Ask these four questions before comparing any products
The three architectures
| Monitored service | Smartwatch | Unmonitored alarm | |
|---|---|---|---|
| Who answers | Staffed centre, 24/7 | Emergency services, plus your contact list | Contacts only |
| Ongoing cost | Monthly fee | Cellular plan, if standalone | None |
| Escalation if unanswered | Yes, down a defined list | Calls emergency services directly on a hard fall | No |
| Works outside the home | On cellular models | Yes | Usually not |
| Wearability | Pendant, visibly medical | An ordinary watch | Pendant |
| Daily charging | Rarely | Yes, and that is the weak point | Rarely |
Picks
By situation
A monitored medical alert service
If the honest assessment is that a fall could leave someone on the floor unable to reach a phone, buy the monitored service and accept the monthly fee. It is the only architecture where a trained human being is guaranteed to be listening, and the pendant form factor requires no charging routine and no software literacy.
In Canada, TELUS Health operates the largest national medical alert service, with in-home and mobile options and optional fall detection. Local providers exist in most cities and are worth a quote.
Apple Watch
The strongest argument for it is not technical. It is that people wear it. A watch carries no signal of frailty, which means it stays on the wrist while a pendant goes in a drawer, and a device that is worn beats a better device that is not.
It detects hard falls, and if you remain immobile it places a call to emergency services and notifies your emergency contacts with your location. Apple enables the feature automatically for users over a certain age, but confirm it is on rather than assuming. On a cellular model it works away from the phone entirely.
The real weakness is the charging routine. A watch that is flat at 4am is not a safety device, so it has to become a fixed habit, charged during a daily sitting rather than overnight.
Cheap unmonitored pendants and "SOS" buttons
Marketplace listings for subscription-free alarms are abundant and mostly do one thing: dial a stored list of numbers over a SIM. When those numbers do not answer, the device has exhausted its plan. Some are simply loud buzzers with no outbound communication at all, useful only if a neighbour is within earshot.
They are not worthless. They are appropriate as a supplementary button in a bathroom, in a household where someone else is usually home. They are not appropriate as the primary safety system for a person living alone, which is exactly how they are marketed.
The thing that prevents more falls than any of this
Grab bars, removing loose rugs, lighting on the route between bed and bathroom, and a review of medications that cause dizziness or affect balance. Detection is what happens after the failure. An occupational therapist home assessment addresses the failure itself, and in most cases costs less than a year of monitoring.
Buy the alert system. Do the home assessment first.
Not medical advice. Recurrent falls are a medical finding, not just a hazard. Repeated falls warrant a physician visit to look for the cause, including blood pressure, medication interactions, inner ear disorders and neurological changes. A monitoring device is not a substitute for finding out why someone is falling.