The rate of deaths from falls among persons aged ≥65 years increased 31% from 2007 to 20161
Clearly the methodologies we are using to lower the risks of death due to falling are not working. There can be many factors that might be affecting the critical nature of a fall; one of which may be an increasing obese population.
What methodologies are we currently using to mitigate the disastrous effects of falls on our seniors and society and how might we improve them? One would have thought that with modern automated fall detection there would have been an improvement in the statistical data surrounding falls. In fact, there is a marked disimprovement. There can be many reasons for more falls resulting in deaths in both at aging in place and in aging communities even with an increase in the use of technology. The following are potential reasons:
- Responses to falls has disimproved
- Automated fall detection does not work
- Automated fall detection has too many false positives
- Push button systems are not used
- Response times are insufficient
- Post fall responses are not helping
- Wearable fall detection equipment is not worn
- More risks are taken when equipment is present (false sense of security)
- Fall detection equipment is not working
- Lack of fall detection equipment
- Will not wear fall detection equipment
- Falls are happening in places where the equipment isn’t worn or not working (showers)
- Responses to falls are poor
- There is no market saturation of fall notification equipment
- There are no good alternatives to prevent damage when someone does fall
No fall at all, is by far the best solution to the epidemic of falls in America. Following no fall at all, preventing damage when a senior does fall is the next best thing. Last on the list is effective fall response and damage mitigation. Prioritizing how we help our seniors is critical in order to be effective. We must do the following in order of execution.
- Prevent damage when there is a fall
- Maximize effectiveness of the response and repair
- Build environments and lifestyles where there is no fall at all
No matter how well we secure our environment, falls will occur. Our goal is to prevent catastrophic damage while respecting the dignity of our seniors. Damage prevention relies on understanding the mechanics of the most damaging falls.
In general, fractures are the most common serious injury resulting from falls in older persons. Specifically, fractures of the hip, wrist, humerus, and pelvis in this age group result from the combined effects of falls, osteoporosis, and other factors that increase susceptibility to injury.2
The vast majority of serious injuries in seniors are impact injuries causing breaks or hematomas. Impact injuries are caused by peak forces.3 Peak force is dependent on the distribution of the force over an area and on the distribution of that force during impact. Stylish clothing that distributes the force of impact over a larger area significantly reduces breaks and hematomas. Companies like Zanthion are perfecting this technology by retrofitting clothes with unobservable comfortable elastomeric impact materials into the knees, coccyx, and hip locations. You can help the industry design clothing to meet your needs by filling out the protective clothing questionnaire.
Effective Response and Repair
The evidence is in and 31% more seniors died from falls than in 2007. This means we have to improve our response and resolution processes for falls. In all situations, time to repair is critical for so many reasons. Blood loss, blood flow and fear play a huge role in falls. The number one priority in a fall is immediate diagnosis and attention. This is a lot more difficult than it sounds. Our nation does not have enough personnel and resources to handle the current fall volume meaning the time to resolution on falls has increased over the last 11 years to 30 minutes on average. 30 minutes is an immense amount of time to be lying on a shower floor with a serious break.
The very first thing we must do is recognize falls when they happen and deliver community services to them as soon as possible. Current methodologies for recognizing falls simply are not working. The question is why? And the answer is, “They are not comprehensive and they are invasive.”
What is Comprehensive?
Comprehensive means that we as users do not, and should not, have to understand nor take action in order for the recognition of a fall event to occur. Many vendors claim this but it is simply untrue. It is untrue because they are relying on a single form factor to deliver results. Pendants, wristbands, motion detectors, and cameras all suffer from the same issue, they are not comprehensive. Wearables can and are taken off. Cameras are affected by light. Motion detectors have a range and location. The solution to comprehensive fall detection is not in a single application but in an array of applications that cover a person and their location without their knowledge and without them taking special actions. There must be multiple motion detectors (one in the shower), multiple cameras, multiple wearable sensors built into the clothes they choose to wear. Wearable sensors must be part of their clothing and lifestyle not something separate that is put on or worn in order to achieve fall notifications or calls for help. You can help choose the design direction taken for wearable sensors by filling out this small survey.
Notifying people that seniors do not know and feel uncomfortable with is not always the best path to success. Not everyone is interested in a stranger entering their life and helping them out. Many seniors have learned that a call for help equates to a thousand dollar ambulance ride and hospital visit for no reason. For this reason it is critical to bring the familiar, or at the very least, the neighborhood into a cooperative service if possible. We will soon be at the point where government services are stretched to capacity when trying to deal with falls in the senior population. Creating a multi level notification and resolution process resolves three major issues in our demographic shift by:
- Moving the potential help closer to the senior improving time to resolution
- Bringing familiarity to the senior and the empathy that comes with that
- Lowering the cost of resolution on non-critical events
Information is critical for rapid successful diagnosis and the establishment of proper protocols by medical staff. Every fall event deserves to be surveyed based on standard established criteria such as this fall assessment.
No Fall At All
If we are to prevent falls from happening both the seniors and the environment will need to be monitored and repaired in real time. Such things are cracked sidewalks, curled carpet corners, and wet surfaces would need to be removed from our environment. This is a lofty, highly expensive impractical goal because of environmental diversity. A practical goal is to monitor seniors and prescribe protocols to maximize their health and minimize disasters. Better than prescribing protocols is to build into our society an active lifestyle that provides value to them and our society. All facets of our society are benefiting from preventative maintenance; aging aircraft in our airlines, supply chains, and manufacturing. In all cases real time data is collected and analyzed with scheduled, understood, frequent preventative maintenance cycles. The first step towards qualified preventative maintenance is scheduled and real time assessment based on monitored data. Whenever the topic of real time monitoring comes up there is inevitably the roar of privacy. It astounds me personally that people feel privacy is a major issue or that technically the issue cannot be dealt with appropriately in our 65+ population when contrasted with the cost of a fall. Falls on average, when individuals are admitted into a hospitals, cost $36,000.4
Technically we are well positioned to record human performance data, analyze it in real time for behavioral patterns, and recommend maintenance and improvements to lifestyle. Zanthion currently has real time data collection and analysis environmental and wearable sensors. Their sensors collect greater than 22 messages per second of anonymized data on gate, activity, location, heart rate, pulse, falls, and degradation in performance. Analytics are run in real time on gateways near the person or on their phones producing activity analysis and stream events to crowdsourced family, friends, staff, or doctors depending on the person’s desire.
User experience, or lack of experience, is a critical element of fall prevention. We grow old in the same environments that we grew up in without modification to hall width, shower entry, chair height, toilet height, or sharp corners. Environmental factors are a critical element in senior health. We are sorely lacking in solution based companies that are inexpensive one stop shops that modify a seniors environment to be stylish and safe. It is incredibly important that sensors are not something that is purposefully worn or added to an environment requiring maintenance. They must be a part of daily life without a recognition as their existence or need for seniors to change behavior. Accomplishing this requires that we integrate technology with our clothes and environment.
What is currently missing from all systems is the social integration, habit modification, and activity recommendation functions that modify and improve the seniors lifestyle so that they do not fall or when they do fall they do not suffer from a catastrophic injury.
Measurement and Data
You won’t find a single scientific community today that does not realize that the better the data the better your results. In the case of fall prevention and damage mitigation that means real time data and assessment. Real time data is not enough, there must be processes in place to ensure that our resolutions are measured and made more effective over time. This means measuring response times and correlating the response times, post fall assessments, and the process improvements with results. As in all things, there are no magic bullets, but we can certainly do much better than we have been doing. Here is how:
- Encourage solutions for environment modification to ensure safety
- Build measurement into our everyday lives
- Use the community to augment emergency services
- Measure the effectiveness of our responses and our solutions
- Respect the privacy and needs of the seniors being provided the service
1“Deaths from Falls Among Persons Aged ≥65 Years — United … – CDC.” 11 May. 2018, https://www.cdc.gov/mmwr/volumes/67/wr/mm6718a1.htm. Accessed 12 May. 2018.
2 “Falls in Older Persons: Risk Factors and Prevention – The … – NCBI – NIH.” https://www.ncbi.nlm.nih.gov/books/NBK235613/. Accessed 12 May. 2018.
3“9146804 – NCBI.” https://www.ncbi.nlm.nih.gov/pubmed/9146804. Accessed 12 May. 2018.
4 “ARTICLE: Falls Cost U.S. Hospitals $34 billion in Direct Medical Costs ….” 22 Apr. 2015, https://www.johnshopkinssolutions.com/newsletters/falls-cost-u-s-hospitals-30-billion-in-direct-medical-costs/. Accessed 12 May. 2018.