The End of “I’ve Fallen and I Can’t Get Up”

Posted on Dec 13, 2012
The End of “I’ve Fallen and I Can’t Get Up”

An excerpt of this post appears in the upcoming book Digital Outcasts: Moving Technology Forward Without Leaving People Behind, to be published by Morgan Kaufmann in June 2013.

Imagine that it’s 1989 and we’re watching late-night television, probably a bad horror movie or dramatic comedy from earlier in the decade. During a commercial break, we see an elderly actress falling to her bathroom floor. She flails around for a bit before touching a gadget around her neck. Pressing a button, she yells, “I’ve fallen and I can’t get up!” Within seconds, a dispatcher is seen being sent to the woman’s home to assist her, thanks to a subscription medical alarm and protection service called LifeAlert.

The intention of the piece was to deliver a powerful example communicating the importance of long-distance care for older people. Unfortunately, most critics took note of the camp, unconvincing performance overshadowing the message. As a result, “I’ve fallen and I can’t get up” became a satiric pop-culture landmark for the late 1980s. Thankfully, the joke has lost currency in today’s comedic vernacular.

I thought about this while standing in the waiting room at Holland Bloorview Rehabilitation Hospital, located in a leafy section of Toronto. The hospital’s fourth floor waiting area consists of brightly colored squares of carpet laid in front of a large screen. Rather than provide a noisy television to help visitors pass the time, the Bloorview research team installed sensors in the carpet that emit signals to the screen when pressed. Lightly stepping on the carpet produces a slight visual effect; applying firmer pressure results in a kaleidoscope of interesting patterns. The haptic carpet rewards effort by creating an entertaining medley for the eyes.

Smart carpets aren’t simply for fun, however; they also detect and measure imperfections in gait and transmit data when a fall takes place. This is just one example of research being done in the area of haptics, as teams explore interface technologies that operate as touch mechanisms for personal emergency response systems (PERS). You might think of PERS as a “panic button,” not unlike the LifeAlert scenario described above.

A recent article in Mobile Health News has issued a call-to-action for nursing homes, assisted-living facilities and senior residences to explore alternatives to the “panic button.” From a user experience perspective, the flaw of today’s PERS is that the user still needs to push a button to activate the device. From someone who is unconscious and unable to summon help, this is a problem.

The future of PERS is not likely to take the form of a pendant or push-button activation system. We can expect tomorrow’s systems to be more fully integrated into our environments, in the form of sensors embedded into furniture and carpets — just like what I saw demonstrated at Bloorview. Someone laying motionless on the floor would be relieved of the onus, since the decision point to summon help could be programmed directly onto the surface upon which she’s fallen.

What we need is for haptic technologies to respond more passively to the needs of the homebound disabled and elderly. We’ll also need more sophisticated algorithms than a simple phone service. Systems will be required to distinguish between authentic emergencies and false alarms, and they will additionally need to triage the appropriate first responder. This can’t be accomplished with just an iPhone app; it involves the design of living spaces that combine comfort with accommodation.