Behold the persistence of PERS (Personal Emergency Response System). Like the little engine that could, this product category refuses to exit. Also called Medical Alarms, Medical Alerts and panic buttons, it is most recognizable as the fear-mongering "I've fallen and I can't get up" device. PERS has been around for decades, but has seen relatively little innovation over most of that time. Actually it's worse, when you think about it. The PERS market is saddled with consumers complaints about shady sales tactics ( Life Alert ), new market entrants with no understanding of seniors , and a widely disseminated worse-than-50% success rate at alerting after a fall, either as a result of the device not being worn or worn but not pressed.

So why is it still around? The device (under its 'medical' moniker) is recommended by health-related channels -- including hospitals, health services, private physicians, social workers -- as a way to improve peace-of-mind for those at risk of falling or who have already fallen. Wearing the button is viewed by all parties, including the referring health organization, adult children who may be payers, seniors who wear it, as reassuring even as the statistical benefit is shaky. Next, and perhaps more useful, pressing the button to test the unit and speaking with a responsive contact center is valuable communication (non-emergency) for the target user -- a frail woman living alone. And there's a chance for a service center agent to ask during a test call if everything else in the home is okay -- and to parse even the most vague answer.

Innovators believe the market has headroom. Philips Lifeline has an often-quoted 650,000+ US subscriber base, built through its large referral network of health-related partners, and the firm has added other services, including medication dispensing and telehealth to its offerings. But given that their numbers are a small percentage of the fastest growing age demographic today of 85+, it is puzzling as to why the business is steady state and why their potential market penetration is relatively small. Given that they have established this market, others seize the opportunity in this recognized category to bring something new.

VRI -- pumped up the sales numbers and added VoIP. VRI was a Lifeline distributor that prided itself on high quality customer service response times ("5 seconds or less"). The firm parted ways with Lifeline seven years ago and had grown to a base of 7000 subscribers under the direction of Darren Torrence. It was bought two years ago by investment entrepreneurs Andy Schoonover and Chris Hendriksen. They recognized an under-penetrated market and focused on feet-on-the-street selling to build up their own referral channels, adding vital sign tracking to round out the rest of the Philips-like model. According to Andy Schoonover, today VRI has grown from 7000 to 50,000 subscribers. Interestingly, 5000 of those subscribers use a Digicare service through VoIP (Voice over IP, aka Internet) telephone service. That makes sense since VoIP is now part of bundled internet offerings that combine Internet access with TV and low-cost phone bundles; at least 26% of 39 million seniors have broadband and will use the Internet to Skype with their grandchildren. Also the landline businesses of the Verizons of the world are dying in favor of their broadband bundle businesses.

MobileHelp -- take the device out of the house. This past year saw the entrance of MobileHelp , whose CEO, Elias Janetis, had a number of years of prior experience in the PERS business and decided to fill another void -- mobility away from the traditional 500-feet distance limit from the base station.  The company offers a wearable device that is trackable through a GPS/Cellular network, locating the user and responding through two-way voice.  And for those seniors who give permission, their adult children will soon be able to use a web portal to locate their whereabouts -- an interesting option for those families who live a distance away from their aging parents and where a spouse may exhibit early signs of dementia.

Wearable and passive -- don't press that button. In the market today are wearable innovations beyond PERS that are similarly focused on helping frail seniors -- these include motion sensing and accelerometer-based fall detection devices from Halo Monitoring and Wellcore -- these also provide immediate alerts to caregiver cell phones and call centers as specified -- ready to send help or determine if the senior is now up and around.  In addition, Halo's chest strap enables transmission of vital signs, including heart rate and whether it has stabilized -- and Wellcore's fall detector records physical activity represented by steps taken, as well as GPS tracking in conjunction with a cell phone.

But innovation for wearable devices continues. TelecareAware just noted a UK entrant called Verity, from iMonSys that has an intriguing description of what looks like a watch: "The on-board system takes the device's data monitoring and processes it through artificial intelligence algorithms and decides whether data variations can be ignored or whether the user should be asked a series of questions about his or her wellbeing. Depending on the answers, or lack of them, the device ONLY THEN starts a routine for alerting... " Watch this space -- we will note when it is released.

Messaging fall prevention should be part of marketing all wearable devices. None of these devices prevents a fall, unfortunately, which, according to the CDC , is experienced by one-third of those aged 65+ each year and is the leading cause of injury death among older adults. Worse, it results in a fear of falling, even after a fall that has not resulted in injury (thus enters the PERS device). Philips has fall prevention tips on its website -- any vendor in the space can do likewise by summarizing from CDC or AARP .  Market entrants who cultivate referral channels should combine PERS or other wearable devices with medication management capabilities as well -- the AARP site notes that besides poor balance, medication issues can be a major reason for falls. In fact, one recent study showed that simply by reviewing medications, fall risk can be lowered by 11 percent .