title: Fall detection devices and their use with older adults: a systematic review.
abstract: BACKGROUND
  Falls represent a significant threat to the health and independence of adults aged 65 years and older. As a wide variety and large number of passive monitoring systems are currently and increasingly available to detect when individuals have fallen, there is a need to analyze and synthesize the evidence regarding their ability to accurately detect falls to determine which systems are most effective.
  
  
  OBJECTIVE
  The purpose of this literature review is to systematically assess the current state of design and implementation of fall-detection devices. This review also examines to what extent these devices have been tested in the real world as well as the acceptability of these devices to older adults.
  
  
  METHODS
  A systematic literature review was conducted in PubMed, CINAHL, EMBASE, and PsycINFO from their respective inception dates to June 25, 2013.
  Articles were included if they discussed a project or multiple projects involving a system with the purpose of detecting a fall in adults. It was not a requirement for inclusion in this review that the system targets persons older than 65 years. Articles were excluded if they were not written in English or if they looked at fall risk, fall detection in children, fall prevention, or a personal emergency response device.
  
  
  METHODS
  Studies were initially divided into those using sensitivity, specificity, or accuracy in their evaluation methods and those using other methods to evaluate their devices. Studies were further classified into wearable devices and nonwearable devices. Studies were appraised for inclusion of older adults in sample and if evaluation included real-world settings.
  
  
  RESULTS
  This review identified 57 projects that used wearable systems and 35 projects using nonwearable systems, regardless of evaluation technique. Nonwearable systems included cameras, motion sensors, microphones, and floor sensors. Of the projects examining wearable systems, only 7.1% reported monitoring older adults in a real-world setting. There were no studies of nonwearable devices that used older adults as subjects in either a laboratory or a real-world setting. In general, older adults appear to be interested in using such devices although they express concerns over privacy and understanding exactly what the device is doing at specific times.
  
  
  CONCLUSIONS
  This systematic review was limited to articles written in English and did not include gray literature. Manual paper screening and review processes may have been subject to interpretive bias.
  
  
  CONCLUSIONS
  There exists a large body of work describing various fall-detection devices. The challenge in this area is to create highly accurate unobtrusive devices. From this review it appears that the technology is becoming more able to accomplish such a task. There is a need now for more real-world tests as well as standardization of the evaluation of these devices.
authors.affiliation: 1Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle. 2Department of Biobehavioral Nursing and Health, University of Washington School of Nursing, Seattle.
authors.forename: Shomir
authors.initials: S
authors.lastname: Chaudhuri
authors.forename: Hilaire
authors.initials: H
authors.lastname: Thompson
authors.forename: George
authors.initials: G
authors.lastname: Demiris
mesh_terms: D000058:Accidental Falls; D000368:Aged; D004867:Equipment Design; D006801:Humans; D018670:Monitoring, Ambulatory / Q000379:methods* / Q000592:standards; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000379:methods* / Q000592:standards