Comparing Fall Alert Devices for a Person With Dementia

Fall-alert devices can provide an important extra layer of safety for a person with dementia who is at risk of falling. However, the best device is not necessarily the one with the most features. For someone with dementia, it is especially important to consider whether the person will consistently wear the device, whether they can remember how to use it, and whether the device can get help even when the person cannot press a button or explain what happened.

No fall-alert device can detect every fall, and these devices should be considered one part of a larger fall-prevention plan.

Choosing among the options (brief summary)

For someone with dementia who is able to recognize a fall and reliably press a button, a traditional medical-alert system may be adequate.

For someone who may not remember to press the button or may be unable to communicate after a fall, consider a system with automatic fall detection.

For someone who walks outside independently or is at risk of wandering, consider a mobile device with GPS.

For someone who will not tolerate a medical-alert pendant, a medical-alert watch or consumer smartwatch may be more acceptable.

For someone who frequently forgets to charge devices, battery life and charging requirements should be a major consideration.

For someone with more advanced dementia, simplicity, continuous wear, automatic detection, GPS, and caregiver involvement may be more important than having numerous smartwatch features.

Examples of recommended devices (note: these are examples of devices that may be appropriate for a given situation, and are not intended to be a comprehensive list of all suitable devices):

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What to consider when choosing a fall-alert device (Detailed)

1. Does it detect a fall automatically?

This is especially important for someone with dementia.

There are two basic approaches:

• Manual help button: The person must press a button after a fall.
• Automatic fall detection: Sensors attempt to recognize a fall and can automatically contact a monitoring center or emergency services.

A manual button may work well for someone who understands when they need help and reliably remembers to press the button. However, a person with dementia may forget to use it, may not recognize that they have fallen, may become confused after a fall, or may be physically unable to reach the button.

For these reasons, automatic fall detection may provide an additional layer of protection.

However, automatic fall detection is not perfect. Devices can miss some falls, including certain slower falls or falls that do not produce the movement pattern the device is designed to recognize. No device should be considered a guarantee that help will be contacted after every fall.

2. Who responds when an alert occurs?

This is an important difference between devices.

Some medical-alert systems connect to a 24/7 professional monitoring center. A trained operator can speak with the person and determine whether emergency services or a caregiver should be contacted.

Other devices, such as an Apple Watch, can contact emergency services and/or designated emergency contacts but do not necessarily provide a dedicated medical-alert monitoring center.

For a person with dementia, professional monitoring may be useful because the person may not be able to clearly explain what happened or determine what type of help is needed.

Families should also understand exactly what happens when an alert is triggered. For example, does the monitoring center call a caregiver first, call 911, or try to speak with the person?

3. Will it work outside the home?

Consider how much independence the person has outside the home.

• Home-only systems generally work within the home using a base station.
• Mobile systems use cellular service and may include GPS.
• Smartwatches can provide protection outside the home when appropriately connected to cellular service or a phone.

For a person with dementia who walks outside independently or may wander, a mobile device with GPS can provide an important additional safety feature.

GPS may also help caregivers or emergency responders locate someone who has become lost.

4. Will the person actually wear it?

For someone with dementia, this may be the most important consideration.

A device provides little protection if the person routinely removes it, forgets it, or refuses to wear it.

Think about whether the person will tolerate:

• A pendant around the neck
• A wrist button
• A smartwatch
• A device clipped to clothing
• A device that needs to be charged regularly

Some people with dementia may become suspicious of a new device or repeatedly remove it. Introducing the device as a "medical alert" or "fall detector" may sometimes increase resistance. Families may find it easier to introduce it as a watch, necklace, or other familiar object, depending on the person's preferences.

5. What happens if the person forgets to charge it?

Battery requirements are particularly important in dementia care.

A person may forget to charge a device or may not remember to put it back on after charging.

Consider:

• How often it needs to be charged
• How long the battery lasts
• Whether someone else needs to monitor the battery
• Whether the device provides a low-battery warning
• Whether the person can continue wearing it while it charges

The UnaliWear Kanega Watch, for example, is unusual because its batteries can be changed while the watch remains on the person's wrist.

6. Can it be worn in the bathroom?

This is particularly important because bathrooms are a common location for falls.

Ideally, the person should be able to keep the device on while:

• Showering
• Bathing
• Using the toilet
• Getting in and out of the shower

If the person removes the device before bathing, there is a period when fall protection is lost.

7. Does it have GPS?

GPS can be particularly useful for a person with dementia who may wander or become lost.

Consider GPS if the person:

• Walks independently
• Goes outside without a caregiver
• Has gotten lost before
• Wanders
• Lives in a large residential community
• May leave the house unexpectedly

GPS does not prevent wandering, but it may make it easier to locate the person if they become lost.

8. How complicated is the device?

More features are not always better for someone with dementia.

A device that requires the person to navigate a touchscreen, remember multiple steps, or interact with a smartphone may be difficult to use.

When possible, look for:

• A simple physical button
• Voice activation
• Automatic fall detection
• Simple charging requirements
• Minimal steps to request help
• Clear instructions
• A device that does not require the person to carry a phone

The device should be chosen based on the person's current abilities, with the expectation that dementia may progress over time.

9. What does it really cost?

Look beyond the advertised monthly price.

Consider:

• Device purchase or rental
• Monthly monitoring
• Automatic fall-detection fees
• Cellular service
• Activation fees
• Replacement batteries
• Equipment replacement
• Additional caregiver or family features

Some systems advertise a relatively low monthly price but charge separately for automatic fall detection.

Major types of fall-alert devices

Traditional medical-alert pendant

Traditional medical-alert systems use a pendant or wrist button that the person presses when they need help.

Examples include systems from Medical Guardian, Bay Alarm Medical, and Lifeline.

Advantages

• Simple
• Large physical button
• Generally easy to understand
• Professional monitoring is available with many systems
• Does not require learning how to use a smartwatch
• Can be appropriate for someone with mild dementia who can reliably use the device

Disadvantages

• The person must remember to press it
• May not help if the person is unconscious or confused
• The person may remove it or forget to wear it
• Traditional home systems may not provide protection outside the home

For a person with dementia who frequently forgets to use the device, automatic fall detection may be preferable.

Mobile medical-alert devices

Mobile medical-alert devices are designed to work both at home and away from home. They generally use cellular service and may include GPS.

Medical Guardian MGMini

The Medical Guardian MGMini is a small mobile medical-alert device (necklace) with GPS, two-way communication, and optional automatic fall detection.

Advantages

• Small and relatively unobtrusive
• GPS
• Works away from home
• Professional monitoring
• Automatic fall detection available
• Does not require a smartphone

Disadvantages

• Must be worn consistently
• Fall detection costs extra
• Requires charging
• The person may forget to put it back on
• May be less acceptable to someone who dislikes medical-alert pendants

For a person with dementia who still goes out independently, this type of device can provide both fall protection and location information.

Bay Alarm Medical SOS All-In-One

The Bay Alarm Medical SOS All-In-One 2 (worn as belt clip or lanyard) combines home and mobile protection. It includes GPS, two-way communication, water resistance, professional monitoring, and optional automatic fall detection.

Advantages

• Works at home and away from home
• GPS
• Automatic fall detection available
• Two-way communication
• Professional monitoring
• Does not require a smartphone

Disadvantages

• Monthly monitoring fee
• Fall detection costs extra
• Requires the person to wear and charge the device

Medical-alert smartwatches

A medical-alert smartwatch can be a useful option for someone with dementia who is comfortable wearing a watch.

Medical Guardian MGMove

The MGMove looks more like a conventional smartwatch but is designed specifically as a medical-alert device. It provides 24/7 monitoring, GPS, and two-way communication, with fall detection available as an add-on.

Advantages

• May be more cosmetically acceptable than a medical-alert pendant
• GPS
• Professional monitoring
• Automatic fall detection available
• Two-way communication

Disadvantages

• More expensive than a basic button
• Requires charging daily
• Touchscreen may be difficult for someone with vision problems, tremor, or cognitive impairment
• More technology can create more opportunities for confusion

For someone with dementia, a smartwatch should be evaluated based on whether the person can actually use it—not simply whether they are physically capable of wearing it.

UnaliWear Kanega Watch

The UnaliWear Kanega Watch is designed specifically as a medical-alert watch. It includes automatic fall detection, GPS, 24/7 monitoring, and voice activation.

One unusual feature is its battery system: the batteries can be changed while the watch remains on the person's wrist.

Advantages

• Automatic fall detection
• Professional monitoring
• GPS
• Voice activation
• Designed for continuous wear
• Batteries can be changed without removing the watch
• Easy setup

Disadvantages

• More expensive than many other systems
• Fewer general-purpose smartwatch features
• Still requires the person to tolerate wearing a watch
• Some of its features may be unnecessary for someone with more advanced dementia

Apple Watch

An Apple Watch can provide fall detection and emergency calling and may be appropriate for someone who is already comfortable using an iPhone and smartwatch.

Apple Watch can detect certain hard falls. If the watch detects a hard fall and the wearer remains immobile for approximately one minute, it can automatically call emergency services and then notify emergency contacts with the person's location.

Advantages

• Automatic fall detection
• GPS and cellular options
• Emergency calling
• Emergency contacts
• Medical ID
• Many other health and activity features
• May be more cosmetically/psychologically acceptable than a medical-alert device

Disadvantages for someone with dementia

• More complicated than a dedicated medical-alert device
• Requires charging
• Some functions depend on an iPhone or cellular service
• Touchscreen may be confusing
• Not a dedicated professional medical-alert monitoring service
• Fall detection is not designed to detect every type of fall

An Apple Watch may work particularly well for a person in the earlier stages of dementia who already uses Apple products. It may be less appropriate as dementia progresses if the person becomes unable to manage the device.

Lively Mobile2

The Lively Mobile2 is a small mobile medical-alert device (lanyard) with GPS and access to Lively's response center. Automatic fall detection is available for an additional fee.

Advantages

• Small
• GPS
• Professional response center
• Automatic fall detection available
• Works away from home
• Does not require a smartphone

Disadvantages

• Must be worn consistently
• Requires charging (every 3 days)
• Fall detection is an additional cost
• Fall detection is designed to work when the device is worn in the appropriate position on its lanyard (needs to be around the neck)

Special considerations as dementia progresses

A device that works well in mild dementia may not work well later.

As dementia progresses, ask whether the person can still:

• Understand what the device is for
• Remember to wear it
• Recognize that they have fallen
• Press the button appropriately
• Follow instructions from a monitoring center
• Keep the device charged
• Avoid removing or hiding the device

If these abilities are declining, automatic fall detection, GPS, and caregiver involvement become increasingly important.

It can also be helpful for caregivers to periodically test the device and make sure they know what happens when an alert is triggered.