Identifying Mobility Types in Cognitively Heterogeneous Older Adults Based on GPS-Tracking: What Discriminates Best?

Person-Environment Exchange Processes in Transition into Dementia: A Scoping Review

BACKGROUND AND OBJECTIVES

The important role that the environment plays in the lives of older people is widely acknowledged. To date, little is known about person-environment processes during the early stages of dementia. This scoping review aims to provide an overview of the processes involved during early dementia and the relationship to different dimensions of their life space.

RESEARCH DESIGN AND METHODS

A scoping review was conducted according to the Johanna Briggs Institute Manual, which involved searching for research on early dementia and the environment across 3 databases.

RESULTS

A total of 1,358 records were screened, with 284 sources included in the first categorization of the diverse relationships that exist between the environment and the person living with early dementia. Finally, 102 sources were selected that describe person-environment exchange processes of agency, belonging, or stress. People living with dementia actively shape, use, seek out, and avoid their environment as a reaction to both declining abilities and environmental barriers. Specifically, feelings of connectedness and familiarity are important.

DISCUSSION AND IMPLICATIONS

Taking both an environmental gerontology perspective and a processual, that is, transition perspective broadens the understanding of the experience and behavior of people living with early dementia. They constantly interact with and shape their environment and desire a sense of belonging. This sense of belonging might be threatened by dementia but can be actively reinforced by people living with dementia. These person-environment processes and their dynamics over time should be further investigated. Especially, quantitative data and data on socioeconomic environments are lacking.

The role of geographic information system and global positioning system in dementia care and research: a scoping review

Background

Geographic Information System (GIS) and Global Positioning System (GPS), vital tools for supporting public health research, provide a framework to collect, analyze and visualize the interaction between different levels of the health care system. The extent to which GIS and GPS applications have been used in dementia care and research is not yet investigated. This scoping review aims to elaborate on the role and types of GIS and GPS applications in dementia care and research.

Methods

A scoping review was conducted based on Arksey and O’Malley’s framework. All published articles in peer-reviewed journals were searched in PubMed, Scopus, and Web of Science, subject to involving at least one GIS/GPS approach focused on dementia. Eligible studies were reviewed, grouped, and synthesized to identify GIS and GPS applications. The PRISMA standard was used to report the study.

Results

Ninety-two studies met our inclusion criteria, and their data were extracted. Six types of GIS/GPS applications had been reported in dementia literature including mapping and surveillance (n = 59), data preparation (n = 26), dementia care provision (n = 18), basic research (n = 18), contextual and risk factor analysis (n = 4), and planning (n = 1). Thematic mapping and GPS were most frequently used techniques in the dementia field.

Conclusions

Even though the applications of GIS/GPS methodologies in dementia care and research are growing, there is limited research on GIS/GPS utilization in dementia care, risk factor analysis, and dementia policy planning. GIS and GPS are space-based systems, so they have a strong capacity for developing innovative research based on spatial analysis in the area of dementia. The existing research has been summarized in this review which could help researchers to know the GIS/GPS capabilities in dementia research.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12942-022-00308-1.

Wearable and Portable GPS Solutions for Monitoring Mobility in Dementia: A Systematic Review

Dementia is the most common neurodegenerative disorder globally. Disease progression is marked by declining cognitive function accompanied by changes in mobility. Increased sedentary behaviour and, conversely, wandering and becoming lost are common. Global positioning system (GPS) solutions are increasingly used by caregivers to locate missing people with dementia (PwD) but also offer a non-invasive means of monitoring mobility patterns in PwD. We performed a systematic search across five databases to identify papers published since 2000, where wearable or portable GPS was used to monitor mobility in patients with common dementias or mild cognitive impairment (MCI). Disease and GPS-specific vocabulary were searched singly, and then in combination, identifying 3004 papers. Following deduplication, we screened 1972 papers and retained 17 studies after a full-text review. Only 1/17 studies used a wrist-worn GPS solution, while all others were variously located on the patient. We characterised the studies using a conceptual framework, finding marked heterogeneity in the number and complexity of reported GPS-derived mobility outcomes. Duration was the most frequently reported category of mobility reported (15/17), followed by out of home (14/17), and stop and trajectory (both 10/17). Future research would benefit from greater standardisation and harmonisation of reporting which would enable GPS-derived measures of mobility to be incorporated more robustly into clinical trials.

Wearable GPS and Accelerometer Technologies for Monitoring Mobility and Physical Activity in Neurodegenerative Disorders: A Systematic Review

Neurodegenerative disorders (NDDs) constitute an increasing global burden and can significantly impair an individual's mobility, physical activity (PA), and independence. Remote monitoring has been difficult without relying on diaries/questionnaires which are more challenging for people with dementia to complete. Wearable global positioning system (GPS) sensors and accelerometers present a cost-effective and noninvasive way to passively monitor mobility and PA. In addition, changes in sensor-derived outcomes (such as walking behaviour, sedentary, and active activity) may serve as potential biomarkers of disease onset, progression, and response to treatment. We performed a systematic search across four databases to identify papers published within the past 5 years, in which wearable GPS or accelerometers were used to monitor mobility or PA in patients with common NDDs (Parkinson's disease, Alzheimer's disease, motor neuron diseases/amyotrophic lateral sclerosis, vascular parkinsonism, and vascular dementia). Disease and technology-specific vocabulary were searched singly, and then in combination, identifying 4985 papers. Following deduplication, we screened 3115 papers and retained 28 studies following a full text review. One study used wearable GPS and accelerometers, while 27 studies used solely accelerometers in NDDs. GPS-derived measures had been validated against current gold standard measures in one Parkinson's cohort, suggesting that the technology may be applicable to other NDDs. In contrast, accelerometers are widely utilised in NDDs and have been operationalised in well-designed clinical trials.

Relationship Between Life-Space Mobility and Health Characteristics in Older Adults Using Global Positioning System Watches

This study aimed to examine the feasibility of using global positioning system (GPS) watches to examine relationships between GPS-based life-space mobility (LSM) metrics and self-report LSM and health measures (physical, psychological, and cognitive function) among older adults. Thirty participants wore a Fitbit Surge for 3 days. Eight spatial and temporal LSM measures were derived from GPS data. About 90% of in-home movement speeds were zero, indicating the sedentary lifestyle, but they made some active out-of-home trips as the total distance traveled and size of movement area indicated. There was a significant difference in total distance traveled and 95th percentile of movement speed between mild cognitive and intact cognition groups. GPS-based higher proportion of out-of-home time was significantly associated with greater functional fitness. Greater GPS use hours were significantly associated with higher cognition. These findings suggest the potential of GPS watches to continuously monitor changes in functional health to inform prevention efforts.

Assessment of Social Behavior Using a Passive Monitoring App in Cognitively Normal and Cognitive Impaired Older Adults: an Observational Study (Preprint)

Background

In people with cognitive impairment, loss of social interactions has a major impact on well-being. Therefore, patients would benefit from early detection of symptoms of social withdrawal. Current measurement techniques such as questionnaires are subjective and rely on recall, in contradiction to smartphone apps, which measure social behavior passively and objectively.

Objective

This study uses the remote monitoring smartphone app Behapp to assess social behavior, and aims to investigate (1) the association between social behavior, demographic characteristics, and neuropsychiatric symptoms in cognitively normal (CN) older adults, and (2) if social behavior is altered in cognitively impaired (CI) participants. In addition, we explored in a subset of individuals the association between Behapp outcomes and neuropsychiatric symptoms.

Methods

CN, subjective cognitive decline (SCD), and CI older adults installed the Behapp app on their own Android smartphone for 7 to 42 days. CI participants had a clinical diagnosis of mild cognitive impairment (MCI) or Alzheimer-type dementia. The app continuously measured communication events, app use and location. Neuropsychiatric Inventory (NPI) total scores were available for 20 SCD and 22 CI participants. Linear models were used to assess group differences on Behapp outcomes and to assess the association of Behapp outcomes with the NPI.

Results

We included CN (n=209), SCD (n=55) and CI (n=22) participants. Older cognitively normal participants called less frequently and made less use of apps (P<.05). No sex effects were found. Compared to the CN and SCD groups, CI individuals called less unique contacts (β=–0.7 [SE 0.29], P=.049) and contacted the same contacts relatively more often (β=0.8 [SE 0.25], P=.004). They also made less use of apps (β=–0.83 [SE 0.25], P=.004). Higher total NPI scores were associated with further traveling (β=0.042 [SE 0.015], P=.03).

Conclusions

CI individuals show reduced social activity, especially those activities that are related to repeated and unique behavior, as measured by the smartphone app Behapp. Neuropsychiatric symptoms seemed only marginally associated with social behavior as measured with Behapp. This research shows that the Behapp app is able to objectively and passively measure altered social behavior in a cognitively impaired population.

Inferring Destinations and Activity Types of Older Adults From GPS Data: Algorithm Development and Validation

Background

Outdoor mobility is an important aspect of older adults’ functional status. GPS has been used to create indicators reflecting the spatiotemporal dimensions of outdoor mobility for applications in health and aging. However, outdoor mobility is a multidimensional construct. There is, as of yet, no classification algorithm that groups and characterizes older adults’ outdoor mobility based on its semantic aspects (ie, mobility intentions and motivations) by integrating geographic and domain knowledge.

Objective

This study assesses the feasibility of using GPS to determine semantic dimensions of older adults’ outdoor mobility, including destinations and activity types.

Methods

A total of 5 healthy individuals, aged 65 years or older, carried a GPS device when traveling outside their homes for 4 weeks. The participants were also given a travel diary to record details of all excursions from their homes, including date, time, and destination information. We first designed and implemented an algorithm to extract destinations and infer activity types (eg, food, shopping, and sport) from the GPS data. We then evaluated the performance of the GPS-derived destination and activity information against the traditional diary method.

Results

Our results detected the stop locations of older adults from their GPS data with an F1 score of 87%. On average, the extracted home locations were within a 40.18-meter (SD 1.18) distance of the actual home locations. For the activity-inference algorithm, our results reached an F1 score of 86% for all participants, suggesting a reasonable accuracy against the travel diary recordings. Our results also suggest that the activity inference’s accuracy measure differed by neighborhood characteristics (ie, Walk Score).

Conclusions

We conclude that GPS technology is accurate for determining semantic dimensions of outdoor mobility. However, further improvements may be needed to develop a robust application of this system that can be adopted in clinical practice.

GPS mobility as a digital biomarker of negative symptoms in schizophrenia: a case control study

Mobility is an important correlate of physical, cognitive, and mental health in chronic illness, and can be measured passively with mobile phone global positional satellite (GPS) sensors. To date, GPS data have been reported in a few studies of schizophrenia, yet it is unclear whether these data correlate with concurrent momentary reports of location, vary by people with schizophrenia and healthy comparison subjects, or associate with symptom clusters in schizophrenia. A total of 142 participants with schizophrenia (n = 86) or healthy comparison subjects (n = 56) completed 7 days of ecological momentary assessment (EMA) reports of location and behavior, and simultaneous GPS locations were tracked every five minutes. We found that GPS-derived indicators of average distance travelled overall and distance from home, as well as percent of GPS samples at home were highly correlated with EMA reports of location at the day- and week-averaged level. GPS-based mobility indicators were lower in schizophrenia with medium to large effect sizes. Less GPS mobility was related to greater negative symptom severity, particularly diminished motivation, whereas greater GPS mobility was weakly associated with more community functioning. Neurocognition, depression, and positive symptoms were not associated with mobility indicators. Therefore, passive GPS sensing could provide a low-burden proxy measure of important outcomes in schizophrenia, including negative symptoms and possibly of functioning. As such, passive GPS sensing could be used for monitoring and timely interventions for negative symptoms in young persons at high risk for schizophrenia.

Assessing Older Adults' Daily Mobility: A Comparison of GPS-Derived and Self-Reported Mobility Indicators

Interest in global positioning system (GPS)-based mobility assessment for health and aging research is growing, and with it the demand for validated GPS-based mobility indicators. Time out of home (TOH) and number of activity locations (#ALs) are two indicators that are often derived from GPS data, despite lacking consensus regarding thresholds to be used to extract those as well as limited knowledge about their validity. Using 7 days of GPS and diary data of 35 older adults, we make the following three main contributions. First, we perform a sensitivity analysis to investigate how using spatial and temporal thresholds to compute TOH and #ALs affects the agreement between self-reported and GPS-based indicators. Second, we show how daily self-reported and GPS-derived mobility indicators are compared. Third, we explore whether the type and duration of self-reported activity events are related to the degree of correspondence between reported and GPS event. Highest indicator agreement was found for temporal interpolation (Tmax) of up to 5 h for both indicators, a radius (Dmax) to delineate home between 100 and 200 m for TOH, and for #ALs a spatial extent (Dmax) between 125 and 200 m, and temporal extent (Tmin) between 5 and 6 min to define an activity location. High agreement between self-reported and GPS-based indicators is obtained for TOH and moderate agreement for #ALs. While reported event type and duration impact on whether a reported event has a matching GPS event, indoor and outdoor events are detected at equal proportions. This work will help future studies to choose optimal threshold settings and will provide knowledge about the validity of mobility indicators.

Towards a comprehensive set of GPS-based indicators reflecting the multidimensional nature of daily mobility for applications in health and aging research

BACKGROUND

GPS tracking is increasingly used in health and aging research to objectively and unobtrusively assess individuals' daily-life mobility. However, mobility is a complex concept and its thorough description based on GPS-derived mobility indicators remains challenging.

METHODS

With the aim of reflecting the breadth of aspects incorporated in daily mobility, we propose a conceptual framework to classify GPS-derived mobility indicators based on their characteristic and analytical properties for application in health and aging research. In order to demonstrate how the classification framework can be applied, existing mobility indicators as used in existing studies are classified according to the proposed framework. Then, we propose and compute a set of selected mobility indicators based on real-life GPS data of 95 older adults that reflects diverse aspects of individuals' daily mobility. To explore latent dimensions that underlie the mobility indicators, we conduct a factor analysis.

RESULTS

The proposed framework enables a conceptual classification of mobility indicators based on the characteristic and analytical aspects they reflect. Characteristic aspects inform about the content of the mobility indicator and comprise categories related to space, time, movement scope, and attribute. Analytical aspects inform how a mobility indicator is aggregated with respect to temporal scale and statistical property. The proposed categories complement existing studies that often underrepresent mobility indicators involving timing, temporal distributions, and stop-move segmentations of movements. The factor analysis uncovers the following six dimensions required to obtain a comprehensive view of an older adult's daily mobility: extent of life space, quantity of out-of-home activities, time spent in active transport modes, stability of life space, elongation of life space, and timing of mobility.

CONCLUSION

This research advocates incorporating GPS-based mobility indicators that reflect the multi-dimensional nature of individuals' daily mobility in future health- and aging-related research. This will foster a better understanding of what aspects of mobility are key to healthy aging.

Development of a Sensor-Based Behavioral Monitoring Solution to Support Dementia Care

Background

Mobile and wearable technology presents exciting opportunities for monitoring behavior using widely available sensor data. This could support clinical research and practice aimed at improving quality of life among the growing number of people with dementia. However, it requires suitable tools for measuring behavior in a natural real-life setting that can be easily implemented by others.

Objective

The objectives of this study were to develop and test a set of algorithms for measuring mobility and activity and to describe a technical setup for collecting the sensor data that these algorithms require using off-the-shelf devices.

Methods

A mobility measurement module was developed to extract travel trajectories and home location from raw GPS (global positioning system) data and to use this information to calculate a set of spatial, temporal, and count-based mobility metrics. Activity measurement comprises activity bout extraction from recognized activity data and daily step counts. Location, activity, and step count data were collected using smartwatches and mobile phones, relying on open-source resources as far as possible for accessing data from device sensors. The behavioral monitoring solution was evaluated among 5 healthy subjects who simultaneously logged their movements for 1 week.

Results

The evaluation showed that the behavioral monitoring solution successfully measures travel trajectories and mobility metrics from location data and extracts multimodal activity bouts during travel between locations. While step count could be used to indicate overall daily activity level, a concern was raised regarding device validity for step count measurement, which was substantially higher from the smartwatches than the mobile phones.

Conclusions

This study contributes to clinical research and practice by providing a comprehensive behavioral monitoring solution for use in a real-life setting that can be replicated for a range of applications where knowledge about individual mobility and activity is relevant.

Location monitoring of physical activity and participation in community dwelling older people: a scoping review

Background: Community participation and physical activity are important for the health of older adults. This review aimed to identify studies which have measured physical activity and community participation in older adults using Global positioning systems.Materials and methods: This scoping review searched key databases using predetermined subject headings and keywords. Two independent reviewers selected studies based on a systematic procedure following current guidelines. Inclusion criteria for studies were: participants aged over 50 years living independently in the community that reported on physical activity and/or participation inclusive of physical and social activity, and including a quantitative measure of location. All searches were limited to English. The primary review question was; "What studies have monitored the location of physical activity in an older population?" with secondary enquiries investigating the types of global positioning system devices, barriers and facilitators for activity and community participation.Results: The search returned 3723 articles (following duplicate removal) and 45 met the inclusion criteria. Studies from 12 countries published over a 12-year period were included. Participants were mainly healthy (n = 23) followed by having a cognitive impairment (n = 10). There were 14 different global positioning system devices used, assessing a variety of outcomes (n = 24). Seventeen studies identified facilitators and barriers to participation and physical activity in an older population. The most common facilitators were safety, weather and access to multi-purpose facilities. The most common barriers were weather, safety, low income/high deprivation areas and use of motor vehicles.Conclusion: This scoping review identified a variety of locational monitoring of older people using global positioning devices. Global positioning systems are a valuable tool to obtain accurate activity locations of older people. There is a need for clear guidelines regarding the use of global positioning system devices and specified outcomes in primary research to enable comparison across studies.Implications for rehabilitationPhysical activity and community participation are vital for healthy ageing.The environment can act as a facilitator or barrier to physical activity and community participation for older adults.Interventions need to target facilitators (weather, safety, facility access and social components) to maximize physical activity and community participation in older people.Interventions should be designed to reduce the barriers (weather, safety, low income and motor vehicle dependency) that prevent older adults from actively participating in their community.

Profiles of Subjective Well-being in Patients with Chronic Back Pain: Contrasting Subjective and Objective Correlates

OBJECTIVE

The detrimental impact of nonspecific chronic low back pain (CLBP) on quality of life is well known. However, patients with CLBP represent a remarkably heterogeneous group, and not all of them report compromised well-being.

METHODS

In this study, we investigated this heterogeneity by identifying profiles (or clusters) of well-being and their correlates in 239 CLBP patients. To take the multidimensionality of subjective well-being into account, we included multiple well-being indicators (depression, anxiety, affective distress, perceived control over life). For an in-depth characterization of the well-being profiles, we assessed 1) sociodemographic indicators (age, gender, education, marital status, occupational status), 2) pain-related measures (pain intensity, subjective and objective pain disability, number of pain locations), 3) psychosocial resources (mental health, resilience, perceived support), 4) biographical factors (trauma), and 5) somatosensory profiles based on quantitative sensory testing.

RESULTS

Based on two-step cluster analysis, we identified three distinct well-being profiles, characterized by either generally high well-being (cluster 1, n = 51), moderate well-being (cluster 2, n = 104), or consistently low well-being (cluster 3, n = 77), respectively. Most differences between the derived well-being profiles regarding sociodemographic, psychosocial, and biographical measures were of weak to moderate effect size. Larger effect sizes were observed for differences in pain intensity and subjective, but not objective, pain disability. Finally, the largest effects were found for differences in psychosocial resources.

CONCLUSIONS

Our findings suggest that not only in nonclinical samples, but also in patients with chronic pain, well-being is more closely associated with psychological resources and subjective evaluations than with objective parameters.

Who is informed and who uninformed? Addressing the legal barriers to progress in dementia research and care

Conduct of research is an essential tool for the evaluation and improvement of health services. In Israel, research on persons with dementia is very limited, with the largest portion of such research involving a few surveys and examining risk factors for dementia. Very few studies describe clinical research, and those that do either include participants at early stages of dementia, or rely completely on caregivers' perceptions and experiences, often without reference to any individual with dementia. This dearth of research is due, to a substantial extent, to Ministry of Health regulations which do not permit family proxy consent for research involving persons with dementia. Alternative models for regulation of consent for research exist in other countries, including the U.S., and these allow for proxy consent under certain conditions. This paper presents such a model and its underlying ethical principles. It contends that the current state of affairs, which stands in the way of clinical research concerning persons with advanced dementia, is contrary to the interests of such persons, their caregivers, and Israeli society. Therefore, this paper calls for a change in the present regulations and/or law in the cause of advancing knowledge and improving care for persons with dementia.

Predictors of Daily Mobility of Adults in Peri-Urban South India

Daily mobility, an important aspect of environmental exposures and health behavior, has mainly been investigated in high-income countries. We aimed to identify the main dimensions of mobility and investigate their individual, contextual, and external predictors among men and women living in a peri-urban area of South India. We used 192 global positioning system (GPS)-recorded mobility tracks from 47 participants (24 women, 23 men) from the Cardiovascular Health effects of Air pollution in Telangana, India (CHAI) project (mean: 4.1 days/person). The mean age was 44 (standard deviation: 14) years. Half of the population was illiterate and 55% was in unskilled manual employment, mostly agriculture-related. Sex was the largest determinant of mobility. During daytime, time spent at home averaged 13.4 (3.7) h for women and 9.4 (4.2) h for men. Women's activity spaces were smaller and more circular than men's. A principal component analysis identified three main mobility dimensions related to the size of the activity space, the mobility in/around the residence, and mobility inside the village, explaining 86% (women) and 61% (men) of the total variability in mobility. Age, socioeconomic status, and urbanicity were associated with all three dimensions. Our results have multiple potential applications for improved assessment of environmental exposures and their effects on health.

Design Recommendations for Recreational Systems Involving Older Adults Living With Dementia

As the population ages, an increasing number of people will be diagnosed with dementia. Studies have found that insufficient activities are offered in memory care units to people with dementia, even though people benefit tremendously from participating in recreational activities. Information and communication technologies (ICT) can potentially facilitate activities in this setting, yet there is little guidance for designers to develop systems that can support people with dementia in engaging in recreational activities. To fill this gap, recommendations were generated through fieldwork and refined in two rounds of expert feedback. Areas covered include hardware, content, applications, and navigation. Systems should be usable by people with dementia, in addition to staff, to counter disempowerment by not enabling people to use their full abilities. In addition, a diversity of materials is needed to appeal to individuals with dementia who have widely varying backgrounds, abilities, interests, and preferences.

Generating GPS activity spaces that shed light upon the mobility habits of older adults: a descriptive analysis

Background

Measuring mobility is critical for understanding neighborhood influences on older adults’ health and functioning. Global Positioning Systems (GPS) may represent an important opportunity to measure, describe, and compare mobility patterns in older adults.

Methods

We generated three types of activity spaces (Standard Deviation Ellipse, Minimum Convex Polygon, Daily Path Area) using GPS data from 95 older adults in Vancouver, Canada. Calculated activity space areas and compactness were compared across sociodemographic and resource characteristics.

Results

Area measures derived from the three different approaches to developing activity spaces were highly correlated. Participants who were younger, lived in less walkable neighborhoods, had a valid driver’s license, had access to a vehicle, or had physical support to go outside of their homes had larger activity spaces. Mobility space compactness measures also differed by sociodemographic and resource characteristics.

Conclusions

This research extends the literature by demonstrating that GPS tracking can be used as a valuable tool to better understand the geographic mobility patterns of older adults. This study informs potential ways to maintain older adult independence by identifying factors that influence geographic mobility.

Electronic supplementary material

The online version of this article (doi:10.1186/1476-072X-13-51) contains supplementary material, which is available to authorized users.