Beyond Safety: Towards Non-Stigmatizing Mobile Emergency

Watches that Empower Older Adults

Marcia Nißen

1,2,3 a

and Simon Prinz

Chair of Digital Health Interventions, School of Medicine, University of St. Gallen, St. Gallen, Switzerland

Institute of Implementation Science in Health Care, University of Zurich, Switzerland

Centre for Digital Health Interventions, ETH Zurich, Zurich, Switzerland

Patronus (RR Technologies GmbH), Berlin, Germany

Keywords: Mobile Emergency Watches, Digital Older Adult Care, Stigmatization, Personalization.

Abstract: The ageing population presents significant challenges for healthcare systems, creating a need for innovative

digital health technologies (DHTs) to enhance autonomy, safety, and care outcomes for older adults. Mobile

emergency watches offer a modern, non-stigmatizing alternative to traditional emergency buttons, combining

mobility and functionality. This paper explores their potential to bring relief to older adults as well as over-

loaded healthcare systems by appealing to a broader audience and enabling more independent lifestyles than

traditional emergency devices and addresses three core challenges: (1) balancing simplicity and reliability

with advanced functionalities; (2) achieving equitable, personalised designs that balance non-stigmatizing

aesthetics and functionality; and (3) navigating fragmented and evolving regulatory frameworks for DHTs.

These challenges are analysed through the lens of a single case study, based on an expert interview and pub-

licly available information on a mobile emergency watch startup. The paper discusses pathways to overcome

these barriers, bridging gaps between innovation, user needs, and regulatory requirements.

1 INTRODUCTION

By 2050, nearly 1 in 4 people in Europe will be over

the age of 65 (Eurostats, 2020). Germany, which is

considered one of the five “super-aged” societies in

the world, where nearly one-third of the total popula-

tion will be over the age of 65 by 2050 (AARP,

2024a), is facing a crisis in older adult care, with de-

mand far surpassing current capacity (Haß et al.,

2024). The number of people in need of long-term

care as defined by the Long-Term Care Insurance Act

(§14 SGB XI, 2024), is expected to rise by 38% and

total approximately 6.7 million people by 2050 (Fed-

eral Statistical Office, 2023).

These changing demographics create opportuni-

ties for digital health (and care) technologies (DHTs)

that aim at improving health and care outcomes and

enhance older adults’ independence, autonomy, ac-

tivity, and safety (Chung, Brakey, Reeder, Myers, &

Demiris, 2023).

DHTs for older adults encompass a broad spec-

trum of technologies. Examples include assistive ro-

https://orcid.org/0000-0002-6082-8825

bots, AI voice assistants, smart scales, smart textiles,

and other sensors that are used for various purposes

such as health monitoring, fall detection, cognitive

games, or promoting healthy lifestyle behaviours

(Chen, Ding, & Wang, 2023). Some devices further

promise to enable more effective communication

among patients, family members, caregivers and

healthcare providers by transmitting basic vital infor-

mation or providing features that lead to better coor-

dination of care and possibly improved health out-

comes (Chen et al., 2023).

One particular type of DHTs are personal emer-

gency response systems (PERS) which are also known

as personal alarms or medical alert systems. These can

be further differentiated into stationary or mobile sys-

tems, and into whether they are activated manually by

users in case of an emergency or whether they auto-

matically trigger alerts (Goyer, 2021)if sensing devices

passively detect an emergency such as a fall (Casabona

et al., 2023). PERS can further be programmed to ei-

ther call an emergency response service centre or a per-

sonal caretaker or relative (Op den Buijs et al., 2018).

1092

Nißen, M. and Prinz, S.

Beyond Safety: Towards Non-Stigmatizing Mobile Emergency Watches that Empower Older Adults.

DOI: 10.5220/0013399800003911

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 18th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2025) - Volume 2: HEALTHINF, pages 1092-1098

ISBN: 978-989-758-731-3; ISSN: 2184-4305

Wearable emergency buttons connected to a

home station and worn as a pendant, wristband, at-

tached to a belt, or carried in a pocket have long been

the standard in older adult care. However, their sta-

tionary design is increasingly out of step with the

needs of an active, mobile, and independent ageing

population (Chen et al., 2023).

Accordingly, popular consumer smartwatches,

enhanced by custom apps and coupled with a 24/7

emergency response service subscription, are ex-

pected to be increasingly repurposed to serve as a

modern alternative to the traditional emergency but-

tons (Orlov, 2022). As “mobile emergency watches,”

these devices work wherever mobile network cover-

age or Wi-Fi is available and set up. Their inconspic-

uous and customary design could encourage earlier

and more consistent use, appealing to a broader de-

mographic and ultimately aiming to empower older

adults to maintain their active lifestyle, preserve their

autonomy and mobility, and delay care dependencies.

Despite their potential, mobile emergency watches

and similar digital health technologies face three core

challenges that must be addressed to unlock their full

potential in older adult care: (a) balancing simplicity

with advanced functionality, (b) achieving equitable,

non-stigmatizing, and personalised design, and (c) nav-

igating fragmented regulatory frameworks.

This paper explores these challenges through the

lens of a single case study based on an expert interview

and additional publicly available information on the

mobile emergency watch startup, discussing pathways

to overcome these barriers and bridge the gaps between

innovation, user needs, and regulatory requirements.

2 METHOD

This position paper aimed to capture insights and vi-

sions of Simon Prinz (hereafter referred to as inter-

view partner SP) exploring the current state, chal-

lenges, and prospects of mobile emergency watches

and DHTs for older adults.

SP is Head of Operations and Customer Success

at Patronus, headquartered in Berlin, Germany. Patro-

nus develops, sells, and operates mobile emergency

watches which look like regular smartwatches as a

“less stigmatizing, mobile and modern version to the

traditional red emergency buttons […] primarily for

older adults” (SP) by preserving their mobility, au-

tonomy, and independence, enabling them to navigate

life confidently and safely both within and beyond the

confines of their homes (Schimroszik & Müller,

2022). SP was selected as an interview partner due to

his expertise in both operational and customer success

areas, providing firsthand insights into user behav-

iour, market trends, and regulatory challenges.

Following informed consent, a semi-structured

expert interview was conducted via Zoom with SP,

lasting approximately 50 minutes. The interview

guide was structured along the following, overarching

themes (cf. Appendix): Implementation, Design Con-

siderations, Future Developments.

The automatically generated transcript of the in-

terview was checked for completeness and correct-

ness and pseudonymised by MN (18 DIN-A4 pages,

single-spaced, 11pt font size). The transcript was then

translated from German to English with DeepL and

ChatGPT 4.0 and again checked for correctness and

completeness by MN. A pragmatic thematic analysis

approach was applied, focusing on identifying key in-

sights relevant to the research scope rather than ad-

hering to a formalized qualitative methodology. MN

coded the translated interview thematically and dis-

tilled a first set of three main, central points. MN and

SP then discussed and refined these propositions, be-

fore MN drafted the first version of the manuscript

synthesizing and discussing the themes. To triangu-

late and further substantiate the interview data and the

extracted central points, MN further collected addi-

tional information and quotes from public sources

(e.g., newspaper articles, online customer reviews, le-

gal texts). Both authors reviewed and refined the final

version of the draft before submission.

Please note that SP participated in this interview

in his personal capacity. His statements do not neces-

sarily represent the official stance of Patronus but re-

flect his personal viewpoints and opinions.

3 DIGITAL OLDER ADULT CARE

3.1 “Don’t Move too far away from the

Actual Focus”: Balancing

Simplicity vs. Innovation

First, there is a delicate balance between providing

user-friendly core functionalities vs. integrating ad-

vanced features: DHTs in general and (emergency)

smartwatches in particular seem to have untapped po-

tential to evolve into multi-functional tools in older

adult care supporting social, but also cognitive and

physiological health. By integrating advanced, smart

features like health monitoring and fall recognition

(Bhattacharyya & Ghosal, 2023; Johnston, Worley,

Grimmer-Somers, Sutherland, & Amos, 2010; Ken-

nedy, 2023), cognitive stimulation training (Vinay et

al., 2024) personalised lifestyle interventions

Beyond Safety: Towards Non-Stigmatizing Mobile Emergency Watches that Empower Older Adults

1093

(Kyytsönen, Vehko, Anttila, & Ikonen, 2023), or

GenAI-powered social interactions with voice assis-

tants (Büchi, 2024), these devices could transition

from reactive tools to proactive health companions

(Yin et al., 2024).

Yet, the growing demand for additional smart fea-

tures may introduce complexity that can overwhelm

users, reduce battery life, and compromise the reliabil-

ity of emergency functions. Eventually, striking the

balance between simplicity and innovation will be crit-

ical for adoption and usability. “We’ve intentionally

kept the interface simple and robust by using a kiosk

mode. This means users can’t access standard apps,

which helps avoid confusion and ensures the crucial

emergency call features are always reliably and easily

available at the click of a button. Features that proved

too complex for older users or are not essential have

been removed to keep the device intuitive.” (SP).

For the current generation of (still) less tech-

savvy, not digital-native older adults, simplicity and

reliability are likely crucial (Chung et al., 2023): their

primary function as an emergency call tool must re-

main effective and intuitive first and foremost.

Second, older adults are a highly diverse group,

with variations in gender, care needs (in Germany as-

sessed in “care grades”), aesthetic preferences, and es-

pecially with regards to tech-savviness and (digital)

health literacy and in terms of their cognitive and phys-

ical capabilities: “[…] over 60% of our users are fe-

male. About 75% of our users have a care grade, with

care grade 2 being the most common. Around 20% are

at care grade 1, and another 20% are at care grade 3.

Very few are in care grades 4 or 5, as these users are

often in intensive care or assisted living facilities. […]

We’re also trying to reach people who aren’t in care

grades, like our parents, for instance, who might be in

their 60s or 70s and still active but want to feel safer

when, say, they go for a bike ride.” (SP)

Therefore, one-size-fits-all approaches are unlikely

to meet diverse requirements, making personalization

a critical aspect of digital older adult tech. At the same

time, distinguishing genuine emergencies from false

alarms remains a major challenge, as accidental

presses, unintentional activations, or even the use of

emergency buttons for social interaction can lead to

system inefficiencies and unnecessary emergency re-

sponses. Indeed, in the case of Patronus as well as other

PERS providers (Casabona et al., 2023), many users

are quick to repurpose the watches for non-emergency

functions, such as chatting, indicating a demand for

broader use cases: “About 20% of our users press the

emergency button at least once a month, but only 5-

10% of these are actual emergencies. The majority of

button presses are accidental or for testing the device.

[…] There are a lot of people who use the button, […]

on certain occasions like Christmas, because they

don’t have anyone else to call.” (SP)

Yet, false alarms may not only increase costs and

response times but could also lead to alarm fatigue, re-

ducing the likelihood of a rapid reaction by family

caretakers in real emergency situations (Casabona et

al., 2023).

According to SP, AI-based filtering mechanisms

and adaptive interface designs that minimize acci-

dental activations could become critical to ensuring

emergency watches remain reliable and effective:

“For instance, AI could help filter emergency calls by

identifying those that are genuine emergencies versus

accidental presses. AI also has the potential for social

engagement. For example, it could act as a conversa-

tional partner for users who feel lonely or isolated.

On the analytical side, AI could process and evaluate

usage data to identify trends, optimize demand bal-

ancing, and improve overall service delivery.” (SP)

3.2 “Don’t Dog Tag Us”: Towards

Non-Stigmatizing, Equitable Digital

Health Technology Designs for

Older Adults

Beyond trading off essential core and advanced fea-

tures, ensuring an equitable, non-stigmatizing, and

personalized design remains another pressing chal-

lenge for mobile emergency watches as they must

navigate competing demands: core functional re-

quirements, such as long battery life, robust mobile

network coverage, and GPS tracking (Yin et al.,

2024) vs. aesthetic and unobtrusive aesthetics. In-

deed, prior research found that frail older women

were more resistant to using PERS despite a per-

ceived risk of “long lies” (Porter & Ganong, 2002 as

cited in Nyman & Victor, 2014). Long lies are situa-

tions where a fallen individual remains on the ground

for extended periods, unable to summon help, leading

to complications like dehydration, hypothermia, or

rhabdomyolysis, and often resulting in long-term fear

of falling, reduced mobility, and diminished quality

of life (Kubitza, Schneider, & Reuschenbach, 2023).

Nyman and Victor (2014) concluded that low use

may be due to older people protecting their self-iden-

tity (Johnston, Grimmer-Somers, & Sutherland, 2010

as cited in Nyman & Victor, 2014), “in that using a

personal call alarm may be perceived as a symbol of

frailty and dependency”.

According to SP, for many of Patronus’ custom-

ers, this is the primary feature why they opt for their

device: “It’s incredibly important. Many customers,

or their families, choose our product specifically to

Scale-IT-up 2025 - Workshop on Scaling Up Care for Older Adults

1094

avoid the stigma of traditional emergency buttons.

We’ve heard stories of people who refused to wear

the red buttons because they felt it marked them as

frail or dependent. A more wearable and discreet de-

vice, like ours, helps users maintain a sense of nor-

malcy and dignity. For example, customers can wear

the watch while shopping without standing out as

someone who needs constant monitoring” (SP)

Indeed, ageing is often, and in various ways, stig-

matized (Nilsson, Andersson, Magnusson, & Hanson,

2024) which makes older adults reject products that

visibly label them as in need of care (Orlov, 2022):

“My grandfather […] he never wanted one of these

things, the classic device, because he didn't see him-

self as someone who now walks around with his red

button like a recognizable dog tag, like someone who

might need help because apparently he cannot watch

out for himself anymore. [A colleague’s] mother […]

had a button like that back then, but never wanted to

use it because […] she just didn't want to walk around

like that. Then what had to happen happened: she fell

somewhere, not wearing the emergency button, and

was found in the bathroom three days later.” (SP)

Generally, there seem to be two pathways to re-

ducing the stigma associated with emergency de-

vices: While some companies have opted to develop

dedicated age-inclusive devices for older adults that,

for instance, resemble fashionable jewellery, hiding

their emergency function, Patronus opted for re-pur-

posing regular smartwatches into emergency mobile

watches by equipping them with self-developed apps

that allow direct phone connections to a caretaker of

the person’s choice and/or a professional 24/7 emer-

gency call centre (Cavalry Ventures, 2022).

Indeed, since 2021 the level of wearable users

among US older adults has risen from 17.5% (Chan-

drasekaran, Katthula, & Moustakas, 2021) to approx.

35% in 2024 (AARP, 2024b). Apparently, the intro-

duction of the Apple watch and the dissemination of

smartwatches in younger generations made the devel-

opment of cool PERS wearables possible in the first

place (Orlov, 2022).

Beyond age, equitable and inclusive design

choices will need to extend to consider other features,

and interfaces that cater to users' heterogeneous

needs, abilities, and backgrounds. For instance,

Figueroa, Luo, Aguilera, and Lyles (2021) stressed

the need for feminist intersectionality in DHT design

to tackle digital health’s gender equities, especially

for women with racial or ethnic minority back-

grounds; and Nißen, Sou, and Kowatsch (2024)

stressed the need for integrating female-specific data

into human-computer interaction research. While the

majority of Patronus’ users are women, which is also

in line with prior research (Casabona et al., 2023),

specific adaptations for gendered needs in emergen-

cies are currently limited with adjustments primarily

focusing on aesthetics, such as smaller and unbulky

watch sizes and feminine colours for the wristbands.

However, feminist intersectionality in digital health

extends beyond aesthetics. Research highlights how

gendered social roles and systemic inequalities shape

access to and engagement with digital health tools

(Figueroa et al., 2021). In the context of mobile emer-

gency watches, this could mean acknowledging that

women, particularly those from racial or ethnic mi-

nority backgrounds, are more likely to be informal

caregivers, bear higher caregiving burdens, and face

digital exclusion. Indeed, according to SP, there could

be significant potential to address social roles and

gender dynamics in caregiving contexts as well as

sex-specific health risks or conditions such as osteo-

porosis. Gender-sensitive design could enhance user

engagement and health outcomes: “We’re aware of

these concepts but haven’t actively implemented them

yet. Our primary focus has been creating an alterna-

tive to the traditional emergency button that is less

stigmatizing and more appealing to older users. We

recognize there’s room for improvement, particularly

in considering gender-specific needs. For example,

women make up the majority of our users, and we’ve

taken small accommodating steps like offering addi-

tional wristband options and testing beige and gold

colour accents. But deeper considerations—like tai-

loring features to common health concerns among

older women—are areas where we could grow.” (SP)

3.3 Regulatory Frameworks Lag

Behind Innovation

Finally, beyond design considerations, regulatory

frameworks present significant constraints and op-

portunities: Germany is a leader in leveraging digital

technology to accommodate a healthier and more en-

gaged older population (AARP, 2024a). As part of a

broader effort to improve healthcare services to the

population, Germany introduced the Digital

Healthcare Act (German: Digitale-Versorgungs-Ge-

setz, DVG) in 2019. With the DVG, Germany was the

first country in the world to introduce “digital health

apps on prescription" (Gerke, Stern, & Minssen,

2020; Schmidt, Pawlitzki, Renard, Meuth, &

Masanneck, 2024; Stern et al., 2022), a concept, com-

monly referred to as DiGA (short for German: “Digi-

tale Gesundheitsanwendung”, English: “digital health

application”). By December 2024, there were 56 Di-

GAs listed, 36 of which were permanent and 20 of

Beyond Safety: Towards Non-Stigmatizing Mobile Emergency Watches that Empower Older Adults

1095

which were pilot projects (Federal Institute for Drugs

and Medical Devices, 2024).

In 2021, as part of the Digital Health and Care

Modernization Act (German: Digitale-Versorgungs-

und-Pflege-Modernisierungs-Gesetz, DVPMG), Ger-

many broadened the concept to also encompass “dig-

ital (long-term) care applications” (German: “Digi-

tale Pflegeanwendung”) or short “DiPAs”. However,

as of autumn 2024, no DiPA has been listed in the

DiPA registry yet (Rybicki, 2024).

While the DVPMG was intended to establish a re-

imbursement pathway for digital tools in long-term

care, but in practice, its implementation has been

slow, leaving many innovative solutions—such as

mobile emergency watches—without a clear regula-

tory framework for integration into the healthcare

system. Indeed, Patronus has not (yet) filed an appli-

cation for their mobile emergency watch to be listed

as a DiPA, as regulatory requirements are difficult to

fulfil and expensive (Hartung, 2024). However, per-

sonal emergency call devices are, generally speaking,

part of the German Care Aid Directory (German:

Pflegehilfsmittelverzeichnis), a list curated by the

Federal Institute of Drugs and Medical Devices and

reimbursed via people’s statutory long-term care in-

surance: “Technically, our device falls under the care

aid directory, which outlines the devices eligible for

reimbursement by health insurance. However, the di-

rectory was created decades ago, probably back in

the 1950s or so, and only includes classic, stationary

[emergency] devices with old-school [stigmatizing]

wearables that do not function when you are a few

meters too far from their base stations. […] We’ve

been […] accepted as an equivalent, even though the

directory still specifies certain criteria, like having a

base station, which our device doesn’t need, […] it is

designed to be mobile. […] Our product essentially

fits the same purpose, but this isn’t universally recog-

nized. Some insurers won’t cover it, leaving users to

pay out of pocket.” (SP)

Overall, the current regulatory landscape in Ger-

many, where mobile emergency watches exist in a

stopgap area, illustrates the need for modernization.

Closing this regulatory gap will be essential to sup-

port innovation in care technologies: “We hope to ei-

ther change the existing category criteria or create a

new category for mobile emergency devices in the

next year.” (SP)

4 CONCLUSIONS

Ageing does not mean giving up on modernity—older

adults want technology that is both functional and

fashionable, too (Orlov, 2022). At the same time,

tech-savviness and interest in digital health to main-

tain an active life are increasing in older adults

(AARP, 2024b).

This paper highlights the potential of mobile

emergency watches as a non-stigmatizing and more

broadly appealing alternative to classic emergency

buttons, designed to reach a wider range of users ear-

lier in life. By preserving older adults' self-identity,

freedom, and dignity, these devices are more likely to

be adopted and worn consistently, contributing to bet-

ter prevention of emergencies and delays in care de-

pendency, which, in turn, has the potential to reduce

the burden on the long-term care system.

To this end, three key challenges were critically

discussed:

• Balancing Simplicity with Advanced Function-

alities: Older adults prioritize reliability, yet

emerging features like fall detection, cognitive

training, or AI-powered assistants may enhance

long-term adoption and engagement. Ensuring

that devices remain intuitive, accessible, and low-

complexity while integrating meaningful smart

features will be crucial.

• Addressing Aesthetic and Functional Design

Trade-Offs: Reducing stigma requires more than

cosmetic changes. Mobile emergency watches

should not only be discreet in appearance but also

integrate gender-sensitive and inclusive features

that reflect diverse user needs, caregiving roles,

and digital health disparities.

• Navigating Outdated Regulatory Frameworks:

Mobile emergency watches remain in a regulatory

grey area, caught between DiPA inaction and out-

dated classifications in the German Care Aid Di-

rectory. Until regulatory pathways evolve to sup-

port modern, mobile emergency solutions, users

will face partial reimbursements or out-of-pocket

costs, limiting broader accessibility.

While the single-case approach provides valuable

insights, it limits the generalizability of findings.

Broader studies across diverse user populations,

PERS providers, and regulatory environments are

needed to validate these conclusions and refine strat-

egies for future development.

Nonetheless, the findings contribute to the grow-

ing discourse on how digital health technologies can

meet the evolving needs of ageing societies, empha-

sizing the importance of innovation that is equitable,

user-centred, and supported by clear regulatory

frameworks.

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1096

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APPENDIX

Interview Guide

The interview will be conducted as a semi-structured Inter-

view. For this reason, the questions listed below are not con-

clusive, and further questions or more in-depth questions can

be asked.

I Implementation

• What are/is the primary digital health technologies of-

fered by Patronus?

• What is your main goal of offering your DHT (new reve-

nue streams, cost-efficiency, improving older adult care,

customer loyalty, …)?

• How does your watch address and excel in meeting the

unique challenges of older adult care?

• What role do emerging technologies (e.g., AI, IoT) play

for your device?

• What challenges have you encountered in scaling your

watch?

• How does your business ecosystem look like?

• …

II Design Considerations

• Have you implemented specific design considerations/con-

cepts in the development of your technology for older

adults (e.g., value-sensitive design, ethics by design, etc.)?

• What steps does Patronus take to ensure equitable access

to care?

• Have you observed any sex or gender-specific barriers to

accessing digital health solutions?

• To what extent are your solutions personalized to account

for gender-related health needs?

• Are there conditions or health issues among older women

that you feel are underserved by current digital health tech-

nologies?

• Do you generally see a market for sex- and gender-specific

digital older adult care technologies?

III Future Directions

• How do you see the role of Patronus Health evolving in the

digital health space over the next 5-10 years, particularly

regarding gender-inclusive innovations?

• What advice would you offer to researchers and practition-

ers aiming to design and implement inclusive digital health

technologies?

• …

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