Small, low-cost GPS devices and other technologies now make it easy to track dementia patients who wander from home or residential facilities, and get lost. But should caregivers and healthcare providers use electronic-tracking devices, if the patients themselves don’t — or can’t — agree to be monitored?
That thorny question is informing a new debate on how to balance the safety and autonomy of Alzheimer’s disease patients and others with dementia, according to a new report on the pros and cons of electronic tracking in this week’s British Medical Journal, featuring two experts on the topic.
Rupert McShane, a geriatrics consultant at Oxford Health NHS Foundation Trust, argues GPS trackers are not a cure-all, but allow lost patients to be found more quickly, reducing the risk of harm. He notes about half of all people with dementia who are missing for more 24 hours die or are seriously injured. Those who wander from home are also more likely to be subsequently placed in a residential facility.
"It is therefore surprising that there has not been more attention paid to ways of reducing this," he writes in the BMJ. "The evidence that patients are given more freedom once they start using a tracker is contradictory, but the finding that the device can reduce conflict between patient and [caregiver] is plausible and useful."
McShane tells Newsmax Health it’s a difficult issue, but it's important for families to balance risks and benefits to patients and caregivers alike.
"This really comes down to a utilitarian analysis: How much distress does the loss of privacy cause the patient, compared with the freedom they are given and the reassurance given to the [caregiver]?" he says. "Patients are not usually greatly distressed by loss of privacy — indeed they cannot be if they have forgotten about it — but they do sometimes get distressed when lost, and certainly get distressed by admission to residential facilities."
But Desmond O’Neill, a professor of geriatric medicine at Trinity College Dublin, contends dementia care must be "patient-centered" and not involve "quick fixes" to suit caregivers. Tracking "has generally been researched among formal and informal [caregivers] only, with the views of those with dementia relegated to the sidelines," he says. He adds that tracking devices "may provide a false sense of security" and more traditional methods such as having patients wear identity bracelets may be equally effective.
Leslie Kernisan, M.D., a board-certified geriatrics specialist affiliated with the University of California-San Francisco, tells Newsmax Health the debate raises important, but tough questions for many families who have to consider the tradeoffs of such devices when dealing with a loved with Alzheimer’s or dementia.
"At the end of the day we need consider these tradeoffs as we try to respect the patients," Dr. Kernisan tells Newsmax Health. "This is an interesting new tool now that GPS trackers are becoming so inexpensive. You can get them easily and they even come in shoes now so you can put them on a person and there’s a possibility they won’t even know they’re there."
She adds, however, that families need to consider all their options and choose one that is best for them.
"Ideally with a family, they would first consider other options for both the wandering and for the anxiety of the caregiver’s experience, worrying about someone wandering away," she says. "In almost all older patients, we struggle with balancing a dementia patient’s safety and autonomy.
"For many patients, they really can’t give consent because they can’t properly appreciate the risk, but they can express preferences. And then we have to figure out what’s the best balance of burden and benefit, if the patients find the device burdensome, either because they see it and know what it is and don’t like it, or because it’s uncomfortable."
Even if the device is unobtrusively placed in a shoe or watch without a patient’s knowledge that raises ethical civil-rights issues.
McShane and Dr. Kernisan note that families of dementia patients have other options they can explore before considering a tracking device. Among them:
- Make sure patients carry identification, such as medical alert bracelets, so if they wander off other individuals who encounter them can help them find their way home.
- Talk to neighbors to be on the lookout for someone who may stray from home and get lost.
- Install a buzzer or security system that sounds an alarm if doors or windows are opened.
- When out of the home with a patient, give him or her one of a pair of alerts that go off if the two devices are separated by more than about 20 yards.
- Some residential facilities install red velvet ropes or black carpets in front of the exits that discourage patients from venturing outside.
Dr. Kernisan adds that it’s important to involve patients as much as possible in all decisions, for clinicians to help caregivers cope with their anxieties, and to try to identify the underlying cause of wandering.
"People often want to jump to a solution and the better path is to see if one can break down the problem," she says. "For instance, if someone is wandering, is it because the person isn’t getting enough exercise or activity? If so, going on a routine walk with a caregiver might be a more individualized solution than strapping on a GPS or other type of tracking device."
The bottom line: There is no one-size-fits-all solution.
"In the end all these families need to learn a process of individualized problem solving, and it’s true that none of our options are ideal," she adds. "So we need to be explicit about the tradeoffs…but it [electronic tracking] is a tool and it could be used after exploring other possibilities."
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