The question was the title of a medical paper in 1981: how dangerous are falls in old people at home? Three researchers, Wild, Nayak and Isaacs, put it to the test in the British Medical Journal by following 125 older people who had fallen at home across six UK general practices. The answer turned out to hinge on a detail nobody was routinely measuring at the time: whether the person could get up again.
Researchers came to call the dangerous version the long lie: falling, being unable to rise, and staying on the floor for an hour or more. Forty-five years of research later, it remains the single scenario the whole medical alert category exists to answer, and almost nobody outside the research literature talks about it plainly.
This page does. Four studies, each named with its journal and year, reported as found, caveats included. Two things to hold onto before the numbers: most falls do not end in a long lie, and nothing here is medical advice or a prediction about any one person.
Prepared by the research desk of Bedford Medical Alert, a Canadian company that sells monitored medical alert systems, August 2026; we state that interest up front so you can weigh it. Every study is named and linked where it appears, and this page is part of our research section.
The evidence on the long lie was built the slow way, by following real people: a 1981 survey of fallers, a 1993 cohort of over 1,100 adults, a 1996 count of people found helpless at home, and a 2008 study of people over 90. Here is what each one found.
Of the 125 fallers Wild, Nayak and Isaacs surveyed, 20 had lain on the floor for more than an hour. Within six months, half of that group had died (British Medical Journal, 1981). People who fell, taken together, had a one-year mortality rate five times that of matched non-fallers.
It was a small study, and home care in 1981 looked nothing like home care today. Those caveats are real, and the researchers’ central observation outlived them: the studies that followed, with more people and better methods, kept finding the same direction.
Twelve years later, Tinetti and colleagues published a larger test in JAMA: 1,103 community-dwelling adults aged 72 and older, followed prospectively (JAMA, 1993). Among fallers who were not injured at all, 47 percent were unable to get up on their own after at least one fall.
Read that number again, because it reframes the problem. Getting stuck on the floor is not a rare complication of a bad fall. It happened to nearly half of the uninjured, the people a bystander would say were fine. The study also linked inability to rise with lasting decline in daily activities, 35 percent versus 26 percent among those who could get up. And an honest note the marketing versions of this research tend to drop: in this cohort, trends toward higher death and hospitalization rates did not reach statistical significance.
The starkest study is also the simplest. Over 12 weeks in San Francisco, Gurley and colleagues counted every person found in their home helpless or dead, 367 people in all (New England Journal of Medicine, 1996).
Time on the floor tracked outcomes tightly. Among people helpless for less than an hour, 12 percent died. Among those helpless for more than 72 hours, 67 percent died. Of the survivors, 62 percent could not return to independent living. The group at highest risk of being found helpless was men 85 and older living alone, at a rate of 123 per 1,000 per year. This was a descriptive study, not a test of any intervention; what it mapped was the natural history of being alone on the floor.
The study closest to the medical alert question followed 110 people over 90 in Cambridge for a year (Fleming and Brayne, BMJ, 2008). Eighty percent of those who fell were unable to get up on their own after at least one fall, and 30 percent lay on the floor for an hour or more. The long lie was associated with serious injury, hospital admission, and moves into long-term care.
Two of its findings land hardest for families. First, 82 percent of falls happened while the person was alone. Second, most of these people had call alarms, and in most falls they did not use them. The only personal characteristic that predicted long lies was cognitive impairment, a finding with real weight for families navigating memory loss; our guide to living alone with dementia covers that territory properly.
Fleming’s non-use finding was no fluke. In a small German interview study of community alarm subscribers, 24 percent never wore the button and only 14 percent wore it around the clock; among subscribers who fell while alone and lay on the floor for more than five minutes, about eight in ten had not pressed it (Heinbuchner and colleagues, Zeitschrift fur Gerontologie und Geriatrie, 2010). Satisfaction with the service was high. It did not predict use.
The reasons, across studies, are humanly familiar. The button comes off for the bath or the night, exactly where the risk concentrates. People wait to see whether they can manage alone. Nobody wants to make a fuss.
One hospital-based cohort shows what sits on the other side of that pattern. Among 413 older fallers seen in an emergency department, Bloch and colleagues found only 18 of the 115 who owned a personal emergency response system had used it to call for help; that small group spent less time on the ground and had lower six-month mortality, while owners as a group did no better than non-owners (Disability and Health Journal, 2017). The researchers are careful about it, and so are we: it is a small subgroup, the users differed from non-users in ways that matter, and whatever benefit exists depends entirely on the device being worn and pressed. A button in a drawer is furniture.
For one condition where pressing is itself the question, our page on Parkinson’s and falls sets out what tremor and softer speech change about a help button.
Deciding whether a worn button would actually get used is half the decision. Bedford’s Canadian care team has that conversation with families every day and will give you a straight read on your situation. Call Bedford Medical Alert at 1-888-755-3055.
Statistics like Gurley’s are heavy, so keep them in their frame. These are findings from specific groups: a 1981 British sample, one American city over 12 weeks, the very oldest old. They are associations, not predictions, and most falls still end with someone getting up, shaken and fine.
What the four studies agree on is where the danger actually lives. It is not the stumble. It is the hour that follows, and the day that can follow the hour. Time on the floor is the variable this whole body of research keeps measuring, which makes it the variable worth planning around.
If falling, or the fear of it, has become part of your life or a parent’s, that conversation belongs with a doctor or care team, who can look at the specifics. Risk itself can often be worked on; our guide to fall prevention at home collects the practical side, from footwear to lighting.
At Bedford Medical Alert®, this research is the honest case for what we do, and it draws the limits of it in the same breath.
The case: the long-lie evidence is why fast access to help matters. A monitored button is built to shorten the wait. Pressing it opens a two-way voice call with an operator at our monitoring centre based in Canada, who follows the response plan your family set in advance; the full sequence is laid out in what happens when you press a medical alert button.
The limits: everything above about unpressed buttons applies to ours as much as anyone’s, which is why wearing it, in the shower and to bed, is the habit that carries the whole system. Some Bedford devices add automatic fall detection, which in general terms senses the motion pattern of a hard fall and can open the call on its own; we explain the mechanism in how automatic fall detection works. No sensor on the market catches every fall, so we treat detection as a backup to the worn button, never a replacement for it. Nothing on this page promises an outcome. What a monitored system is designed to change is the length of the wait, and the wait is what these four studies kept measuring.
Bedford brings three generations of experience to exactly one problem: the fall in an empty house, and the wait that follows. We are Canadian owned and operated, an OCSA member, and trusted by clinicians across Canada, having supported hospital education programs and research initiatives from UHN Toronto Rehab to Trillium Health. Families rate the service 4.9 stars on Google. We wrote this page because the research deserves to be read straight, not dressed up as a scare.
If someone you love spends part of every day alone, the Home Freedom in-home system pairs a worn help button with 24/7 monitoring based in Canada. Equipment is included with the subscription, Easy Setup has it working in minutes, and there is no long-term contract. Call Bedford Medical Alert at 1-888-755-3055 to talk through whether it fits.
