months the system was in use.
The Missing Ingredient: Dignity
One reason that more modern apps and gadgets aren’t on the market: When it comes to wearable tech, seniors are a challenging population to design for.
“The vast majority of products we look at have major flaws,” says Richard Caro, a San Francisco-based scientist/inventor. “They’re basically designed with some 20-year-old audience in mind, not an 80-year-old audience.”
Caro organizes the Longevity Explorers, an online and in-person community of people over 70, who meet up to talk about aging and test out new senior tech gadgets.
The products typically fall into one of two categories, he says. Either they solve a problem users don’t think they have, or they solve a problem people do have, but the solutions are so poorly implemented they're not that usable.
For instance, the products will come with instructions in tiny gray type or they’ll have buttons that don’t work well with shaky hands. On the other end of the spectrum, some products are so simple and dumbed down that they don’t offer the user interface and normal functionality people need.
“A lot of people buy them and don’t wear them,” says Caro. "While the devices are pretty useful, they are mostly rather ugly. They look like you’ve escaped from the hospital."
Sanjay Khurana has heard those objections, too –- from his own mother, who lives in an independent living facility. He gave her an emergency pendant to wear, but she doesn’t like it.
“And I asked her, ‘Mom, why don’t you wear this?’ She goes, ‘I wouldn’t be caught dead with the device.’ Because it requires you to wear it around your neck, it signals to the rest of the world that you are in need of help.”
He says design could make the difference.
"If the same product could be designed with a little more dignity, you would wear them, right? Maybe if it was a better-designed pendant, or a wristwatch. A smartwatch could integrate that.”
At least two companies are attempting just that. One is GreatCall, which makes the Lively Wearable, a fitness tracker that looks like a sport watch with only one button –- an emergency button. It syncs to a smartphone but only works in an emergency if you’re carrying your smartphone with you.
The other one is Wellnest, which is a smartphone watch you dial by voice. It has built-in 4G LTE and you converse with it via an Amazon Alexa interface. It can guide you home, order an Uber for you, remind you to take your meds, and sense when you’ve fallen. It will notify your caregivers if you’ve missed your meds or have been slipping a lot as you walk. It also allows them to ping your location in an emergency. (Lively Wearable is already available; Wellnest is due out by the end of the year.)
Finally, what about after you’ve fallen, but before you hit the floor? One prototype idea in the Fall Prevention Challenge was a Spanx-like pair of underwear with built-in hip protectors – and a motion sensor that calls an ambulance after a fall. In fact, the "senior airbag" concept abounds. One is a "smart belt" you attach around your waist that activates in milliseconds after a fall, theoretically before you hit the ground.
Of course, all this technology requires the elderly person to be willing to use it, which means acknowledging they are at risk. Marketing and design teams have a heavy lift to make fall prevention technology relevant to Baby Boomers, a generation distinguished more by rejecting aging than by accepting the limits it imposes.