Attitudes and expectations of technologies to manage wandering behavior in persons with dementia

Abstract

Purpose Wandering is aimless or repetitive locomotion that may expose persons with dementia to falls, injuries, elopement, and untimely death. Using data from focus groups, this study obtained opinions on the potential effectiveness of existing technologies for managing wandering in persons with dementia living in the community, and on the elements that such technologies should possess from the user's perspective. Design & Methods Cross-disciplinary, consensus-based analysis was applied to data from 6 focus groups consisting of 7 elderly nursing home residents, 7 caregivers of persons with dementia, 9 home healthcare staff, 7 long term care staff, 7 medical surgical staff caring for dementia patients, and 6 engineers working in rehabilitation settings. Each group received a briefing on available technology for wanderer monitoring systems and elopement management systems. Results Participants in all groups wanted flexible systems that would allow for a normal daily life, accommodate to changes over time, and be inexpensive. Inside the home, motion detectors and weight-sensitive mats by doors were preferred over camouflage and other visual deterrents; outside, Global Positioning System based elopement management was preferred. For both technologies, ranges and sensitivities must be programmable and changeable as environmental and human conditions warrant. Policy Implications 60% or more of the 4.5 million Americans with Alzheimer's disease will wander and wandering predicts nursing home entry. The need for effective technologies to manage wandering in home and formal care settings is underscored by the high cost of nursing home care on the caregiver, his or her family, and government healthcare organizations. These technologies promise to delay nursing home entry and improve care but they must perform reliably, simply, effectively and inexpensively.

Ethical and practical concerns of surveillance technologies in residential care for people with dementia or intellectual disabilities: an overview of the literature

“…Practical problems in these studies included removal of the device by the resident (Blackburn, 1988;Kearns et al, 2007), system misses and false alarms (Chen et al, 2007;Schikhof and Mulder, 2008), a power failure or refusal by the resident . S A F E T Y / R I S K S Many articles mention in passing that surveillance technologies could lead to a reduction of serious incidents or increased safety, but frequently they do not substantiate this claim (Marr, 1989;Futrell and Melillo, 2002;Welsh et al, 2003;Nelson et al, 2004;Mental Welfare Commission Scotland (MWCS), 2005;Sävenstedt et al, 2006;Robinson et al, 2007b;; Table 1.…”

“…S A F E T Y / R I S K S Many articles mention in passing that surveillance technologies could lead to a reduction of serious incidents or increased safety, but frequently they do not substantiate this claim (Marr, 1989;Futrell and Melillo, 2002;Welsh et al, 2003;Nelson et al, 2004;Mental Welfare Commission Scotland (MWCS), 2005;Sävenstedt et al, 2006;Robinson et al, 2007b;; Table 1. Central themes and subthemes on effectiveness and acceptability of surveillance technologies in residential care for people with dementia and ID as covered in the literature EFFICACY Aud 2004;Blackburn, 1988;Bharucha et al, 2009;Gaffney, 1986;Kearns et al, 2007;McShane et al, 1998;Miskelly, 2004;Negley et al, 1990;Nijhof et al, 2009;Robinson et al, 2006Schikhof and Mulder, 2008;Topo, 2009 DUTY OF CARE VS.…”

The development of safer walking technology: a review

“…However, this cannot be said of the technology described in studies 7+8, and these studies would benefit considerably from a more in-depth consideration of the views and preferences of people with dementia. It is argued by Kearns et al (2007) that in order to achieve this companies need to work closely with both people with dementia and their carers to ensure devices meet their actual needs. This joint working was precisely what is being described in study 13 and through the study McCabe and Innes (2013) were able to show that assistive technology and in particular GPS tracking was of interest to potential users and that they were enthusiastic about the potential benefits to their lives.…”

GPS Devices for Elopement of People With Autism and Other Developmental Disabilities: A Review of the Published Literature

“…The limitations of the functionality of a range of devices have been highlighted; for example, the coverage (especially in rural areas), portability, reliability, range, size, ease of use, natural barriers and obstructions in the environment, availability and reliability of electronic networks, the need for multiple pieces of equipment, attenuation from clothing or other worn items, electronic interference, the need for regular testing, battery replacement, the involvement of a service center, and finally, the need in some cases to recognize that a person has in fact eloped (see Altus et al, ; Bantry White et al, ; Baptiste et al, ; Faucounau et al, ; Hodgkinson et al, ; Kearns et al, ; McShane et al, ; Miskelly, ; National Autism Association, ; Niemeijer & Hertogh, ; Niemeijer et al, ; Perry et al, ; Rasquin, Willems, de Vlieger, Geers, & Soede, ; University of Toronto, ; Williams et al, ).…”

“…There is discussion in the emerging literature of the risk of GPS and other monitoring devices taking the place of appropriate and necessary support and intervention for people who are prone to elope: the “peace of mind” and “day‐to‐day convenience” effect of monitoring devices (Bantry White et al, ; Baptiste et al, ; Eltis, ; Harada et al, ; Landau, Auslander, Werner, Shoval, & Heinik, ), reducing reliance upon human caregiving (Alisky, ; Dunk et al, ; Kearns et al, ; Landau et al, ; Niemeijer et al, ; Perry et al, ), distraction of organizations from the need to provide adequate staff training (Niemeijer et al, ), carers feeling more confident, and comfortable in their role (Altus et al, ) and thus not directly attending to the needs of the person (Hughes & Louw, ). The devices could also contribute to a false sense of security, so‐called risk compensation (Bantry White et al, ; Eltis, ; McShane et al, ).…”