RFID Technology: A Novel Observational and Measurement Method in Dementia-Related Wandering

RFID Technology: A Novel Observational and Measurement Method in Dementia-Related Wandering

William D. Kearns, Ph.D., Department of Aging and Mental Health, University of South Florida, Tampa, Florida andD. Helen Moore, Ph.D., JAHVA Hospital Patient Safety Center of Inquiry, Tampa, Florida

William D. Kearns, Ph.D., Department of Aging and Mental Health, University of South Florida, Tampa, Florida andD. Helen Moore, Ph.D., JAHVA Hospital Patient Safety Center of Inquiry, Tampa, Florida

Introduction RFID is presently used in alarm systems in

nursing homes to differentiate patients from staff and visitors at exitways and to provide selective lockdown. It is well-proven, robust and widely-used technology;

Most studies of wandering have occurred in nursing homes; much about wandering and wandering-related behavior at home remains unknown;

Radio frequency identification systems (RFID) represent an innovative approach to studying wandering and wandering-related behaviors in home-based settings.

Introduction RFID is presently used in alarm systems in

nursing homes to differentiate patients from staff and visitors at exitways and to provide selective lockdown. It is well-proven, robust and widely-used technology;

Most studies of wandering have occurred in nursing homes; much about wandering and wandering-related behavior at home remains unknown;

Radio frequency identification systems (RFID) represent an innovative approach to studying wandering and wandering-related behaviors in home-based settings.

DefinitionsRFID - a wireless system capable of

collecting 24-hour data on date, time of day, identity of the person entering monitored zones and duration of time spent in the monitored zone.

Wandering - meandering, aimless or repetitive locomotion that exposes a person to harm and is incongruent with boundaries, limits or obstacles.

[Source: North American Nursing Diagnosis Association. Nursing Diagnoses: Definitions and Classifications.2005-2006. Philadelphia, PA.]

Wandering-related behaviors - lurking, shadowing, elopement

Lurking - persistent lingering near exitways

Shadowing -closely following or trailing others who seek to exit

Elopement - a wanderer’s unattended penetration of the perimeter of a care setting

DefinitionsRFID - a wireless system capable of

collecting 24-hour data on date, time of day, identity of the person entering monitored zones and duration of time spent in the monitored zone.

Wandering - meandering, aimless or repetitive locomotion that exposes a person to harm and is incongruent with boundaries, limits or obstacles.

[Source: North American Nursing Diagnosis Association. Nursing Diagnoses: Definitions and Classifications.2005-2006. Philadelphia, PA.]

Wandering-related behaviors - lurking, shadowing, elopement

Lurking - persistent lingering near exitways

Shadowing -closely following or trailing others who seek to exit

Elopement - a wanderer’s unattended penetration of the perimeter of a care setting

RFID ComponentsDatabaseTransmitter/ReceiverTransponder (worn by the wanderer)

Proposed RFID Methodology Studying wandering at home

RFID operational definitions of wandering-related behavior

Lurking - wanderer remains in zone 01 ≥ 10 seconds

Shadowing - wanderer closely follows (within 2 seconds) another person into zone 01

Elopement - wanderer transitions from zone 01 to zone 02 unattended by a caregiver

RFID ComponentsDatabaseTransmitter/ReceiverTransponder (worn by the wanderer)

Proposed RFID Methodology Studying wandering at home

RFID operational definitions of wandering-related behavior

Lurking - wanderer remains in zone 01 ≥ 10 seconds

Shadowing - wanderer closely follows (within 2 seconds) another person into zone 01

Elopement - wanderer transitions from zone 01 to zone 02 unattended by a caregiver

Hypothetical RFID Data: Shadowing, Lurking & Elopement

Hypothetical Single Subject Plot of Wandering in Interior Zones

(Dark stair-step line signifies intervention introduction)

ImplicationsThe rich level of detail offered by

RFID technology can provide increased understanding of wandering and wandering-related behaviors.

Such understanding can lead to effective interventions and improved elopement risk management.

Hypothetical RFID Data: Shadowing, Lurking & Elopement

Hypothetical Single Subject Plot of Wandering in Interior Zones

(Dark stair-step line signifies intervention introduction)

ImplicationsThe rich level of detail offered by

RFID technology can provide increased understanding of wandering and wandering-related behaviors.

Such understanding can lead to effective interventions and improved elopement risk management.

Background Wandering occurs in up to 59% of community-

residing people with dementia. [Source: Cohen-Mansfield J., Werner P., Marx M.S. & Freedman, L. (1991).Two studies of pacing in the nursing home. Journal of Gerontology ;46:M77-83].

Over 50% of persons living at home with dementia elope and recurrence is likely. [Source: McShane, R., Gedling, K., Keene, J., Fairburn, C., Jacoby, R. & Hope, T. (1998). Getting lost in dementia: a longitudinal study of a behavioral symptom. International Psychogeriatrics, 10, 253-260.]

If not located within 24 hours, 46% of those who elope may die. [Source: Rowe, M.A. & Bennett, V. (2003). A look at deaths occurring in persons with dementia lost in the community. American Journal of Alzheimer's Disease and Other Dementias, 18(6), 343-348.]

Wandering at home frequently leads to institutionalization of the demented individual as caregivers become stressed and worried about elopement. [Source: Balesteri, L., Grossberg, A., & Grossberg, G.T. (2000). Behavioral and psychological symptoms of dementia as a risk factor for nursing home placement. International Psychogeriatrics, 3, 363-366.]

The cost of caring for patients with Alzheimer's disease, including cost of institutionalization, is extraordinary; annual expenditures total $83.9 billion (in 1996 U.S. dollars). [Source: Wimo A, & Winblad B. (2001). Health economical aspects of Alzheimer disease and its treatment. Psychogeriatrics, 1:189-93.]

Background Wandering occurs in up to 59% of community-

residing people with dementia. [Source: Cohen-Mansfield J., Werner P., Marx M.S. & Freedman, L. (1991).Two studies of pacing in the nursing home. Journal of Gerontology ;46:M77-83].

Over 50% of persons living at home with dementia elope and recurrence is likely. [Source: McShane, R., Gedling, K., Keene, J., Fairburn, C., Jacoby, R. & Hope, T. (1998). Getting lost in dementia: a longitudinal study of a behavioral symptom. International Psychogeriatrics, 10, 253-260.]

If not located within 24 hours, 46% of those who elope may die. [Source: Rowe, M.A. & Bennett, V. (2003). A look at deaths occurring in persons with dementia lost in the community. American Journal of Alzheimer's Disease and Other Dementias, 18(6), 343-348.]

Wandering at home frequently leads to institutionalization of the demented individual as caregivers become stressed and worried about elopement. [Source: Balesteri, L., Grossberg, A., & Grossberg, G.T. (2000). Behavioral and psychological symptoms of dementia as a risk factor for nursing home placement. International Psychogeriatrics, 3, 363-366.]

The cost of caring for patients with Alzheimer's disease, including cost of institutionalization, is extraordinary; annual expenditures total $83.9 billion (in 1996 U.S. dollars). [Source: Wimo A, & Winblad B. (2001). Health economical aspects of Alzheimer disease and its treatment. Psychogeriatrics, 1:189-93.]

Contact Information

William Kearns, Ph.D.Louis de la Parte Florida Mental Health Institute

University of South Florida, Tampa, FL 33612 Telephone: (813) 974-9356

Fax: (813) 974-1968 Email: kearns@fmhi.usf.edu

D. Helen Moore, Ph.D.VISN8 James A Haley VA

Patient Safety Center of Inquiry(118M) 8900 Grand Oak Circle, Tampa, FL 33637

Email: Dorothy.Moore4@va.gov

Contact Information

William Kearns, Ph.D.Louis de la Parte Florida Mental Health Institute

University of South Florida, Tampa, FL 33612 Telephone: (813) 974-9356

Fax: (813) 974-1968 Email: kearns@fmhi.usf.edu

D. Helen Moore, Ph.D.VISN8 James A Haley VA

Patient Safety Center of Inquiry(118M) 8900 Grand Oak Circle, Tampa, FL 33637

Email: Dorothy.Moore4@va.gov

Baseline All Door A

Door B

Door C

IntroduceBarrier on A

IntroduceAlarm on B

MaintainBaseline on B

Maintain Baseline on C

Maintain Baseline on C

Remove Alarm on B

Maintain Baseline on C

MaintainBarrier on A

RemoveBarrier on A

Time in Days

Wanderer entries into monitored zone A01

Wanderer entries into monitored zone B01

Wanderer entries into monitored zone C01

Baseline All Door A

Door B

Door C

IntroduceBarrier on A

IntroduceAlarm on B

MaintainBaseline on B

Maintain Baseline on C

Maintain Baseline on C

Remove Alarm on B

Maintain Baseline on C

MaintainBarrier on A

RemoveBarrier on A

Time in Days

Wanderer entries into monitored zone A01

Wanderer entries into monitored zone B01

Wanderer entries into monitored zone C01

A0111:00:04.511/01/050000159X2A0111:00:04.511/01/050000160H1A0111:00:04.011/01/050000160H1

(Both persons remain at door)A0111:00:03.511/01/050000159X2

(Shadowing - both at the door)A0111:00:03.511/01/050000160H1A0111:00:03.011/01/050000159X2A0111:00:02.511/01/050000159X2A0111:00:02.011/01/050000159X2A0111:00:01.511/01/050000159X2

(Family member enters zone 1)A0111:00:01.011/01/050000159X2Detector NumberTimeDateTransponder ID

Table 1. Raw Data Showing Shadowing. (Family member 0000159X2

enters first into detector zone A01, followed at 11:00:03.5 by the person with dementia 0000160H1)

A0111:00:04.511/01/050000159X2A0111:00:04.511/01/050000160H1A0111:00:04.011/01/050000160H1

(Both persons remain at door)A0111:00:03.511/01/050000159X2

(Shadowing - both at the door)A0111:00:03.511/01/050000160H1A0111:00:03.011/01/050000159X2A0111:00:02.511/01/050000159X2A0111:00:02.011/01/050000159X2A0111:00:01.511/01/050000159X2

(Family member enters zone 1)A0111:00:01.011/01/050000159X2Detector NumberTimeDateTransponder ID

Table 1. Raw Data Showing Shadowing. (Family member 0000159X2

enters first into detector zone A01, followed at 11:00:03.5 by the person with dementia 0000160H1)

A0212:43:06.011/02/050000160H1A0212:43:06.511/02/050000160H1A0212:43:07.011/02/050000160H1

A0212:43:05.511/02/050000160H1(Elopement occurs here)A01 12:43:05.011/02/050000160H1A0112:43:04.511/02/050000160H1A0112:43:04.011/02/050000160H1A0112:43:03.511/02/050000160H1A0112:43:03.011/02/050000160H1A0112:43:02.511/02/050000160H1A0112:43:02.011/02/050000160H1A0112:43:01.511/02/050000160H1Detector NumberTimeDateTransponder ID

Table 2. Raw Data Showing Lurking Followed by Elopement.(Person with dementia 0000160H1 persists in monitored zone A01 for first 3 seconds and then penetrates doorway and elopes from building)

A0212:43:06.011/02/050000160H1A0212:43:06.511/02/050000160H1A0212:43:07.011/02/050000160H1

A0212:43:05.511/02/050000160H1(Elopement occurs here)A01 12:43:05.011/02/050000160H1A0112:43:04.511/02/050000160H1A0112:43:04.011/02/050000160H1A0112:43:03.511/02/050000160H1A0112:43:03.011/02/050000160H1A0112:43:02.511/02/050000160H1A0112:43:02.011/02/050000160H1A0112:43:01.511/02/050000160H1Detector NumberTimeDateTransponder ID

Table 2. Raw Data Showing Lurking Followed by Elopement.(Person with dementia 0000160H1 persists in monitored zone A01 for first 3 seconds and then penetrates doorway and elopes from building)

A01A02

B01

C01

C02

B02

Transponder

Barrier

Database

Transmitter / Receiver

Entrance door

= Interior RFID coverage

= Exterior RFID coverage

A01A02

B01

C01

C02

A01A02

B01

C01

C02

B02

Transponder

Barrier

Database

Transmitter / Receiver

Entrance door

= Interior RFID coverage

= Exterior RFID coverage