Factors Affecting the Implementation, Use, and Adoption of Real-Time Location System Technology for Persons Living With Cognitive Disabilities in Long-term Care Homes: Systematic Review

Abstract

Background As the aging population continues to grow, the number of adults living with dementia or other cognitive disabilities in residential long-term care homes is expected to increase. Technologies such as real-time locating systems (RTLS) are being investigated for their potential to improve the health and safety of residents and the quality of care and efficiency of long-term care facilities. Objective The aim of this study is to identify factors that affect the implementation, adoption, and use of RTLS for use with persons living with dementia or other cognitive disabilities in long-term care homes. Methods We conducted a systematic review of the peer-reviewed English language literature indexed in MEDLINE, Embase, PsycINFO, and CINAHL from inception up to and including May 5, 2020. Search strategies included keywords and subject headings related to cognitive disability, residential long-term care settings, and RTLS. Study characteristics, methodologies, and data were extracted and analyzed using constant comparative techniques. Results A total of 12 publications were included in the review. Most studies were conducted in the Netherlands (7/12, 58%) and used a descriptive qualitative study design. We identified 3 themes from our analysis of the studies: barriers to implementation, enablers of implementation, and agency and context. Barriers to implementation included lack of motivation for engagement; technology ecosystem and infrastructure challenges; and myths, stories, and shared understanding. Enablers of implementation included understanding local workflows, policies, and technologies; usability and user-centered design; communication with providers; and establishing policies, frameworks, governance, and evaluation. Agency and context were examined from the perspective of residents, family members, care providers, and the long-term care organizations. Conclusions There is a striking lack of evidence to justify the use of RTLS to improve the lives of residents and care providers in long-term care settings. More research related to RTLS use with cognitively impaired residents is required; this research should include longitudinal evaluation of end-to-end implementations that are developed using scientific theory and rigorous analysis of the functionality, efficiency, and effectiveness of these systems. Future research is required on the ethics of monitoring residents using RTLS and its impact on the privacy of residents and health care workers.

Algorithmic harms and digital ageism in the use of surveillance technologies in nursing homes

“…There is also ample research that demonstrates the negative impact of confinement on older adults, workers, and others, including confinement related to COVID-19 (Borges-Machado et al, 2020;Steele et al, 2020;Graham, 2021). While surveillance technology can be used on an as needed basis to locate an individual who becomes lost or to enable supervised movement (e.g., escorting the individual; Wigg, 2010), a more common finding is that surveillance is more widespread and used to supplement rather than to replace confinement and use of restraints (Grigorovich et al, 2021).…”

“…In the context of COVID-19, there has been a push to adopt or repurpose these technologies to assist with digital contact tracing or to support infection and control practices (NAS, 2022). Examples include Real Time Locating Systems (RTLS), fall detection systems, activity sensors, and tracking apps (Grigorovich and Kontos, 2020;Chandonnet, 2021;Fan et al, 2021;Grigorovich et al, 2021). Increasingly, these devices employ algorithms to automate recognition of certain deviations in activities or movements and to trigger responses to preprogrammed parameters (e.g., alert triggered if resident spends too long in one spot as compared to their routine; resident approaches a virtual fence).…”

Indoor Location Data for Tracking Human Behaviours: A Scoping Review

“…Additionally, where lower-granularity RTLS sensors are used, it may be helpful to combine passive sensor modalities that do not interfere with daily living (e.g., door sensors) to augment the quality of the data and increase the depth of analyses that can be performed. Previous review literature reinforces the existence of a trade-off between implementation costs and data precision and richness [ 10 , 11 ]. The level of in-depth or basic analysis varied widely between studies and subsequently creates a variation in the applicability of study results to their target use case.…”

“…Presently, there are a small number of review papers regarding the applications of RTLS in healthcare [ 1 , 10 ]. However, these papers focus on the feasibility and user-acceptance of the technology rather than examining approaches to analyzing RTLS data to describe human movement and behaviour.…”

Real-time location systems technology in the care of older adults with cognitive impairment living in residential care: A scoping review

“…In a previous technical review, the authors identified the ways in which meaning can be extracted from RTLS data to describe human behaviors in a variety of different settings (healthcare, education, workplaces, shopping malls, art galleries) ( 11 ). We have also completed a previous systematic review to identify factors that affect the implementation of RTLS for use with persons living with dementia in long-term care homes ( 16 ). However, neither of these reviews addressed the ways in which RTLS data was being used as a clinical outcome or how the data was used to inform clinical decision-making processes.…”