Could AT&T prevent falls?

About 20 years ago, BT were probably the first large organisation anywhere in the world to consider the role of telecoms in the care of older people. Their plans for intelligent systems making use of their telephone network stalled for many reasons, but the main one was that they didn't have a route to market. It was research at the University of Wales in Bangor that recognised the role of the community alarm infrastructure as a vehicle for taking forward telecare, and this was published in the Journal of Telemedicine and Telecare back in 1996.

There followed a plethora of new devices and monitoring suggestions to detect falls and to identify the behaviour that might lead to an identification of pre-fall patterns so that timely interventions could be made. All this was published before the turn of the century when it was also recognised that real people behave in very different ways and that falls are such a complex combination of intrinsic and extrinsic factors that good predictions are almost impossible unless the home is literally filled with sensors. The answer is therefore good assessment and the prescription of either fall detectors or bed occupancy monitors, virtual sensor combination or lack of movement detection to give everyone who is at risk of a fall the confidence to live life to the full in the knowledge that they would not have to endure a long lie before someone comes riding to their rescue.

Dare I suggest that the USA (and its telecoms companies) are therefore still more than a decade behind the UK in telecare? If anyone would like a copy of a 1998 paper on the subject of fall prediction, please e-mail me: dr.k.doughty@btinternet.com

You are right to point out that the technology to do this is already ubiquitous. However, I'm of the opinion that the people who we need to identify are those who do not want to be monitored and who don't want to be told of their vulnerability. They would hate to be called patients!

I guess that every big telecoms company wants a slice of the social and medical care market. They don't want to be only the bit carriers. I'm afraid that BT failed 4 times to enter the social alarm (i.e. PERS) market - so AT&T could face an uphill battle to take on the likes of GE, Philips, Siemens and Intel.

I believe that mobile phone technology will play a big part in telecare services in about 10 to 15 years, when older people are used to the devices. Meanwhile, I see a line drawn between devices for mobile care (for everyone) and those based in the home (for house-bound older people).

My opinion is that telecare is aimed primarily in the UK at the old, old. They are typically people who are aged over 85, rarely leave their own homes, and don't own (or want to own) a mobile device. For others, there will be mobile care (m-care or e-care) for which the interface will more than likely be a cell-phone device with 3G capability.

However, I believe that the mobile operators will concentrate on functions that will be more relevant to younger people and to those who live an active lifestyle. This will include location and reminder function, as well as parameters of relevance to general well-being. In other words, I predict that there will be two quite separate product development streams with two well-defined markets over the next decade.

Thereafter, as the different cohorts move through, the two streams will merge. I have seen very negative reactions from older members of my own family when I suggest that they adopt new devices from digital TV through to DVD players. It would be wrong (and commercially dangerous) to try to force too much change on this generation before they are ready for it.

I'm all in favour of looking for new ways to engage our older people in new technologies - and that's exactly what I've been doing for the past 20 years, and that includes introducing everything from computers through to robot floor cleaners to my 88 year old father and my 89 year old mother-in-law. They will play along for a while, but rapidly lose interest unless it's something that they will need and use every day. So while they both now have digital TVs with hard discs for recording programmes, and pretty complicated remote controls, neither has bothered to use the DVD players that came with them even though we stayed with them to watch The Sound of Music or Sink the Bismark to show them how the technology works.

They have both used Play Stations, Wii and Nintendo DS consoles to play games with my kids at Christmas - but when asked again in the New Year, they said no.

Whilst I would encourage designers to consider the need to engage older users as a matter of course, I still ask the question whether we should be trying to push very old people into accepting something new today, rather than waiting 10 years when people of a similar age will readily embrace it. I am certain that Baby Boomers (including myself) will have very different views on using technology than today's older old. M-care will play a major role in reducing the cost of healthcare for us - but we need to be patient.