The pendant problem
If your parent has had a fall, or you are worried about one, a pendant alarm is probably the first thing that comes to mind. It is the standard recommendation from GPs, social workers, and well-meaning relatives. Press the button, help arrives.
It sounds simple. The problem is that it does not work as well as everyone assumes.
Research consistently shows that 70–80% of falls among pendant users occur when the pendant is not being worn. A 2023 University of Manchester study found that 73% of their participants who fell were not wearing their pendant at the time. An NHS Digital report put nighttime non-compliance even higher, at around 80%.
These are not outlier findings. They reflect a fundamental reality: pendants require the person to do something (wear them, charge them, press a button) and the people most at risk of falling are often the least able or willing to do those things.
Why pendants fail (it is not stubbornness)
When families buy a pendant and their parent does not wear it, the easy explanation is that they are being difficult. But the real reasons run deeper:
Stigma and identity
A pendant alarm is a visible symbol of frailty. For someone who has been independent for 70 or 80 years, wearing one is an admission that they are "that kind of old person." Research from King's College London found that the single biggest predictor of pendant non-use was not physical, it was psychological. People who saw themselves as still capable refused the pendant because it contradicted their self-image.
Removal during highest-risk activities
The moments when falls most commonly occur are precisely the moments people remove their pendants. Bathing (wet, slippery surfaces, the most dangerous room in the house) requires taking the pendant off, or wearing a supposedly waterproof model that many people find uncomfortable in the shower. Getting up at night (disorientation, dark rooms, bare feet on smooth floors) catches people without their pendant because they do not sleep in it.
Useless when most needed
If someone falls and hits their head, loses consciousness, or is too confused and frightened to find the button, the pendant does nothing. The people most likely to have severe falls (those with balance disorders, cognitive impairment, or frailty) are also the people least likely to be able to use the button after a fall.
Forgetting
Mild cognitive impairment affects around 15–20% of people over 65. These individuals may have just enough memory difficulty to forget the pendant but not enough to qualify for a dementia diagnosis. They put it on the nightstand, leave it in the bathroom, or forget it exists entirely.
If any of this sounds familiar, you are not alone. For more on why parents resist these devices, see our dedicated guide: Why Your Parent Won't Wear a Medical Alert — and What to Try Instead.
Alternative 1: smartwatches
Modern smartwatches (Apple Watch, Samsung Galaxy Watch, Google Pixel Watch) include automatic fall detection using built-in accelerometers and gyroscopes. When the watch detects a fall signature, it can automatically call emergency services if the wearer does not respond within 30–60 seconds.
What is better than a pendant
- Less stigmatising: looks like a normal watch
- Automatic detection without pressing a button
- Additional features (GPS, heart rate, blood oxygen)
- Already part of normal life for some people
What is not better
- Still must be worn. Removed for charging (usually overnight, when falls are most dangerous).
- Complex technology that many elderly people cannot manage
- Requires a paired smartphone and app setup
- High false-positive rate: vigorous arm movements, dropping into a chair, or catching themselves on a doorframe all trigger alerts
- Costs £250–£500 plus an ongoing phone plan
Best for: Tech-comfortable parents who already wear a watch and use a smartphone. Not a solution for people who refuse wearables. A watch is just a nicer-looking pendant.
Alternative 2: camera-based AI
Some systems use indoor cameras with artificial intelligence to detect falls visually. The camera watches the room and algorithms identify when someone transitions from upright to on the floor.
What is better than a pendant
- Nothing to wear, fully passive detection
- Can visually confirm what happened
- Improving accuracy with modern AI
What is not better
- Privacy: most elderly people flatly refuse cameras in their home, and rightly so
- Legal issues: under GDPR and UK data protection law, cameras in bedrooms and bathrooms raise serious legal concerns, especially when carers or visitors are also being recorded
- Cannot go where falls happen most. Bathrooms and bedrooms are legally and ethically off-limits for cameras, yet these are the highest-risk locations.
- Requires good lighting (or infrared for night)
- Someone must review alerts. Cameras generate data but not action.
- Creates family conflict. Installing cameras in a parent's home without enthusiastic consent damages trust.
Best for: Communal areas in care facilities where monitoring is expected. Not recommended for private homes unless the elderly person genuinely consents, which, in practice, almost never happens.
Alternative 3: motion sensor patterns
PIR motion sensors and smart home devices (door sensors, smart plugs, bed sensors) track daily activity patterns. If the morning routine is disrupted (no kettle used by 10am, no movement in the hallway, bathroom door not opened), an alert is sent to family members.
What is better than a pendant
- Nothing to wear
- Non-intrusive and private
- Good at detecting changes in routine over days and weeks
- Low cost (£100–£300 for a starter kit)
What is not better
- Does not detect falls. It detects the absence of expected activity, not the fall itself.
- Alert delay: it may be hours before a missed routine is flagged
- Cannot help during the first hour after a fall
- High false-alarm rate: any deviation from routine (visitor, unusual nap, early outing) triggers notifications
Best for: A supplement to another fall detection system. Useful for long-term pattern tracking but not reliable as a standalone fall detection solution.
Alternative 4: radar-based ambient sensors
Wall-mounted sensors using 60GHz FMCW radar (the same technology in modern car safety systems) detect falls by monitoring human movement with radio waves. No cameras, no microphones, nothing to wear. The sensor tracks position, movement, and posture, and can distinguish a fall from sitting down or lying in bed based on velocity, height change, and post-fall immobility.
What is better than a pendant
- Truly passive: nothing for your parent to wear, charge, remember, or interact with
- Works 24/7, including nighttime, bathroom, during sleep, in the dark. No coverage gaps.
- Detects falls automatically, even if your parent is unconscious or confused
- Privacy-preserving: no images, no video, no audio. Just motion data. GDPR-compliant by design.
- High acceptance. Because there is nothing visible on the person and no cameras watching them, most elderly people accept radar monitoring without resistance.
- Activity monitoring: tracks daily patterns and flags gradual changes that may indicate declining health
Limitations
- Cannot distinguish between multiple people in the same room
- Requires internet connectivity for alerts
- Higher upfront cost than pendants (e.g. HomeCare: €400 hardware + €29/month)
- Not a medical device: alerts family or carers, not emergency services directly
- Does not work outside the home
Best for: Any situation where compliance is a concern, which is most situations. Especially suitable for people who live alone, refuse wearables, have cognitive impairment, or are at high risk of nighttime/bathroom falls.
Making the decision
There is no universal "best" option. The right choice depends on your parent's specific situation:
Ask these questions:
- Will they actually wear it? Be honest. If they have already refused a pendant, rejected a wristband, or have a track record of "forgetting," a wearable solution is not the answer, no matter how advanced the technology.
- When are they most at risk? If nighttime and bathroom falls are your primary concern, only passive systems (radar, camera) provide coverage, and cameras cannot go in bathrooms.
- What is their cognitive state? If there is any cognitive decline, passive systems are essential. The person cannot be responsible for their own safety technology if they cannot reliably remember to use it.
- How will you respond to alerts? Any system needs a response plan. Who will get the alert? How quickly can they reach your parent? Is there a neighbour or local contact who can respond in minutes?
- What will they accept? Have the conversation before buying anything. Many families buy technology that ends up in a drawer because they did not involve their parent in the decision. The least intrusive option that your parent will agree to is always better than the most sophisticated option they reject.
The bottom line
If your parent will reliably wear a device and can manage the technology, a smartwatch or modern pendant with automatic fall detection is a reasonable starting point. If they will not (and most will not), a passive system that works without their involvement is the only option that actually provides protection.
For a full comparison of every fall detection technology available in 2026, with cost analysis and recommendations for different situations, see our guide: Fall Detection for Elderly: Every Option Compared (2026).