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Old Age Problems, New Age Technologies: Radio Frequency Identification Aids in Identifying The Elderly
Introduction
The numbers are both heartening…and alarming. Through improved nutrition, new pharmacological interventions and astounding new medical technologies, greater and greater numbers of us are living into our sixties, seventies, eighties, nineties…even past the century mark. However, one of the very real consequences of our ability to extend our lifespans is that as we age, there are more and more individuals – and their family members acting as caregivers – who will have to deal with the diseases and syndromes associated with old age. Certainly, Alzheimer’s disease and dementia are at the forefront of these concerns today.
According to the Alzheimer’s Association, an estimated 5.2 million Americans of all ages presently have Alzheimer’s disease. The Alzheimer’s Association estimates that there are approximately half a million Americans under age 65 who have Alzheimer’s or another dementia, and about 40 percent of them have Alzheimer’s disease. In all, one in eight persons age 65 and over has Alzheimer’s disease at present. Over the course of our lifetimes, one in six women and one in ten men who live past the age of 55 will someday develop Alzheimer’s disease. Over time, the numbers only grow worse, for unless there are medical breakthroughs in the prevention of the disease, estimates are that there will be between 11 and 16 million Americans living with Alzheimer’s by 2050.
All of us have an occasional “senior moment,” forgetting a lunch meeting or misplacing our car keys, but more and more seniors are experiencing far more serious problems with their memory and cognitive functioning. Alzheimer’s is the most common cause of dementia, accounting for fully 70% of all cases in older adults. Unfortunately, dementia is common amongst the elderly – even those who do not have Alzheimer’s. Today, research has shown that over 40% of those aged 85 and older have some form of dementia.
Dementia is a severely debilitating condition that can occur in persons of any age, but today is largely a condition affecting older people – whether or not they have Alzeheimer’s as an underlying condition. People suffering from dementia experience a global decline in their ability to cognitively function. This leads to problems with perception, reasoning, memory, and temporal/spatial awareness. In addition to experiencing these cognitive impairments, persons with dementia often exhibit potentially dangerous behaviors. These include becoming less inhibited, displaying verbal and/or physically aggressive behavior towards others, or what is known as “wandering” – where the patient moves for no apparent reason.
When a dementia sufferer wanders, he or she may simply restlessly walk about their home or their assisted living facility in an endless manner – often for hours at a time. However, for hospital and assisted living center administrators, a dementia patient who wanders may simply wander out the doors of the facility – creating a quite concerning situation for their facility. Furthermore, patients with dementia who do not have a history of displaying wandering behavior may be at risk of accidentally leaving the facility simply through becoming disoriented or forgetful of their surroundings. Such wandering – even once – becomes a “life or death” decision area for health care administrators. As Patti Harris, Vice President of Sales and Marketing for Brookfield, Wisconsin-based RF Technologies, recently remarked: “Although it’s not front page news, there are people who wander outside of nursing homes and freeze to death right outside the building because no one accounted for them.”
People suffering with dementia are therefore in great need of constant assistance and supervision. This places great stress on the personal and professional lives of their caregivers, who are often their adult children and/or spouses. Thus, most eventually need to be cared for in an assisted living facility. And thus, while the direct and indirect costs of caring for patients with dementia and Alzheimer’s is calculate to be in the tens of billions of dollars today in the United States and far more on a global basis, this number will go higher and higher with the continuing trend toward a longer-living population with a greater incidence of both Alzheimer’s and dementia.
RFID AND DEMENTIA CARE/DIAGNOSIS
Over the past decade, we have seen increasing levels of utilization of automatic identification technologies in health care facilities, in areas ranging from employee identification and access control to specific applications with RFID (Radio Frequency Identification), ranging from equipment monitoring to blood banking and pharmaceutical dispensing. We have also seen long-standing use of RFID for patient identification and control in the pediatric area to match babies with their parents.
Now today, we are seeing increased interest in using RFID to help protect the safety of patients suffering from dementia from wandering outside designated areas of the facility or even outside the doors of their care center. In the process, auto-ID protection helps ease and mitigates the very serious operational and liability concerns health care administrators have over having vulnerable patients in their care venture outside the bounds of the facility. Also, for technologically progressive hospitals and health care facilities that have already undertaken RFID investments in say, equipment tagging and pediatric wing security, such new projects can dovetail with their existing investments in RFID-related hardware, software and integration efforts to expand the benefits of both their legacy projects and a new effort to provide increased security for their dementia patients and their family members.
We have seen several recent trials and implementations of RFID technology in this area, including installations specifically geared for monitoring of dementia-affected patients in the United States, Canada and Europe. While door alarms and staff vigilance can help prevent patients from wandering outside a designated area or outside the perimeter of the facility, RFID-based monitoring can certainly provide a much more comprehensive security solution for the care of dementia-affected patients. Salim Devji, Deputy Administrator at the Delta View Habilitation Centre in British Columbia, Canada, which implemented an RFID-based monitoring systems for both patients and equipment last year – the first known installation geared specifically at dementia care in the country, recently commented on the importance of locating wandering patients quickly, stating that with physical counts in any elder care facility when you have “so many care staff keeping track of so many residents who are moving.” RFID tags – in the form of wristbands or badges – can enable tracking within the four walls of a designated area, with the level of surveillance determined by the positioning of readers at doorways, stairwells, exit doors and other “choke points.”
Active RFID will be preferable in most instances – due to the need to assure continuous patient monitoring, and there must be special attention to having power backups for the monitoring systems. As Robert Heppenheimer, executive director and owner of the Nesconset Center for Nursing & Rehabilitation, located in Nesconset, New York, which has implemented a comprehensive ultra-wide band RFID-based system for tracking staff, equipment and patients, pinpointed the importance of such a comprehensive and reliable approach when he stated – quite bluntly – “Oh, well, we had a power outage and the system didn’t reset, so Mom got outside and got hypothermia, or worse.” As has been found with the monitoring of infants in pediatric units, readers should be positioned in a manner so as to minimize the number of false alarms from patients coming near to – but not actually passing through – designated doorways.
In Luxembourg, for instance, the country’s largest health care facility – the Hospital St. Louis – has implemented an active tag system from Redwood City, California-based AeroScout, Inc. (http://www.aeroscout.com) to track both durable medical equipment and high-risk dementia patients. The Luxembourg project makes use of Cisco’s Unified Wireless Network to provide visibility on both hard and human assets throughout the facility. The value of such projects, in the view of Richard Roberts, Cisco’s Director of Wireless Business Development, is that: “Location-based services, such as the system deployed by Hospital St. Louis, can help improve patient care and help reduce costs with a real-time view of where their patients and assets are located.”
The special needs of the elderly who suffer from dementia has led to several innovative projects for improving both their safety and quality of life while residing in assisted living centers and health care facilities. For instance, for health care administrators, one of the very practical concerns is in the area of laundry management. Getting the right clothes back to the right patient can be a complex matter, made even more so when patients with dementia in many instances may not be able to identify whether or not the clothes they are wearing are their own. This can distract a great amount of staff time and attention away from direct patient care to simply getting the right socks, underwear, and shirts to the right room and the right person. To an outsider, a patient wearing the wrong clothes may seem rather harmless. However, for the patient, this may cause a lack of dignity, and for their families, it may raise their suspicions over the level and quality of care that their loved one is being provided at that facility (bringing to mind the famous analogy from American airline entrepreneur Donald Burr that “coffee stains on the flip-down trays mean that we do our engine maintenance wrong”). From a health perspective, wearing other residents’ clothing could expose patients to potential skin allergies and also raise the likelihood that various skin-related conditions could be spread amongst patients. And today, there are rising concerns world-wide over more serious conditions such as MRSA (Methicillin-resistant Staphylococcus Aureus), a type of staph infection that is resistant to conventional anti-biotic treatment. MRSA can often be fatal, and it can spread rapidly amongst patients in hospitals and nursing homes, where the elderly and people with weakened immune systems are particularly susceptible to MRSA infection.
In Nottingham, England, the City Council has recently embarked on a unique initiative to assist persons living with dementia, providing a reassuring service for they and their family members that also helps ensure resident safety. The Nottingham City Council has implemented a program to promote more accurate clothing identification across five “Care Homes for Older People” in the community. At these care centers, clothing for approximately 150 dementia patients are now tagged with RFID-enabled buttons, provided by UK-based Tunstall (http://www.tunstall.co.uk/). The tags are designed both to be hardy for repeated washings and to be hard for anyone to intentionally remove. They are thus far more reliable than sewn-in nametags or permanent markings (which some older patients find demeaning) and the readers can enable laundry to be easily sorted, as the buttons identify each tagged article by the patient’s name, room number, and unit or wing location. The buttons can also be quickly reprogrammed as circumstances change. The program has received positive responses from the patients and their families, as well as kudos from the administrators and staff members of the Care Homes.
Finally, RFID has demonstrated potential to no just protect individuals suffering from dementia, but to help doctors diagnose the condition as well – and at earlier stages in the disease’s progression where more treatment options and interventions are available. A team of researchers from the University of South Florida, working in conjunction with RFID-start-up Silent Partner Technologies (http://www.silentpartnertech.com/), based in nearby Tarpon Springs, Florida, have successfully field-tested an RFID-based diagnostic system. Fourteen residents at an assisted-living facility in Tampa wore active RFID-tagged wristbands. The ante-room – through which residents had to pass to enter the facility’s dining room for their meal service – was equipped with RFID readers. Each participant’s movements were tracked as they repeatedly passed through the room for their breakfast, lunch and dinner meals. The goal was to precisely monitor the resident’s walking patterns, as wandering is a significant sign of the on-set of dementia. The HERMES – Health Research Management and Evaluation System, making use of sophisticated mathematical modeling and data mining the resident’s many movements over time, seeks to identify a person’s tendency to walk in a way other than in a straight-line when crossing the monitored walkway.
According to Silent Partner’s President, William Kearns, the system’s value is based on research showing that “variations in patterns of movement are indicative to pathological changes in the mind.” In the Tampa test, each participant was given a short mental fitness exam. The South Florida researchers found that participants whose mental exam results showed mild levels of cognitive impairment also were found to exhibit patterns of wandering in their movements through the monitored area, both consistent with the early stages of dementia. Thus, this patent-pending technology could enable hospitals and assisted living centers to not simply employ RFID to prevent those affected by dementia and Alzheimer’s from unauthorized movements or leaving the facility, but to aid health professionals in diagnosing the conditions at an early stage.
ANALYSIS
There are areas of concern among both members of the general public and health care professionals regarding the use of RFID in such assisted care and hospital settings that must be acknowledged. First, there is the issue of patient privacy. Indeed, academic commentators on the subject have observe that due to the proven ability of RFID to accurately track people in a wide variety of settings, the principal challenge in this case in not technological. Rather, the challenge is to be able to develop and implement systems that are sound and acceptable from both an ethical and legal perspective. Writing in the journal Surveillance & Society, Alison Marie Kenner of the Rensselaer Polytechnic Institute commented that: “Monitoring systems for dementia care call to mind similar products used for children or prisoners on house arrest. Like these groups, elderly citizens, and those with dementia in particular, are often in a position that makes them vulnerable.” Dr. Richard Nicholson, who serves as Editor of the Bulletin of Medical Ethics, recently commented that such tracking could be misused, stating: “The problem with this is that you could see second-class care – using it as a way of making life easier for carers (caregivers) rather than as a way of making life safer or more pleasant for the person with Alzheimer’s.” There are proposals in the United Kingdom and Australia for using RFID to identify dementia-affected persons outside of care facilities – ideas that have raised the level of concerns of privacy activists. Certainly, wearable RFID identifiers (such as patient wristbands or buttons) are far less invasive and permanent than any instance of implanting RFID devices in patients, which has only been done on a limited trial basis to date. Also, there are legal and ethical concerns over the inability to obtain informed consent from patients suffering from dementia for such an invasive procedure.
Finally, there has also been much discussion over the safety of RFID usage in health care amongst both health professionals and members of the wider research community since the publication of a study in the June 2008 issue of the prestigious Journal of the American Medical Association (JAMA). In their JAMA article, researchers from The Netherlands pinpointed concerns over potential electromagnetic interference between RFID and critical medical devices, such as pacemakers and ventilators. While their research showed interference in only a quarter of all tests they conducted an that disruptions were considerably more common with passive than active tags, the study spotlighted the importance of taking such concerns into account when designing in-hospital applications of auto-ID technology and potentially shielding medical devices, although much more study will be needed regarding the technological issues involved.
It is clear that RFID-based security systems for dementia patients will pay benefits to patients, to family members, to health care providers and facility administrators. As we have seen, RFID also makes possible new and innovate care and diagnostic tools for use in health care facilties. We are also seeing very interesting research and early investments in efforts to RFID-enable homes to make them more conducive for the needs of those with diminishing cognitive functioning. Thus, with the aging population and the rising number of cases of both Alzheimer’s and dementia, this will certainly be an area that will see a great deal of experimentation and activity by RFID solutions providers.
Biography
David C. Wyld (dwyld.kwu@gmail.com) is the Robert Maurin Professor of Management at Southeastern Louisiana University in Hammond, Louisiana. He is a management consultant, researcher/writer, and executive educator. His blog, Wyld About Business, can be viewed at http://wyld-business.blogspot.com/. He also serves as the Director of the Reverse Auction Research Center (http://reverseauctionresearch.blogspot.com/), a hub of research and news in the expanding world of competitive bidding. Dr. Wyld also maintains compilations of works he has helped his students to turn into editorially-reviewed publications at the following sites:
Management Concepts (http://toptenmanagement.blogspot.com/)
Book Reviews (http://wyld-about-books.blogspot.com/) and
Travel and International Foods (http://wyld-about-food.blogspot.com/).
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