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Haslam-Larmer L, Shum L, Chu CH, McGilton K, McArthur C, Flint AJ, Khan S, Iaboni A. Real-time location systems technology in the care of older adults with cognitive impairment living in residential care: A scoping review. Front Psychiatry 2022; 13:1038008. [PMID: 36440422 PMCID: PMC9685159 DOI: 10.3389/fpsyt.2022.1038008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION There has been growing interest in using real-time location systems (RTLS) in residential care settings. This technology has clinical applications for locating residents within a care unit and as a nurse call system, and can also be used to gather information about movement, location, and activity over time. RTLS thus provides health data to track markers of health and wellbeing and augment healthcare decisions. To date, no reviews have examined the potential use of RTLS data in caring for older adults with cognitive impairment living in a residential care setting. OBJECTIVE This scoping review aims to explore the use of data from real-time locating systems (RTLS) technology to inform clinical measures and augment healthcare decision-making in the care of older adults with cognitive impairment who live in residential care settings. METHODS Embase (Ovid), CINAHL (EBSCO), APA PsycINFO (Ovid) and IEEE Xplore databases were searched for published English-language articles that reported the results of studies that investigated RTLS technologies in persons aged 50 years or older with cognitive impairment who were living in a residential care setting. Included studies were summarized, compared and synthesized according to the study outcomes. RESULTS A total of 27 studies were included. RTLS data were used to assess activity levels, characterization of wandering, cognition, social interaction, and to monitor a resident's health and wellbeing. These RTLS-based measures were not consistently validated against clinical measurements or clinically important outcomes, and no studies have examined their effectiveness or impact on decision-making. CONCLUSION This scoping review describes how data from RTLS technology has been used to support clinical care of older adults with dementia. Research efforts have progressed from using the data to track activity levels to, most recently, using the data to inform clinical decision-making and as a predictor of delirium. Future studies are needed to validate RTLS-based health indices and examine how these indices can be used to inform decision-making.
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Affiliation(s)
- Lynn Haslam-Larmer
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Leia Shum
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Charlene H Chu
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Kathy McGilton
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Alastair J Flint
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Shehroz Khan
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Mental Health, University Health Network, Toronto, ON, Canada
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Sharp CA, Schulz Moore JS, McLaws ML. Two-Hourly Repositioning for Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse? JOURNAL OF BIOETHICAL INQUIRY 2019; 16:17-34. [PMID: 30671872 PMCID: PMC6474851 DOI: 10.1007/s11673-018-9892-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress.
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Affiliation(s)
- Catherine A Sharp
- School of Public Health and Community Medicine, University of New South Wales, 3rd Floor Samuels Building, Sydney, NSW, 2052, Australia
| | | | - Mary-Louise McLaws
- School of Public Health and Community Medicine, University of New South Wales, 3rd Floor Samuels Building, Sydney, NSW, 2052, Australia.
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Nonaka T, Suto S, Yamakawa M, Shigenobu K, Makimoto K. Quantitative evaluation of changes in the clock-watching behavior of a patient with semantic dementia. Am J Alzheimers Dis Other Demen 2014; 29:540-7. [PMID: 24650896 PMCID: PMC10852945 DOI: 10.1177/1533317514523486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clock-watching activity in patients with dementia has not been documented in detail. METHODS A male patient having semantic dementia was monitored at a dementia care unit in a general hospital in Japan. We used an integrated circuit monitoring system to record the distance and location of ambulation and the total number of movements that occurred outside the patient's room. RESULTS The patient was reported to clock watch a couple of years prior to monitoring. In 2011, when monitoring started, he regularly came out of his room saying, "8 o'clock" about 40 minutes into every hour. It seemed as if he could only recognize the minute hand. The median number of sensor detections increased by 4-fold at this clock-watching phase. Behavior consistent with his clock-watching patterns was also detected during the night. In 2012, clock-watching activity disappeared. CONCLUSIONS This study documented the progression of clock-watching and subsequent disappearance with worsening cognitive function.
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Affiliation(s)
- Takahiro Nonaka
- Department of Clinical Nursing, Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Shunji Suto
- Department of Community Medicine, Nara Medical University, Kashihara, Japan
| | - Miyae Yamakawa
- Department of Clinical Nursing, Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kazue Shigenobu
- Dementia Care Center, Asakayama General Hospital, Sakai, Japan
| | - Kiyoko Makimoto
- Department of Clinical Nursing, Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
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Nishikata S, Yamakawa M, Shigenobu K, Suto S, Makimoto K. Degree of ambulation and factors associated with the median distance moved per day in Alzheimer's disease patients. Int J Nurs Pract 2013; 19 Suppl 3:56-63. [DOI: 10.1111/ijn.12174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shiori Nishikata
- Department of Clinical Nursing, Division of Health Sciences, Graduate School of Medicine; Osaka University; Osaka Japan
| | - Miyae Yamakawa
- Department of Clinical Nursing, Division of Health Sciences, Graduate School of Medicine; Osaka University; Osaka Japan
| | - Kazue Shigenobu
- Department of Psychiatry; Asakayama General Hospital; Osaka Japan
| | - Shunji Suto
- Department of Community Medicine; Nara Medical University; Nara Japan
| | - Kiyoko Makimoto
- Department of Clinical Nursing, Division of Health Sciences, Graduate School of Medicine; Osaka University; Osaka Japan
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Yayama S, Yamakawa M, Suto S, Greiner C, Shigenobu K, Makimoto K. Discrepancy between subjective and objective assessments of wandering behaviours in dementia as measured by the Algase Wandering Scale and the Integrated Circuit tag monitoring system. Psychogeriatrics 2013; 13:80-7. [PMID: 23909964 DOI: 10.1111/psyg.12011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 08/19/2012] [Accepted: 08/27/2012] [Indexed: 11/30/2022]
Abstract
AIM Although wandering is one of the major research focuses of the behavioural psychological symptoms of dementia, assessment of wandering has mostly relied on caregiver-administered questionnaires. The purpose of this study was to compare staff-administered Algase Wandering Scale outcomes with objective temporal and spatial movement indicators obtained from the Integrated Circuit (IC) tag monitoring system. METHODS Patients with dementia were recruited from a dementia care unit in Osaka, Japan in 2007. Primary nurses administered the Algase Wandering Scale, and the temporal and spatial movements of the subjects were monitored by the IC tag. Written informed consent was obtained from each subject's proxies. RESULTS Nurses' assessments of wandering were in agreement with the IC tag outcomes only during the day shift. Spatial movements assessed by the staff did not reflect those measured by the IC tag. CONCLUSION This objective measurement of wandering showed the limitations in the assessment of spatial and temporal movement by the staff.
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Affiliation(s)
- So Yayama
- Faculty of Nursing, Senri Kinran University, 5-25-1 Fujishirodai, Suita, Osaka, Japan.
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Vuong NK, Goh SGA, Chan S, Lau CT. A mobile-health application to detect wandering patterns of elderly people in home environment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:6748-6751. [PMID: 24111292 DOI: 10.1109/embc.2013.6611105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Wandering is a common and risky behavior in people with dementia (PWD). In this paper, we present a mobile healthcare application to detect wandering patterns in indoor settings. The application harnesses consumer electronics devices including WiFi access points and mobile phones and has been tested successfully in a home environment. Experimental results show that the mobile-health application is able to detect wandering patterns including lapping, pacing and random in real-time. Once wandering is detected, an alert message is sent using SMS (Short Message Service) to attending caregivers or physicians for further examination and timely interventions.
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Liao XY, Yamakawa M, Suto S, Shigenobu K, Makimoto K. Changes in activity patterns after the oral administration of brotizolam in institutionalized elderly patients with dementia. Psychogeriatrics 2012; 12:99-105. [PMID: 22712643 DOI: 10.1111/j.1479-8301.2011.00401.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Little is known about the side effects of sedative-hypnotic agents in elderly dementia patients with sleep disorders. The present study describes activity pattern changes after a single dose of brotizolam in elderly patients with dementia. METHODS We conducted retrospective analysis of prospectively collected data from a case series at Asakayama Hospital (Osaka, Japan) between September 2008 and September 2009. Around-the-clock movements of dementia patients who were administered a single dose of brotizolam were recorded by the integrated circuit tag monitoring system during a 4-week baseline and 7-day peri-administration period. Diurnal and nocturnal activity levels and the onset times of the least-active and most-active phases were then measured. RESULTS Seven patients (four men, three women; age range 59-85 years) were analyzed. All seven patients had disturbed activity patterns during the peri-administration period. Compared with the pre-administration period, the incidence of reversed rest-activity pattern increased significantly in the post-administration period, as measured by the distance moved per hour (P < 0.000). Patients with advanced stages of dementia had prolonged and delayed activity responses. CONCLUSIONS Findings showed changes in activity levels and reversed active/resting phases after a single dose of brotizolam in elderly patients with dementia. Use of brotizolam in elderly patients with dementia, especially in advanced stages, calls for closer attention and longer observation periods.
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Affiliation(s)
- Xiao Yan Liao
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Lancioni GE, Perilli V, Singh NN, O'Reilly MF, Cassano G. A man with severe Alzheimer's disease stops wandering during a picture colouring activity. Dev Neurorehabil 2011; 14:242-6. [PMID: 21732808 DOI: 10.3109/17518423.2011.575439] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the effects of a picture colouring activity on the wandering (and constructive engagement) of a man with severe Alzheimer's disease. METHOD The colouring activity was compared with a music listening condition and a baseline/control condition. A choice phase involving the colouring activity and the music condition was also implemented. RESULTS Wandering was constant during the baseline condition, but it was reduced to low or virtually 0% levels during the music condition and picture colouring activity. Moreover, the patient regularly selected the colouring activity (which also promoted constructive engagement) during the choice phase. CONCLUSION Simple leisure activities, such as picture colouring, might help patients with Alzheimer's disease reduce wandering.
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