Unsupervised Keypoints for Real-Time Fall Detection: Comparative Analysis Under Real-world Conditions with Predictive Bandwidth Reduction

Falls among older adults are a major safety and health-systems challenge, yet continuous in-person monitoring is difficult to sustain across home and clinical care settings. Video-based monitoring can capture fall-relevant motion, but scalable real-time deployment is limited by privacy, compute, and bandwidth constraints, and existing keypoint-based methods typically rely on supervised or anatomical pose representation, which is vulnerable to occlusion and partial body visibility. We propose a fall-monitoring framework that replaces continuous video transmission with compact motion representations, using unsupervised keypoints which are extracted locally, and a variational recurrent model is used to forecast motion at the staff end, followed by fall classification. We evaluate the framework on the UR Fall and Human Fall datasets under random, subject-disjoint, and occlusion-based splits to systematically characterize when each representation has an advantage. We find that random splits do not discriminate between representations, and under subject-disjoint evaluation no uniform advantage emerges; performance varies across held-out subjects with their visual characteristics. Under occlusion, however, unsupervised keypoints substantially outperform supervised keypoints, retaining strong detection sensitivity where supervised keypoints miss approximately half of falls; this advantage reflects their anatomical independence and persists under bandwidth-constrained prediction. The unsupervised detector also requires roughly two orders of magnitude less computation, supporting privacy-preserving, bandwidth-aware, always-on fall monitoring.