# Presentation: 776393

## 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 and**
**D. 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.

**Definitions**
**RFID** - 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 Components**
- Database
- Transmitter/Receiver
- Transponder (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)**
**Implications**
- The 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.]

**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](mailto:kearns@fmhi.usf.edu)__ _
**D. Helen Moore, Ph.D.****VISN8 James A Haley VA ****Patient Safety Center of Inquiry(118M) **
**11605 N. Nebraska Ave., Tampa, FL 33612**** Email:** _[Dorothy.Moore4@va.gov](mailto:Dorothy.Moore4@va.gov)_

**Notes:**
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, so much about wandering and wandering-related behavior at home remains unknown. Radio-frequency identification systems (RF(D) represent an innovative approach to studying wandering and wandering-related behaviors in home-based settings.

BACKGROUND
Wandering occurs in up to 59% of community-residing people with dementia (Cohen-Mansfield, Werner, Marx & Freedman (1981).
Over 50% of persons living at home with dementia elope and recurrence is likely (McShane, Gedling, Koene, Fairburn, Jacoby & Hope, 1998).
If not located within 24 hours, 46% of those who elope may die (Rowe & Bennett, 2005).
Wandering at home frequently leads to institutionalization of the demented individual as caregivers become stressed and worried about elopement. (Balesteri, Grossberg & Grossberg (2000).
The cost of caring for patients with Alzheimer’s disease, including cost of institutionalization, is extraordinary; annual expenditures total $83.9 billion (in 1996 US$) (Wimo & Winblad, 2001).

DEFINITIONS
RFID—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.
WANDING-RELATED BEHAVIORS: 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 COMPONETS: (1) Database; (2) Transmitter/Receiver; (3) Transponder (worn by the wanderer).

PROPOSED RFID METHODOLOGY
Studying wandering at home using RFID technology

IMPLICATIONS
The 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.

This poster was prepared by William D. Kearns, PhD of the USF Department of Aging & Mental Health and D. Helen Moore, PhD of the James A. Haley VA Hospital’s Patient Safety Center of Inquiry, both in Tampa, FL