Geographic localisation and safe monitoring of Alzheimer patients - Geoloc

Warum wurde diese Initiative implementiert?

‘Alzheimer’s wandering’ carries a high risk for patients who are disorientated in time and space. As soon as they move away from their usual environment, they will feel lost and unable to find their way back. Due to potential lack of supervision and in order to avoid adverse events, families or professional care staff may have to restrain such patients. As a consequence many Alzheimer’s patients are not allowed to move freely. This may reduce the risk of adverse events, but it may also further reduce their physical and mental health status and quality of life. Physical or pharmaceutic restraints may also be seen as a form of ‘ill treatment’. Another issue is that family members should be able to continue carrying on with their routine activities and maintain a reasonable level of quality of life, rather than experiencing constant anxiety regarding the safety of their relative. It therefore becomes important to find solutions for Alzheimer’s patients, families and/or for professional staff to allow users to move as freely as they want and, if they get lost, to be found safely and quickly. 

Beschreibung

The initiative started in 2009 and has since been available all over France. Once the family or the staff/management of a care home applies for the service, a technician will visit the potential user’s living environment to check whether there is a need. He will then explain to everyone involved how the system works and what are its underpinning ethical principles. One way of assessing the capacity of the family to use the system will be to define the usual walking pattern of the patient with the help of the family, and search for the best balance between freedom and safety. Enlarging the area too much would increase the risk of adverse effects, while restricting it would reduce risks but trigger more false alarms at the expense of the user’s freedom to move. Once the patient and family have agreed, the technician will check that the GPS/GPRS localisation system works well in the appropriate area.

The monitoring process consists of a ‘passive’ and an ‘active’ trigger. Passive triggering relates to cases when the patient, wearing a special bracelet with GPS/GPSR software inside, moves away from the defined zone – the system then will send repeated signals to the call centre. Staff will get in touch with one of the contact people to check whether an investigtion is needed. The contact person is verified as legitimate through a security code and a return call. It may happen, for example, that the user is being accompanied but the call centre has not been informed in advance, so no further action would be taken.

But in cases of wandering unaccompanied, once the patient has been located as being or moving outside his/her defined walking zone alone, s/he is traced by staff at the call centre until the location is accurately determined. Then one of the contact people will be called and informed where the patient is or in which direction s/he is moving.

Active triggering will be applied when, for instance, a family member cannot find his/her relative. S/he may then contact the call centre and ask them to locate the user.

In domestic environments it is usually the family that pays for the service. Patients with low income are entitled to a lower tariff, sometimes with a co-payment from agencies involved in LTC regulations. Equinoxe rents the technical devices (69 euros for a three month renewable period) and provides maintenance on a regular basis (defective devices are replaced with no extra charge).

All staff members (technicians, managers, call centre staff) are very aware of the family and user’s living situations. They have been trained in how to support them and specific training regarding the target population has been put in place in 2011.

Welche Effekte wurden erzielt?

By July 2011 the organisation (Equinoxe) had installed 360 devices while only 168 were active. The average period of time for which the system is used amounts to 9.3 months (278 days) only. This is due to users’ deterioration in health status which meant that either  the system was not appropriate any more, and/or the patient was transferred to residential care. In no single case was the system abandoned due to family members’ complaints. In five cases, the patients did not like wearing the bracelet any more.

The results of the first 18 months (1 January 2009-30 June 2010) revealed that 231 requests were answered positively: 56% of users were women, most users were between 75 and 79 years of age.

A majority of users lived in care homes (63%), a fact that indicates the low level of information provided to families concerning the existence and availability of such a service. However, requests were in many cases triggered by family members (44%), frequently after a first loss episode (50%). Most areas covered were located near big cities (Paris, Lyon).

2,841 calls were received (158 per month) with a peak during summer time and between 9 and 11 am and 2 and 4 pm.

Passive triggering accounted for 73.5% of cases, but only 30% of these entailed an investigation with an average of 50 minutes between the call and the patient’s return to his/her usual environment. 21.7% of all cases were active triggering – with an even lower average ‘recovery time’ (13 minutes).

The remaining 4.8% of cases were alerts to the call-centre where the patient was left alone outside of his/her zone.

Even in cases when the call centre lost the signal (Faraday effect), the system was able to relocate the patient after a delay which did not lead to adverse events.

A qualitative survey conducted by the organisation in 2010 showed that families using this system and living at home with a user had experienced difficulties and delays accessing information about service availability. Information came more frequently by word of mouth, contrary to families with patients in residential care as professional staff are more aware of its existence through professional exchange.

Worin bestehen die Stärken und Schwächen der Initiative?

Strengths

The system is efficient in retrieving patients on a technical and practical level, whether passively or actively triggered.

There is a strong commitment to ethical principles which assure an appropriate use of the system by limiting the risk of being used by families against its intended purposes.

There are high levels of staff training and commitment to the service’s mission; and to their ability to assess the capacity of the family to carry the risk of user’s freedom.

Limitations  

Technical inconveniences are very limited. They consist of the following features:

• Not all geographical areas are covered (white areas) and the operating system of one mobile phone company is not compatible with the Equinoxe system. 
• The software battery included in the bracelet must be checked every day in order to insure it permanently functions. Poor functioning may result in patients refusing to carry the bracelet leading families withdrawing from the service (less than 3%).

Other limitations come mostly from deficits within the French LTC system:

• There is lack of information for families and even care homes regarding the system availability and functioning as it is poorly marketed. Information is currently being transferred mostly by word of mouth (the website has just been renewed).
• According to the French assessment tool, the disability levels of Alzheimer’s patients is often rated as low, which does not entitle them to public funding.
• As preventative policies are only emerging, there is no public support for this initiative, except for limited local areas.
• Potential funding bodies (not-for-profit insurers, retirement agencies) are only beginning to cover some of the user’s costs.

Opportunities

The organisation is testing the efficacy of the system for people with a physical disability who could use the bracelet as an emergency alarm button when they need help and are alone.

Impressum

Externe Links und Literatur

• Equinoxe -GEOLOC (2011) Bilan du 01/2009 au 30/062011
• http://www.equinoxe-france.com/fr/geolocalisation
• Alzheimer wandering patients 
• Thomson Dennis (dec 2006) Strategies to deal with an Alzheimer patient who wanders 

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