And this is a rather I don't want to say fortuitous show,

but it's a show I've been looking forward to for some time with Dr.

Shea Gregg.

Shea and I have known each other for a number of years, and beyond being a trauma

surgeon, he is the president and founder of something called Fall Call, and focuses

Well, his passion really is about helping patients, predominantly a lot of his

geriatric patients who are dealing with falls, manage, hopefully, to not fall.

Or, if they do fall, get the help that they need beforehand, or not

even beforehand, but after the fact.

But, Dr.

Gregg is a husband, a father, and a caregiver for his parents,

where he's going down the path of caring for the beginning stages

of aging of his own parents.

So he's kind of one of us, not just a brilliant doctor.

So that's good.

He received his undergraduate degree in neuroscience at Brandeis University and

his MD at Dartmouth Brown Medical School.

He is currently chair of the surgery department at St.

Vincent's Medical Center, which is He's predominantly based in New

York, although they have locations all around the New England area.

But he's also a trauma surgeon with Hartford HealthCare, a member of the

board of the Medical Alert Monitoring Association, and is chairman, of the

State of Connecticut Trauma Committee.

And he's been that position for eight years or so now.

But, if that's not enough, as I said, he's also the president and

founder of an organization, which is best in class called Fall Call.

And I'm going to get into a little bit about Fall Call a little later on in our

conversation, because, Shea, I really want to talk first about explaining what

A trauma is, and what a trauma surgeon does, I'm not a medical professional.

So trauma might be different to you versus myself or somebody else that we know.

So can you explain exactly what that is?

Dr. Shea Gregg: Sure, so Nancy, again, as you mentioned, this is a long time coming.

I'm so excited to be on your podcast and to be a part of your show.

So, I get you forgot something very important.

I also like to go fishing too.

So,

Oh, okay.

Dr. Shea Gregg: uh,

You killed a fish, so you're a doctor, so I'll double check that one.

Dr. Shea Gregg: most, most of them make it, make it out

Catch and release?

Okay, I got it.

Dr. Shea Gregg: it right, so we're pretty good about that, but, you ask a

sort of a core question, what is trauma?

And, when you think of trauma, depending on where your point of

view is from, people can think of, people, I will say it's basically

injury, unintentional injury.

All right, when we think of many of the times, it's unintentional injury.

Sometimes it's sadly can be intentional injury, but we can break it down

and do with the taxonomy of physical injury versus mental based injury.

All right, so when a trauma surgeon is dealing with a patient who is hurt.

through some sort of mechanism, whether it's a penetrating trauma as in guns

or knives or a fall, which is the most common cause of trauma, that we see

in the United States and in our trauma centers, or motor vehicle crashes.

There's another obviously mechanism, motorcyclists, we think of physical

injury and, we, as trauma surgeons, are trained to manage the injuries

associated with physical trauma.

That's when you think of trauma surgery and you watch the, you know,

the medical dramas on TV, that's the, that's where you sort of think of

where a trauma surgeon fits in, is fixing those injuries or managing those

injuries with their incredible team.

But that being said, which I'm very excited about, is that, that finally

we embrace the fact that mental injury actually accompanies physical injury.

And we are learning with time how to better manage, patients who suffer

physical injuries, but also the scars associated, with mental injury, um, which

could be anything from PTSD to prolonged depression to, anxiety, not being

able to sleep, nightmares, et cetera.

So it all goes together and we have to, um, yes, we'll, you know, fix the physical

things and, um, uh, based on mechanism.

But we also have to really address what the trauma is associated

with, because the mind is a very powerful thing, and that needs to

be in the recovery process as well.

And there's more being done, both from societies and from hospitals on

managing both aspects of the trauma.

Well, I, I can actually understand that because, years back,

that's probably about 30 years ago, I had a very bad head on car accident myself,

right in front of our house on Super Bowl Sunday, and, both my legs were broken.

But I have to tell you, the, I will call it so that the flinch reaction that I

had anytime my husband was driving and I was not in control, which I couldn't

be, because I've got a cast on one leg, a boot on the other, and sitting in the

back seat, my reaction was like, stop!

Don't do that, turn left, put your blinker on.

I'm like the backseat driver, the worst there ever has been.

And hyper, hyper sensitive when I got behind the wheel as far as what

was happening, what was around me.

So I'm not sure I would call that trauma necessarily from my

perspective, but it was a heightened awareness of what could happen when.

so I guess there was some, mental stress,

Dr. Shea Gregg: Oh, absolutely.

And there's a classic book that's out there, um, called,

uh, Trauma, The Body Keeps Score.

And what they found in, a variety of studies is that, people who

suffer physical trauma do, Many of them suffer, emotional and or

mental trauma associated with it.

So, the startle reflects the, it's sort of like a baseline.

You know, they might be sort of hypervigilant, um,

uh, that could be one form.

But the waking up, I mean, I screen my patients now on a regular basis, where

I will say, are you having nightmares after your motor vehicle crash?

And like, and a lot of them are saying, yeah.

We didn't ask those questions years ago.

Um, or people who are the victims of gun violence or, or knife related

violence and penetrating trauma, they can remember hearing those.

And if they hear a loud sound, it's, it's, it's something that haunts them.

So, we really have to be tuned in to all aspects of that, when it comes to

dealing with the physical trauma, always remembering that there's emotional

and mental trauma and the body has that intense reaction at the time.

And that intense reaction is something that may be in our subconscious that

we have to learn how to get ahead of and how to treat that in addition

to, as part of the recovery process.

I would imagine that if, let's say, you've got an older patient who's

fallen and had a broken bone or some sort of issue happened, that even wanting to

get up and stand on their own two feet for fear of falling can also be an issue.

So now the body's not recovering as it could or should properly

because the muscles aren't working.

Is that correct?

Dr. Shea Gregg: Um, yes, and that's multifactorial.

So there's an indicator that we look at called the fear of falling, and

if you do surveys on folks after they fell, that fear of falling is very

real, and it actually gets magnified from before and after, as expected.

And the reticence to get out of bed, especially when you're dealing with

frailty or other sort of, metabolic issues, poor nutrition, and a variety

of other things, that could potentially be affecting the older adult.

Um, but it's something that we have to tune into and how we have to be

empathetic and sensitive to as we think about the recovery process

in older adults after a fall.

I want to take a side detour because you mentioned something

about, what outcomes and predictive models are understanding what's going

to happen after certain situations, and I read in a, it was probably a two

year old Twitter note that you put up there about AI means machine learning

and better understanding predictive models as a result of AI or machine

learning, whatever you want to call it.

that were better in predicting outcomes than traditional methods.

Are you seeing changes in that now so that, let's say a patient comes in or

a family comes in and the doctor may say, oh, this is the routine, but if

you put their information through some sort of program that you might have.

Again, I'm not in the hospital, so I don't necessarily know what, software

programs you have there, that you can actually predict what the outcome

or recovery is going to be for that particular person versus just saying,

yeah, we see this all the time.

This is either going to work or not work.

Dr. Shea Gregg: The answer is absolutely.

And there's actually, it's interesting as we transition into this new world of AI.

hmm.

Dr. Shea Gregg: Which is really a prospective learning tool, on a classic

model or based on the models of previous information that's been fed into it.

I mean, that's really what AI is.

So you have good, so long as you have good data in, then

you can expect good data out.

That's one key thing.

So you've got to make sure that you capture the good data and then ultimately

to predict, what people's outcomes were, are going to be, then you have to look

at your different types of variables and.

Traditionally, we did this through either prospective or retrospective and

randomized control studies, et cetera.

Um, many of this are observational studies where we know, if a person over the age

of 45, and they have, rib fractures, 45 to 65, we say, then, they, their chance

of dying with one to two rib fractures might be in the single percentages.

You go from three to four, it gets slightly higher.

But you get up to, greater than six, like your mortality might

be, 10 to 15 percent at most.

Whereas if you have someone over the age of 65, we would look at those studies and

we know that the mortality is significant.

Um, it could be, 10 to 15 to 20 to 25 percent based on

the number of rib fractures.

That's how we classically studied it.

You know, we did it through retrospective observational studies

or maybe some prospective validation.

Now we have AI models where we can take much larger datasets, plug it in.

And there are these databases that exist out there and ultimately

predict, what is the risk of dying associated with this injury pattern?

we get very, we can be very accurate.

Does that change management is the ultimate question.

And, um, really there's so many other sort of factors that we are now feeding into

these models as in frailty, nutrition, labs that are associated with it.

There's so much more that we need to learn from just the fact that I broke my ribs.

Well, that's quite, that can be a very variable Patient population, but AI, I

think will, at least in the predictive analytics within the hospital after it's

happened, have some tremendous value.

But I think what I'm excited about is the preventative aspects of AI.

we talked about the mind earlier and and we even talked about

this before we got on the recording, is that the mind itself, whether you're

in a trauma situation or not, is a very powerful tool for any individual.

And I'm guessing that if you are told that your outcomes of survival are

minimal at best, that also has an impact on your ability to recover well too,

Dr. Shea Gregg: The self fulfilling prophecy is what they say.

Yeah, it definitely can be.

And in.

It really, what I, I, you

I'm going to ask 1 more question before you go there.

Dr. Shea Gregg: sure.

And this is, probably more of a, I don't, I'm not sure I'd

call it a medical moral question, but does a doctor have a right to

tell a patient that information that they're going to potentially die?

Or do they tell a family member in a situation like that?

Not knowing whether that individual has a strong will to say, I'm

going to fight like hell and screw that, I'm going to prove them

wrong, no matter what their age.

What's your take on that one?

Dr. Shea Gregg: yeah, so I will basically say, um, first of all, when someone

comes through the front door and who's at a status quo, any trauma, a physical

trauma whatsoever, we are going to one, do whatever we can to save their life.

Unless there's documentation that states code status, DNR, DNI, as in

do not resuscitate, do not intubate, and a person's on hospice and they're

sent in really to be made comfortable,

But the majority of the time, if a person's coming to the hospital

after a trauma related incident, which has resulted usually in

injury, we will do everything possible to try to save their life.

so that being said.

When you actually are going through those initial moves, there are families,

and there's actually support systems in these incredible, models out there,

where there's geriatric medicine actually participating in the trauma.

So they will actually talk to people as they go through.

Maybe we'll do that initial resuscitation and they'll have a breathing tube

in and they'll, go through that initial sort of life saving measures,

get a bunch of blood, but then we discover that there's a horrible

this injury or horrible that injury.

Then it's a matter of saying, we know that based on this injury pattern, that

there is a higher risk of mortality.

What would your loved one want to do if they were standing at the base of

their bed looking down at themselves?

That's, some of them will say, they would want everything done because they,

want to get to a wedding in two months.

Other people will say, You know, this is not be what you're doing

right now is not what she would want, and we want to respect that.

So it's really the wedding of what are, what is the person's

wishes through the door?

Most of the time we basically go through and it's sort of working with the family.

The best thing and the most powerful thing, I think, from a physician

but not necessarily the patient if they're having problems

making their decisions or not.

Dr. Shea Gregg: If a patient is unable to make decisions, then your best,

your best bet is going to be the prior paperwork as in power of attorneys,

et cetera, to understand their wishes.

And also, you're going to be relying on the people usually next of kin or close

member of their friend or family circle.

but if the patient can hear and understand what's going on and understand

the dire situation, I guess you explain the situation on what's happening, but

you don't say, you're potentially a goner.

Dr. Shea Gregg: Oh, no, no.

It's, see, again, we have to get back to what I believe,

what medicine is all about.

Medicine is really, it's advocating for the patient's wishes in many regards.

We always, if we lose track of that, then I think we've lost our way in medicine.

and honestly providing the medical opinion and, support a patient's autonomy to make

decisions and also support the families.

So.

Uh, that's the whole basis of the doctor patient relationship in many ways.

So, um, if we have the ability to engage someone, whether, even when they're

intubated with flight sedation, we will.

And they, they, they can make more informed decisions.

Now, I will not say, you're a goner.

That's not in my lexicon.

that was my,

Dr. Shea Gregg: Yeah.

And,

I wouldn't say that you would necessarily.

Dr. Shea Gregg: Yeah.

But the key, the key is, is just like you have a, you know, you have

a significant injury pattern that's gonna require you potentially two to

three months of, of hospitalization.

In our best understanding in the likelihood of needing a nursing

facility for the a good portion of the rest of your life, are we a

hundred percent accurate in that?

No.

But there are certain injuries that can't be fixed, and there are certain things

that can't be, brain injuries especially, on various other types of injuries.

And, we can give us, give the best information that we can be aware

of, but usually that comes later in the course of a hospitalization.

right, after you fix them up, I in, again, like non doctor terms

to make sure that they are able to then understand or comprehend exactly

the situation as it is and how to make decisions for themselves or get somebody

else to help them make those decisions.

Dr. Shea Gregg: Time is your friend.

we in the medical profession try to leverage that to the best of our

abilities, and give people the most time if there is, highly fatal injuries.

and if it's, less fatal, but have a high likelihood of long term morbidity or

being in, um, a facility that someone doesn't want and they want, they're

going to lose that independence.

That might be the equivalent of a death sentence for someone in their mind.

So we try to respect a person's autonomy and their wishes and, and,

and a family's, support of that.

and, and, uh, move forward in the, uh, medical journey.

How frequently do you see doctors actually, I'm going to use

the term, interfere in those decisions to try and direct a family or an

individual to make a decision to, to end a life, to pull a plug or whatever?

how frequently do you see that?

Dr. Shea Gregg: the days of paternalistic medicine.

I think are coming to a close.

We really do view things, from a medical profession and many, at least

in the hospitals I've worked at, and I've worked in many major health

systems, is that it's the partnership.

and even when families and people do not have family members, again, we

always have to consider someone's best interest, what would be, based on a, a

pattern, um, are there situations that are extremely, or have a very high fatality?

Will we say that, um, this person has a high, you know, a very high fatality?

You need to know this in preparation so you can actually speak for that loved

one and provide their wishes to us since you know them better than we do.

Um, but that partnership is integral to good care.

uh, and, and then eventually, you know, it might lead to

end of life care and hospice.

It might lead to let's keep going.

Let's watch for 72 hours and let's see how things go.

or let's say that if this gets worse, Then we have to start to pull things back.

And, based on, the, the family meetings, we have these things, these

family meetings, and there is not going to be a physician that I, at

least I haven't seen one in any time.

In fact, I can't even remember if I've ever seen one where

they, we walked in and said.

We should stop.

Everything should stop.

This is, this is futile.

I've seen the extremes, that, uh, where we all, like all the attendings might have

thought someone was actually going to die.

And, the bottom line, she didn't.

Right,

Dr. Shea Gregg: And, the body is going to do what it's going to do.

The spirit's going to do what it's going to do.

And I think the best thing that we can do is actually partner with the

family to provide true care, along this journey, either to the end of

life or wherever they're going to go.

that's really, encouraging to hear.

I had personally had a slightly different experience at one point with, with my

dad where the hospital said we're not going to do it anymore and we said, yes

you are, because these were his wishes.

So it was, it was a touch and go with the, the hospital personnel to, to say,

listen, if you're not going to do it, you're not You know, Forget insurance.

Well, whatever it takes to get it done, to follow my father's wishes.

So that was a rather interesting experience.

Not that it happens everywhere, I understand.

And yes, he was, you know, he was 99 years old at the time, so I get it.

You know, when is enough is enough, and uh, and how do you make that decision,

or help a family know when, A decision could result in pain and suffering.

I guess is that might be might might be the alternate best way to say that.

Dr. Shea Gregg: yeah, think of it this way.

When we're doing things for people, We're doing the right thing where

we're doing things to people.

That's when we really have to consider it, you know, reconsider.

And, there are times where we might be asked to do something that is

futile, that's it's medical futility.

And as a physician in many States, actually, I think probably in all States,

we are not obligated to do futile things And that's where it sort of gets, it

gets interesting, but I can say, Again, the partnership usually, heals that,

that issue and it's rare that you get to a point where it's like, you know,

it's a crossroads and a butting heads.

we know we had a great cardiologist, who, who really was

supportive and helped us with the decisions and, and help when we,

when we know we couldn't do anymore.

I mean, it's, uh, it's tough to come to the end of a rope when a parent

doesn't want to give up and you know that, well, you know, it's either this

or, you know, you know, you die and on, on an, on an operating table alone.

And that's, It was a very difficult decision, but, in any case, thankfully,

our situation was not everybody's situation, and I think we did the best we

could when, when we needed to at the time.

So, but that's just one family's experience, it's not 100 percent of them.

Now I want to get into Fall Call because your background has been

in trauma, in geriatric trauma predominantly, is that correct?

Correct.

Dr. Shea Gregg: Yes, as far as my research and my interests, I've

really focused in on that demographic.

and what are some of the, typical things, if there is

such a thing, that happens within, a geriatric patient or an elderly

patient as it relates to trauma?

it's falls, heart attacks, I guess is in that category too, or is that not

considered in the category of trauma?

Dr. Shea Gregg: So again, with, with trauma, um, uh, even though,

heart attack can actually lead to traumas and falls, the number

one, mechanism, for, uh, Traumatic injury in the older adult are false.

That's the number one.

we also can treat people with, motor vehicle crashes, people are driving, you

know, God bless them and that's great.

They should, drive for as long as you can, if that's what you and some people are out

on motorcycles, so we take care of those.

But, but falls and hip fractures.

There's basically three types of injuries that we see in the older

adult, and that's going to be hip fractures, rib fractures, and head

trauma, usually with intracranial bleeds.

Yeah, those are the three types of injuries.

And, and the majority of them are from ground level falls.

Really?

Okay.

So they're not falling down the stairs or, out of tall buildings

single bound or whatever it

Dr. Shea Gregg: Yeah, exactly.

No, stairs actually is quite a quite common mechanism.

Bathroom related falls, um, changes in position where you're going from

a sitting to a standing position, or you're in a hot shower and you can

have a vagus episode where you just, get lightheaded and you pass out.

bathrooms are very popular places to fall.

Falling down stairs because you're just missing a stair.

Um, I tend to see a lot of rib fractures in that situation.

I can see hip fractures.

where's the breakout on those?

do you have sort of a percentage breakout of, head versus, rib

fractures versus hip and leg fractures

Dr. Shea Gregg: yeah, what I would say is that what would he know is for all

traumas, all comers, about 50 percent of the traumas that we manage are usually

head injuries, that's actually all age

50%?

Really?

Dr. Shea Gregg: Yeah, 50 percent of all, as in people who present

with trauma in a trauma center, about 50 percent are head injuries.

Um, hip fractures though, I would say would probably be the most, uh, if you

haven't had a head injury, then you have, you present to a trauma center, we see a

lot of hip fractures, very, very common.

and then you're looking at rib fractures, as I would probably

say is the next level of,

I would imagine that if you have one, there could be multiple.

So if you fall and break your hip, you could hit your head

as well at the same time.

So there could be more than one situation.

it's interesting.

I know somebody who recently had a bad fall, an Alzheimer's patient, sadly.

And, multiple brain bleeds, which did not end well.

so that's why I'm asking, and I've also, seen where doctors will say at a

certain age if a hip fracture happens, the chance of survival for an extended

period of time is fairly, I've heard the numbers, like six months kind of thing.

Is that typical or is that not

Dr. Shea Gregg: um, it's, it's interesting.

again, I'm going to say it depends.

I, I've heard is, the 6 months, but really, I've heard 2 years.

but.

There are pathways now, and this is so important that we, we as a trauma

community who takes care of these patients, who know that the mortality

rate on a yearly basis in the United States on falls over the age of

65 is about 43 to 45, 000 people.

if you take, if you add up all your motor vehicle crashes, you add up all

your, your penetrating trauma, you're getting pretty close to, that number.

It's slightly above actually for those

And what, what per, what percentage is that you said 45, 000,

what percentage of, well, you said it's about 50 percent of the injuries

are for over 65, it's about hips, hips and legs and, and whatnot, right?

Dr. Shea Gregg: Yeah, they might be head injuries, they might be hips.

The three most common under that umbrella, um, at least of people who've died, yeah.

But we also have to think about what the incidence of fall is,

which is one in four people over the age of 65 will fall every year.

really?

Dr. Shea Gregg: One in four.

Yeah, that's CDC data, and it used to be one in three, so we're doing something

right as far as prevention methods.

But yeah, they say one in four people will actually fall every

year, according to the CDC.

And, 20 to 30 percent can actually sustain some sort of injury.

Um, there's several hospitalizations.

And it's interesting because that incidence of falls, Is actually

very similar across the world.

So if you look at individual studies in throughout Europe, Australia,

wherever you go, Africa, one in four is a very common number of people who fall over

the age of 65, which is very interesting.

Do you think that has to do with, muscle strength or

osteoporosis as we age or not?

Dr. Shea Gregg: You're going through the risk factors.

These are classic risk factors.

We know that, again,

Obesity.

Dr. Shea Gregg: obesity is, but also frailty is the other

sort of aspect of things.

Medical conditions that are associated with weakness, which could be anything

from congestive heart failure, COPD,

Or medications that they might be taking, other things that are

causing dizziness or, breathing issues.

Dr. Shea Gregg: Yeah, and urinary tract infections.

If you are going to have an infectious cause of a fall, 40 percent of the time,

in one study, states that it is going to likely be a urinary tract infection.

Urinary tract infections, can actually either, as we all get older, we all

get to look forward to in men having larger prostates, and in women.

Having potentially some bladder laxity, et cetera, with pelvic wall

and pelvic muscle, musculature laxity.

So the inability to empty can lead to increased risk of UTIs.

UTIs has been shown, to have an increased, association with falls.

And,

why?

Because a UTI can cause all sorts of issues that could

even be mistaken for dementia.

Correct.

Dr. Shea Gregg: Absolutely.

And actually you describe sort of a classic pathway is that when you have

an untreated infected source anywhere in your body, you know, whether it's a

kid with appendicitis or, someone even with COVID, there's a variety of sort

of infectious causes that's untreated.

You can have mental status changes.

You can have weakness, you can have instability, you can have dizziness,

you can have all these things.

And therefore, based on the literature, and actually, we published some stuff when

I was at Brown on this about increased mortality associated with UTIs and falls.

Um, I get a urinalysis on every single person that comes into that

trauma center, who had a, a fall.

Based on the data, because if I can actually treat someone and, treat a

urinary tract infection, for three to seven days, depending on the

situation, then I have the ability to potentially reduce their fall risk,

And improve recovery, ultimately for

everything else that's going

Dr. Shea Gregg: exactly

you don't have a, you don't have an infection that's going through the

body, not just in the bladder area, right?

Dr. Shea Gregg: You got it.

And, the whole body can be affected, by a UTI and I've seen

it over and over and over again.

actually the way people react to UTIs, I think is rather fascinating

because it's so easily misdiagnosed as, as other issues that are going on,

if you're a non medical professional.

Yeah.

So that brings us to fall call because, as I understand early on when we first

met that the falls and the trauma that you saw as a result of falls in

the work that you do was one of the reasons why you decided to figure out

is there a solution to this or is there a way to, to deter, accidents from

happening for anybody, but predominantly those that are, 65 plus, on average.

Is that correct?

Dr. Shea Gregg: Yes.

Yes.

some very poignant memories of, being back in 2000.

13, 14, 15, in my sort of middle practice, if you will, years so far, and I remember

just, I, I would ask people, who are down for long periods of time, two hours,

three hours, they have pressure ulcers, they've got muscle breakdown, they've

got all these things and kidney effects from it, and I'll never forget some woman

who was, who fell, had a medical alert system, it was in her bedroom, But, uh,

where she was lying, which was under a grandfather clock, for she didn't,

she couldn't access her medical alert.

So, she was there, I think, for like seven, eight hours, stuck under a clock.

She could keep track of the time, but that's how she knew

how long she was down for.

But the problem was, is that she couldn't access the medical alerts

because she was embarrassed to use it.

And so.

I said, how can we make this better?

how can we, A, make, a system that people aren't embarrassed to wear, and B, a

non stigmatizing system, and B, make it so it has the ability to better detect

falls, that people aren't afraid to, drop their pendants or whatever else.

Enter Apple Watch, totally inspired by this device.

It looked like it was going to be a neat, a decent looking thing, potentially

have a lot of health capability.

and early on we, I got access to it and I said this is the

future of emergency response.

I found out it had an accelerometer in it and I said I want to build the

next generation of medical alert where no longer are you going to be tethered

to a hub that you have to buy for.

your hardware.

I wanted to make the mobile phone the hub.

Now, saying that in 2016, People didn't believe me.

They're like, yeah, who's going to take up mobile phones, let alone Apple Watches?

Well, here we are, folks.

AARP just said, 80 to 90 percent of people over the age of 50, 60, 70, actually

own a smartphone and use it daily.

And, watch uptake is actually almost as, in the older adult population is almost

as quick as, uh, the younger population.

it's transitioned tremendously.

that's great to hear.

I know that there's a, certain percentage of the population

that won't wear, a watch.

I, I've got a Fitbit and some other things, so I get it.

but they just rely on their, phone to check their watch.

the time or whatever else, or they don't check the time.

those of us who are time obsessed of getting things done or counting steps

or heart rate or whatever it is, right?

But, what I liked about your approach besides the fact that it was easy to

wear and it didn't look like a medical device, because I know my mom, my mom

and dad, when they went into a care facility for They, they wanted to go.

That was their choice.

we took them out eventually.

and most people who've heard the podcast understand that story.

But the last thing my mom wanted to come across on, and certainly

my dad, is to look frail or old or sick in any way, shape, or form.

So anything that looked like a, a band aid colored thing with a red

button on it that's, the old joke, help I've fallen and I can't get up.

and if you're not going to wear it like this woman said, she's under

the clock, why would they do that?

So I think that, what you were doing originally, Was fabulous and have

attracted along, but now you're also doing attractive pendants.

They look like fashion designer items

Dr. Shea Gregg: Yes, it's so again, fulfilling the thought

process of non stigmatizing,

or vanity.

Dr. Shea Gregg: Yeah, yeah.

Vanity tech, safety depending on what level.

we partnered with companies looking specifically for things

that people found attractive.

In fact, I've done surveys with my, my users and I asked whenever I would

bring a product online or consider bringing a product, would you use

this and our, upcoming launch of our fall call pendant was based out of

the survey data that they said, hey, this is something that is attractive.

It's non stigmatizing and it actually has fall detection built into it.

And it has the safety bin, but it's an extension that

you can use with your phone.

It's almost like a remote.

but it was so important to me to bring, stylish accessories that

fit into your everyday life that didn't make people feel old.

And, it's one of those things that once you set it up.

And then you have access to it and use and even more importantly is since I

don't have all this hardware that I need to sell and install in your house

that I can charge half the price as

Oh, even better.

there's so much out there that's a crazy price.

And I say, the big business of aging care and younger companies

are trying to get into this market.

And I understand.

it's a growing market, as it is for Fall Call.

You were, I would say, my take on Fall Call is that you were more mission

driven I think that's partially what I really liked and it was a doctor,

especially a trauma doctor, who is specifically looking at solving or

trying to help solve a problem so

that, it's easy to use.

How does it work?

Because we're on audio right now and I'll, I can put in on a YouTube channel

a little bit about some of how things work visually, but how would you describe

this from an audio perspective or a podcast perspective that people, what

would they see and how does it work?

Dr. Shea Gregg: Sure.

The pendant will pair with the app, which is basically you press

the button on the back of the app.

And for those, if it does go to video, this is what it looks like.

It's a very simplified pendant.

So there's a button on the back of that pendant.

Dr. Shea Gregg: on the back of it, that is the button.

So it doesn't even, it doesn't, it's not even bright

and red or anything like that.

Dr. Shea Gregg: nope, it is something that basically is supposed to fit in.

It has a gold chain on it.

And, and built into this actually is some amazing technology that is, has

just a button to turn it on in the sense that when you first pair your pendant,

you actually just go to the screen where it says pair pendant, you tap

the button on the back of the pendant.

It will pair.

You go, you put your address in, you eventually

your earbuds.

Same thing.

Dr. Shea Gregg: It's, it's actually, it's exactly that process.

and uses but in this case it's, it's beacon based technology,

which does u utilize Bluetooth.

And, once you're paired, then, think of it as basically a FAA remote.

For activating help calls to that, to your phone.

So, instead of that hub that would be installed as a landline, your

pendant would attach to, etc.

Think of your phone as your new hub.

And so, as they say that 60 percent of falls occur in the house.

Well, if you wear your pendant, you have your phone with you.

And let's say you're separated from your phone and you're like 200 feet

away from it and whether in the grocery store or whatever else and you have a

fall and maybe you're in the parking lot and this pendant will pick up

the fall, will let the phone know and basically that will beam the signals

up through a lot of redundancies up to our central monitor system and

it'll try to call back the phone.

But if you're away, say you broke your hip and you're in a Parking lot, then

it'll actually try to either the central monitor will contact the either the

primary caregiver or 911, depending on what you designate as the user.

And, then emergency response will come because we have outstanding GPS capability

within phones and mobile devices.

That's the beautiful thing is all these hardware devices that are installed

by traditional PERS companies, personal emergency response companies.

They have technology built in, but with the mobile phones,

it's the latest technology.

So, location based technology, Bluetooth based technology,

everything that's in there, it's the latest and greatest 5G speeds.

And, by that activation, either by the fall or by the button press,

it could actually activate that.

Now, what happens if you're wearing the pendant, or your mom's

wearing the pendant, and she leaves her phone back in, at the house, and

she's at the grocery store in Falls?

Dr. Shea Gregg: So, like any pendant, or that's out on the market, with the

exception of the mobile purse that has, built in 4G, but obviously that has

limitations as far as the antennas and everything else, then obviously you

will not have that range unless you, you're within like the 150 to 200 feet.

but.

That's where, we have a lot of our users, and as we grow our partnerships, I'm

more and more excited to introduce other devices that will potentially have that

cellular connectivity, and, but yet the attractiveness of a non medical device

or non, traditional medical alert device.

you could have your phone on your watch, on your Apple Watch,

and still wear the pendant, or do you need both at the same time?

Dr. Shea Gregg: well, if you actually If you have your Apple

Watch, you have everything you need to actually activate a help call.

I can be wherever, because the way we built the app on Apple Watch is

that, once you onboard everything, you can turn off your phone and your

Apple Watch will run fall detection, get the phone calls, you can activate

help calls, everything from your watch and not be next to your phone at all.

And the only thing you need to do is make sure it's charged.

Dr. Shea Gregg: yep, exactly.

Just make sure it's charged.

You got it.

Now, I, I love this, because the watch gives the gentleman, or like

my dad, if my dad was going to be an option to wear that, cause he's not going

to wear a pretty attractive pendant.

at least my dad never would, but he would wear a watch for sure.

And the other thing that you've done recently is now you have a door lock

for houses, which I think is phenomenal.

Because in some states, if a call is made and nobody's home or there's a,

somebody's checking in and you send the emergency to your parents and the

front door is locked, there's no way for them to get in unless they bring.

a police department or a police officer who has approval to enter the house.

The EMTs typically will not do that if a door is locked

or even if there's a lock box.

There's, there are certain parameters, It depends upon the community,

but generally they don't do that.

Your system is different.

It's just replacing the lock that's in the door with the ability to unlock

it, from any location in the country so that an emergency responder could enter.

And help a parent or a spouse, whoever it is that needs it.

Dr. Shea Gregg: Yes, so again, solving real problems that the medical alert

industry has faced for decades.

Right.

Dr. Shea Gregg: One of the biggest challenges is accessing

patients behind locked doors, as you beautifully framed it.

And when thinking about this, I actually, again, I have the frontline

experience of hearing about this, about the broken down doors, etc.

It doesn't happen often, but it

Or even a grandchild there who doesn't know how to open the door

and grandma's falling in the back.

Um,

Dr. Shea Gregg: Exactly.

And the grandchild's scared, etc.

And I've heard these horrible stories.

And when we approached Kwikset, with this idea, they immediately embraced it.

they said, this is a wonderful idea.

It enhances access.

And the way that we wanted to make sure we protect the security of a

home is we know specifically in Fall Call when an ambulance is dispatched.

At that point, that's when the signal actually will unlock the door.

Only when an ambulance is dispatched.

Because the majority of calls to a call center are false alarms.

So if you aren't dispatching an ambulance, then I'm not going to unlock your door.

Not me, but my system is not going to unlock the door.

but if there is a true ambulance emergency, And, then basically

the door will get unlocked.

Uh, so when EMS arrives, they will be able to enter and treat that patient.

And if they are in a situation where they're progressively more unconscious.

Then you're going to have minutes.

I mean, sometimes minutes make the difference.

And even more importantly, which I felt was important, is we know

when the ambulance crew clears.

And once we get that all clear, and they actually clear the

scene, the door will lock again.

I saw that's, there's a video that I'll put in the, in the episode notes

so people can see because how this works, it's beautifully demonstrated and just

watching the video, is peace of mind.

I wish it was around when my parents were here, because I, I would have installed

it in a heartbeat, no pun intended.

What are some of the things that you're looking at?

I mean, beyond the watch, the pendants, and the lock, are there other things that

you're looking at in this, fall scenario?

to really break into new territory or new grounds in this area, because I've, I,

I'm going to back up a second because what you're doing is, is different and you've

probably seen as well as I do all, besides the, help I fall and I can't get up,

there are all sorts of like bumpers that you can blow up that are on waste that

are, it's like all of a sudden you fall down and it turns into a giant balloon

on somebody's waist and they fall and it's just like, you've got to be kidding.

And it's like a bouncy house belt, I call it for fall detection.

Yeah, airbags.

Thank you.

Better description.

I'm thinking, really?

I mean, I can see that being a bigger problem more than anything

else, but, that's, I'm not a

Dr. Shea Gregg: Yeah, there are options.

I think that we need to, as an industry, start, getting into the

business of, preventing falls.

All right.

And, and PERS has traditionally been reactive.

It's time that we become proactive.

And the beautiful thing about, At least my vantage point is, as a

physician, I see what the endpoints are, but I also know the risk factors

for what can cause these things.

So high heart rates associated with a variety of medical conditions,

rapid atrial fibrillation, pulmonary embolus, et cetera.

What we, or, and then irregular heartbeats, new onset atrial fibrillation

or maybe an arrhythmia, et cetera.

If I have the ability.

Which I will and I do have the ability to actually send out a high heart rate

alert to our monitoring center that the monitoring center could actually come

back in and call the person say we've reached the caregiver's role would receive

a high heart rate alert, you know, and we know that high heart rate alert.

This is based on some technology that Apple's developed.

We know that that high heart rate alert is usually tracked during low activity

levels, maybe sitting down, et cetera.

So it's irregularly high.

so if we can send out a high heart rate alert to our monitoring center

will call the person and say, Hey, do you have any, uh, is everything okay?

Do you have any chest pain?

Go through the algorithm.

Do you have any, uh, pressure?

Do you have any lightheadedness when you stand up, et cetera?

And they say, yeah, you know, maybe I do.

Something's not right, um, or they have a fever, which can

lead to a high heart rate.

Then all of a sudden you can preemptively, dispatch a crew to check on the

patient or the person who's calling, maybe send a caregiver over and then

make a decision and then reactivate it and get the ambulance, et cetera.

But if we can preemptively discover if someone has irregular heart rates,

high heart rates, and we're actually developing some technology where we

know that if you go to the bathroom more than two times a night, actually you

urinate more than two times a night, you're at an increased risk for UTI.

And as I mentioned earlier.

Your increased risk for UTI, you have an increased risk of falling.

Well, if I can actually figure that out, and actually understand those,

those motion patterns through machine learning, which I'm, we're training the

system to do, not out in the market yet internally, then I, if I can diagnose

the risk of a UTI, or an active high heart rate, or irregular heart rate, then

I have the ability to prevent a fall.

Wouldn't that be great?

It's all coming, Nancy.

It's all coming.

And that's so exciting to me because, if you can pick this up,

then, uh, and intervene early, then you will avoid the hip fracture

with, say, the atrial fibrillation.

You know, you'll just have someone with a high heart rate and you'll be

able to treat that more effectively and hopefully avoid that fall.

I, I keep saying I love this, you know, I do, there's a, a product

that you may or may not be aware of called Pixie Pads, which is, yeah, I

had, I met those folks early on and they were doing UTI, early UTI detections.

The problem with that and it's not that it's.

It's a bad product.

I think it's an excellent product.

It's kind of, icky.

I feel like I describe it.

So by icky, I mean, for those that are listening, it's, it's a,

it's basically an absorbent pad that goes into the undergarments.

And so when there's a leakage or pee happens, then, the pixie pad is scanned.

with a, a phone to determine what are the oxalates in the urine at the time.

And it's pretty accurate to figure out whether a UTI is coming on.

But the, the icky part is like, you got to pull this thing

off and you got to scan it.

who really wants to do that?

I mean, really?

I get it.

I, I know the importance of doing it, but it's not something

I personally would want to do.

although we used them for, for my folks for a while until we

monitored and figured out what was going on and, we could see that.

And they were expensive, very expensive to use.

So, as good as they were, the cost of use was, became a little prohibitive for us.

for us and I think probably for a lot of other people, but knowing that certain,

bathroom habits, getting up two or three times in the middle of the night is,

is something that you want to monitor.

So I would also think that this is, is very helpful from a GPS perspective,

if you don't lose a phone for, Alzheimer's and wandering and things

like that could very much come into play where, um, even in, in time,

these could be sewn into clothing at some point so that it's easier to.

To help those folks as well.

Dr. Shea Gregg: Yeah, we're getting there, Nancy.

There's so many things I think that are exciting in the future, but if

we start shifting from reactive to proactive, I think that that is going

to ultimately really make an impact.

if we can stabilize.

The incidence in the, reduce the mortality associated with maybe having

different admissions for, say, high heart rates or other other risk factors,

then I think we're doing our job, you

Well, the whole medical industry, yeah, medical

and healthcare industry has been working on that for many years.

And you know as well as I do and many others else, it's, that's a behavioral

change that sometimes happens in the home.

And that's the hard part with us as patients or, or individuals, just to

change our habit patterns and really want to, So we're proactive, not just

hoping that, uh, like yourself are going to patch us up and turn us into bionic

creatures so that we can just go off and do the next marathon at 89 years old.

Dr. Shea Gregg: Yeah, and I'll tell you what I also believe,

too, is this technology has.

Technology has the ability, to be in your face, we live in a world of where

technology wants to be in your face.

I want our technology to be silent.

I don't want anybody to do anything to our technology other than maybe put it

on your wrist, turn it on, And that's it.

And if I can get an entire, and I can get all these readings, et cetera,

and send out risk factors, especially when we have, caregiver, crunches,

the sandwich caregiver who has to deal with kids and parents, et cetera.

I mean, I'm in that situation now.

I know what it's like.

Um, I know what it's like to

right?

we've got one aid on average for every 17 residents, which is very typical,

whether it's a rehab facility, or a hospital, or even a care home.

that's where this could be coming into play.

This has been terrific.

Yeah.

Thank you.

Thank you, Shay.

Thank you so much.

And thank you for sharing.

I know that you'll keep us posted on new technology and

new work that you're working on.

In the meantime, for everybody who's listening, there will be links to

everything that we've talked about in this show in the episode notes and

anything else that I can get my hands on research that might be of help to you.

We'll be putting there as well as a website that's in the

process of being put together.

We're a little slow on that at the podcast has been the primary

focus and getting the word out.

The faster we can do it, the more benefit to you.

so thank you very much, Shae I appreciate you being here with me and with everybody

else who's listening in as well.

For

Dr. Shea Gregg: Thank you so much Nancy

those who are listening, as you know, I always like to say, please share

this with a friend, a family member, or maybe even somebody that you're seeing

at the Dunkin Donuts line who needs a little extra help, whether they're

taking care of somebody else or they just might need some help themselves.

Share this with them because it can be your gift to them.

And it's our gift, Shae's and mine, to you.

To you.

We'll see you soon and we'll hear you soon.

And don't forget to tune into Eldercare Success on YouTube as well.

Take care.

Bye bye and stay well and off the floor.