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					                                                        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 and
                                                           D. Helen Moore, Ph.D., JAHVA Hospital Patient Safety Center of Inquiry, Tampa, Florida

               Introduction                                                     Background                                                                                Definitions                                                         RFID Components                                             Hypothetical RFID Data:
 RFID is presently used in alarm systems in              Wandering occurs in up to 59% of community-                                            RFID - a wireless system capable of                                          Database                                                                        Shadowing, Lurking & Elopement
  nursing homes to differentiate patients from             residing people with dementia.                                                          collecting 24-hour data on date, time of                                    Transmitter/Receiver
                                                                                                                                                                                                                                                                                                          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)
                                                                                                                                                                                                                                                                                                                                                                                               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)

  staff and visitors at exitways and to provide            [Source: Cohen-Mansfield J., Werner P., Marx M.S. & Freedman, L. (1991).Two studies     day, identity of the person entering                                        Transponder (worn by the wanderer)
                                                                                                                                                                                                                                                                                                          Transponder ID
                                                                                                                                                                                                                                                                                                          0000159X2
                                                                                                                                                                                                                                                                                                                                  Date
                                                                                                                                                                                                                                                                                                                                  11/01/05
                                                                                                                                                                                                                                                                                                                                                  Time
                                                                                                                                                                                                                                                                                                                                                  11:00:01.0
                                                                                                                                                                                                                                                                                                                                                                       Detector Number
                                                                                                                                                                                                                                                                                                                                                                       A01
                                                                                                                                                                                                                                                                                                                                                               (Family member enters zone 1)
                                                                                                                                                                                                                                                                                                                                                                                               Transponder ID
                                                                                                                                                                                                                                                                                                                                                                                               0000160H1
                                                                                                                                                                                                                                                                                                                                                                                               0000160H1
                                                                                                                                                                                                                                                                                                                                                                                                                  Date
                                                                                                                                                                                                                                                                                                                                                                                                                  11/02/05
                                                                                                                                                                                                                                                                                                                                                                                                                  11/02/05
                                                                                                                                                                                                                                                                                                                                                                                                                                Time
                                                                                                                                                                                                                                                                                                                                                                                                                                12:43:01.5
                                                                                                                                                                                                                                                                                                                                                                                                                                12:43:02.0
                                                                                                                                                                                                                                                                                                                                                                                                                                               Detector Number
                                                                                                                                                                                                                                                                                                                                                                                                                                               A01
                                                                                                                                                                                                                                                                                                                                                                                                                                               A01
                                                           of pacing in the nursing home. Journal of Gerontology ;46:M77-83].                                                                                                                                                                             0000159X2               11/01/05        11:00:01.5           A01                     0000160H1          11/02/05      12:43:02.5     A01

  selective lockdown. It is well-proven, robust                                                                                                    monitored zones and duration of time                                                                                                                   0000159X2
                                                                                                                                                                                                                                                                                                          0000159X2
                                                                                                                                                                                                                                                                                                          0000159X2
                                                                                                                                                                                                                                                                                                                                  11/01/05
                                                                                                                                                                                                                                                                                                                                  11/01/05
                                                                                                                                                                                                                                                                                                                                  11/01/05
                                                                                                                                                                                                                                                                                                                                                  11:00:02.0
                                                                                                                                                                                                                                                                                                                                                  11:00:02.5
                                                                                                                                                                                                                                                                                                                                                  11:00:03.0
                                                                                                                                                                                                                                                                                                                                                                       A01
                                                                                                                                                                                                                                                                                                                                                                       A01
                                                                                                                                                                                                                                                                                                                                                                       A01
                                                                                                                                                                                                                                                                                                                                                                                               0000160H1
                                                                                                                                                                                                                                                                                                                                                                                               0000160H1
                                                                                                                                                                                                                                                                                                                                                                                               0000160H1
                                                                                                                                                                                                                                                                                                                                                                                                                  11/02/05
                                                                                                                                                                                                                                                                                                                                                                                                                  11/02/05
                                                                                                                                                                                                                                                                                                                                                                                                                  11/02/05
                                                                                                                                                                                                                                                                                                                                                                                                                                12:43:03.0
                                                                                                                                                                                                                                                                                                                                                                                                                                12:43:03.5
                                                                                                                                                                                                                                                                                                                                                                                                                                12:43:04.0
                                                                                                                                                                                                                                                                                                                                                                                                                                               A01
                                                                                                                                                                                                                                                                                                                                                                                                                                               A01
                                                                                                                                                                                                                                                                                                                                                                                                                                               A01


  and widely-used technology;                             Over 50% of persons living at home with                                                 spent in the monitored zone.                                                                                                                           0000160H1

                                                                                                                                                                                                                                                                                                          0000159X2
                                                                                                                                                                                                                                                                                                                                  11/01/05

                                                                                                                                                                                                                                                                                                                                  11/01/05
                                                                                                                                                                                                                                                                                                                                                  11:00:03.5           A01
                                                                                                                                                                                                                                                                                                                                                          (Shadowing - both at the door)
                                                                                                                                                                                                                                                                                                                                                  11:00:03.5           A01
                                                                                                                                                                                                                                                                                                                                                                                               0000160H1
                                                                                                                                                                                                                                                                                                                                                                                               0000160H1
                                                                                                                                                                                                                                                                                                                                                                                                                  11/02/05
                                                                                                                                                                                                                                                                                                                                                                                                                  11/02/05
                                                                                                                                                                                                                                                                                                                                                                                                                                12:43:04.5
                                                                                                                                                                                                                                                                                                                                                                                                                                12:43:05.0
                                                                                                                                                                                                                                                                                                                                                                                                                                               A01
                                                                                                                                                                                                                                                                                                                                                                                                                                               A01
                                                                                                                                                                                                                                                                                                                                                                                                                                              (Elopement occurs here)


 Most studies of wandering have occurred in
                                                                                                                                                                                                                                                                                                                                                                                               0000160H1          11/02/05      12:43:05.5     A02
                                                                                                                                                                                                                                                                                                                                                           (Both persons remain at door)

                                                           dementia elope and recurrence is likely.                                               Wandering - meandering, aimless or                                                                                                                      0000160H1
                                                                                                                                                                                                                                                                                                          0000160H1
                                                                                                                                                                                                                                                                                                                                  11/01/05
                                                                                                                                                                                                                                                                                                                                  11/01/05
                                                                                                                                                                                                                                                                                                                                                  11:00:04.0
                                                                                                                                                                                                                                                                                                                                                  11:00:04.5
                                                                                                                                                                                                                                                                                                                                                                       A01
                                                                                                                                                                                                                                                                                                                                                                       A01
                                                                                                                                                                                                                                                                                                                                                                                               0000160H1
                                                                                                                                                                                                                                                                                                                                                                                               0000160H1
                                                                                                                                                                                                                                                                                                                                                                                               0000160H1
                                                                                                                                                                                                                                                                                                                                                                                                                  11/02/05
                                                                                                                                                                                                                                                                                                                                                                                                                  11/02/05
                                                                                                                                                                                                                                                                                                                                                                                                                  11/02/05
                                                                                                                                                                                                                                                                                                                                                                                                                                12:43:06.0
                                                                                                                                                                                                                                                                                                                                                                                                                                12:43:06.5
                                                                                                                                                                                                                                                                                                                                                                                                                                12:43:07.0
                                                                                                                                                                                                                                                                                                                                                                                                                                               A02
                                                                                                                                                                                                                                                                                                                                                                                                                                               A02
                                                                                                                                                                                                                                                                                                                                                                                                                                               A02
                                                                                                                                                                                                                                                                                                          0000159X2               11/01/05        11:00:04.5           A01

  nursing homes; much about wandering and                  [Source: McShane, R., Gedling, K., Keene, J., Fairburn, C., Jacoby, R. & Hope, T.       repetitive locomotion that exposes a
                                                           (1998). Getting lost in dementia: a longitudinal study of a behavioral symptom.                                                                                                                                                                   Hypothetical Single Subject Plot of
  wandering-related behavior at home                       International Psychogeriatrics, 10, 253-260.]                                           person to harm and is incongruent with
  remains unknown;                                                                                                                                 boundaries, limits or obstacles.                                            Proposed RFID Methodology                                                        Wandering in Interior Zones
 Radio frequency identification systems                  If not located within 24 hours, 46% of those
                                                                                                                                                   [Source: North American Nursing Diagnosis Association. Nursing Diagnoses:
                                                                                                                                                    Definitions and Classifications.2005-2006. Philadelphia, PA.]
                                                                                                                                                                                                                                              Studying wandering at home                                      Baseline All
                                                                                                                                                                                                                                                                                                              Door A
                                                                                                                                                                                                                                                                                                                                             Introduce
                                                                                                                                                                                                                                                                                                                                             Barrier on A
                                                                                                                                                                                                                                                                                                                                                                                   Maintain
                                                                                                                                                                                                                                                                                                                                                                                   Barrier on A
                                                                                                                                                                                                                                                                                                                                                                                                                Remove
                                                                                                                                                                                                                                                                                                                                                                                                                Barrier on A
                                                                                                                                                                                                                                                                                                                                                                                                                                                Wanderer
                                                                                                                                                                                                                                                                                                                                                                                                                                                entries into
                                                                                                                                                                                                                                                                                                                                                                                                                                                monitored
                                                                                                                                                                                                                                                                                                                                                                                                                                                zone A01
  (RFID) represent an innovative approach to               who elope may die.                                                                     Wandering-related behaviors -                                                                                 C02                 Entrance door
                                                                                                                                                                                                                                                                                                              Door B                         Maintain                              Introduce                    Remove Alarm
                                                                                                                                                                                                                                                                                                                                                                                                                                                Wanderer
  studying wandering and wandering-related                 [Source: Rowe, M.A. & Bennett, V. (2003). A look at deaths occurring in persons with    lurking, shadowing, elopement                                                                               C01
                                                                                                                                                                                                                                                                                                                                             Baseline on B                         Alarm on B                   on B
                                                                                                                                                                                                                                                                                                                                                                                                                                                entries into
                                                                                                                                                                                                                                                                                                                                                                                                                                                monitored
                                                           dementia lost in the community. American Journal of Alzheimer's Disease and Other                                                                                                                                                                                                                                                                                                    zone B01
  behaviors in home-based settings.                        Dementias, 18(6), 343-348.]                                                                                                                                                                                    Database
                                                                                                                                                                                                                                                                                                              Door C                         Maintain Baseline                     Maintain Baseline            Maintain Baseline

                                                                                                                                                   Lurking - persistent
                                                                                                                                                                                                                                                                                                                                                                                                                                                Wanderer
                                                                                                                                                                                                                                                                                                                                             on C                                  on C                         on C
                                                                                                                                                                                                                                               A01                                                                                                                                                                                              entries into
                                                                                                                                                                                                                                        A02                           Transponder                                                                                                                                                               monitored
                                                                                                                                                                                                                                                                                                                                                                                                                                                zone C01
                                                                                                                                                    lingering near exitways
                                                          Wandering at home frequently leads to                                                                                                                                                     Barrier
                                                                                                                                                                                                                                                                            B01
                                                                                                                                                                                                                                                                                            Transmitter
                                                                                                                                                                                                                                                                                                                                                                    Time in Days


                Contact Information                                                                                                                                                                                                                                                         / Receiver         (Dark stair-step line signifies intervention introduction)
                                                           institutionalization of the demented individual
                                                                                                                                                  Shadowing -closely                                                              = Interior RFID coverage                  B02




                 William Kearns, Ph.D.
                                                           as caregivers become stressed and worried
                                                                                                                                                   following or trailing
                                                                                                                                                                                                                                   = Exterior RFID coverage
                                                                                                                                                                                                                                                                                                                                                 Implications
    Louis de la Parte Florida Mental Health Institute
                                                           about elopement.                                                                                                                                                                                                                                     The rich level of detail offered by
                                                                                                                                                   others who seek to                                                                 RFID operational definitions of
     University of South Florida, Tampa, FL 33612          [Source: Balesteri, L., Grossberg, A., & Grossberg, G.T. (2000). Behavioral and
                                                                                                                                                                                                                                                                                                                 RFID technology can provide
               Telephone: (813) 974-9356                   psychological symptoms of dementia as a risk factor for nursing home placement.         exit                                                                                 wandering-related behavior
                                                           International Psychogeriatrics, 3, 363-366.]
                  Fax: (813) 974-1968                                                                                                                                                                                          Lurking - wanderer remains in zone 01 ≥ 10                                       increased understanding of
              Email: kearns@fmhi.usf.edu                  The cost of caring for patients with Alzheimer's                                       Elopement - a                                                                seconds                                                                          wandering and wandering-related
                                                           disease, including cost of institutionalization, is                                     wanderer’s unattended                                                       Shadowing - wanderer closely follows (within                                     behaviors.
                D. Helen Moore, Ph.D.
              VISN8 James A Haley VA
                                                           extraordinary; annual expenditures total $83.9                                          penetration of the                                                           2 seconds) another person into zone 01                                          Such understanding can lead to
                                                           billion (in 1996 U.S. dollars).                                                                                                                                                                                                                       effective interventions and
        Patient Safety Center of Inquiry(118M)                                                                                                     perimeter of a care setting                                                 Elopement - wanderer transitions from zone
       8900 Grand Oak Circle, Tampa, FL 33637              [Source: Wimo A, & Winblad B. (2001). Health economical aspects of Alzheimer
                                                                                                                                                                                                                                                                                                                 improved elopement risk
           Email: Dorothy.Moore4@va.gov                    disease and its treatment. Psychogeriatrics, 1:189-93.]                                                                                                              01 to zone 02 unattended by a caregiver
                                                                                                                                                                                                                                                                                                                 management.

				
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