The KineAssist is an example of how technology that was once used to study ailments is now used to help patients. Advanced brain scanning, having identified the regions responsible for balance, now diagnoses damage that affects them. Accelerometers attached to people’s ankles and wrists have been used in experiments, plotting induced falls directly into a computer for study, and are now being used to diagnose balance problems – or to detect when someone living alone has fallen and summon help.

“Over one-half of older adults who fall are unable to rise independently, and are at risk for a ‘long lie’ after a fall, especially if they live alone, which can greatly increase the clinical consequences of the falls,” says Stephen Robinovitch. He and his colleagues are working to develop wearable sensor systems that detect falls with high accuracy, as well as providing information on their causes, and on near-falls.

Researchers at the Massachusetts Institute of Technology took the “wearable” out of the equation by developing a radio wave system that detects when someone has fallen and automatically summons help. The Emerald system was shown off at the White House in 2015 but is still finding its way to a market chock-full of devices that detect falls, invariably pendants.

Not that a device needs to be high-tech to mitigate falls. Wrestlers use mats because they expect to fall; American football running backs wear pads. Given that a person over 70 is three times as likely to fall as someone younger, why don’t elderly people generally use either?

The potential benefit of cushioning is certainly there. The CDC estimates that $31 billion a year is spent on medical care for over-65s injured in falls – $10 billion for hip fractures alone (90 per cent of which are due to falls). Studies show that such pads reduce the harmful effects of falling.

‘Fall 5 – Journal of Falls’ © Dave Imms

But older people have all the vanity, inhibition, forgetfulness, wishful thinking and lack of caution that younger people have, and won’t wear pads. More are carrying canes and using walkers than before, but many more who could benefit shun them because, to them, canes and walkers imply infirmity, a fate worse than death (80 per cent of elderly women told researchers in one study that they would rather die than have to live with a debilitating hip fracture). This sets up another vicious cycle related to falling: fearing the appearance of disability, some elderly people refuse to use canes, thereby increasing their chances of falling and becoming disabled.

Padded floors would seem ideal, since they require none of the diligence of body pads or canes. But padding environments is both expensive and a technical challenge. If a flooring material has too much give, wheelchairs can’t roll and footing is compromised. That’s why nursing homes tend not to be thickly carpeted. People pick up their feet less high as they age, and so have a tendency to trip on carpets.

There are materials designed to reduce injuries from falls. Kradal is a thin honeycombed flooring from New Zealand that transmits the energy of a fall away from whatever strikes it, reducing the force. A study of the flooring in Swedish nursing homes found that while it did reduce the number of injuries when residents fell on it, they fell more frequently when walking on it, leading to a dilemma: the flooring might be causing some falls even as it reduced the severity of resulting injuries.

One unexpected piece of anti-fall technology is the hearing aid. While the inner ear’s vestibular system is maintaining balance, sound itself also seems to have a role.

“We definitely found that individuals with hearing loss had more difficulty with balance and gait, and showed significant improvement when they had a hearing aid,” says Linda Thibodeau, a professor at the University of Texas at Dallas’s Advanced Hearing Research Center, summarising a recent pilot study. “Most people don’t know about this.”

Horak agrees, saying that people who have cochlear implants to give them hearing also find their balance improves. Hearing is not as critical for balance as proprioception, vision and the vestibular system, she says, “But hearing may also contribute and we don’t understand how. We think you can use your hearing to orient yourself.”

Thibodeau says one reason it’s important to establish this link is that insurance companies don’t typically cover hearing aids, because they are seen as improving lifestyle more than sustaining basic health. Hearing aids can be expensive – up to $6,000 – but a broken hip, which insurance companies do cover, can cost five or ten times that figure, or more, and lead to profound disability or death.

More than half of people in their 70s have hearing loss, but typically wait ten to 20 years beyond the time when they could first benefit before they seek treatment. If the connection to balance and falls were better known, that delay might be reduced.

The role of hearing reminds us that, while walking is considered almost automatic, balance is at some level a cognitive act, achieved by processing a cloud of information. Pile demands on our attention and that itself can cause falls, particularly among people who are already compromised physically or cognitively.

Thibodeau once led a group of people with hearing impairments to the Dallas World Aquarium to test out wireless microphone technology in the real world. “There’s a stairway going by an enormous fish tank,” she says. “I had a participant fall on the stairs, and someone at the aquarium told me, ‘A lot of people fall going down those stairs, looking at the aquarium.’” (Asked to comment whether this indeed is a common problem there, the Dallas World Aquarium director did not reply, a reminder perhaps that the legal aspects of falls can inhibit dissemination of information about them).