Technology for safer walking has the potential to offer benefits to people with dementia and their carers in specific circumstances. But practical and ethical issues, and the concerns of people with dementia and their carers, have yet to be fully addressed.
Walking in a safe environment provides physical and psychological benefits for people with dementia. Walking usually represents a response to a need, such as boredom or discomfort.
However, some walking is associated with risk. This behaviour, known as “wandering”, is a compulsion to leave home that affects 15-60% of people with dementia (Robinson et al., 2007). Wandering exposes people with dementia to a significant risk of getting lost. One study found that 40% of people with dementia get lost outside their home (McShane et al., 1998). People with dementia can be confined at home, or moved to a care home, as a result.
Interventions may be required to reduce risks associated with walking. However, these should assist safer walking rather than prevent wandering, in order to balance minimising risk with maintaining personal freedom and the benefits of walking (Coltharp et al., 1996; Cohen-Mansfield and Werner, 1998).
Devices that have been developed to help people live more independent lives, known as assistive technology, can help with safer walking. Two types of technology may be used. First, an alarm system that is used to alert carers to the fact that an individual has moved outside a set boundary. Second, tracking devices to locate a person at any time or place.
Assistive technology has become more advanced, and affordable, in recent years. For more information on devices, please see www.atdementia.org.uk.
2. What the Society calls for:
- Protection of civil liberties. Technology may increase independence, allowing an individual more freedom, and reduce the need for more restrictive measures, such as locked doors. However, it also has the potential to restrict movement, particularly if an alarm system is used, and raises confidentiality and privacy issues. Tracking is associated with a loss of privacy, in particular (Hughes et al., 2002). Decisions about the appropriateness of technology should balance the benefits to the individual, and carers, with the potential infringement of a person's civil liberties.
- Informed consent. Safer walking can compromise a person’s privacy, autonomy and wellbeing and are subject to informed consent. Organisations that commission, refer or provide assistive technologies should have regard to NICE guidance and the Mental Capacity Act, in particular to Deprivation of Liberty Safeguards.
- Avoiding stigma. Using technology can increase the stigma attached to people with dementia due to the association with other types of tagging (Welsh et al., 2003). Technology, which is often used to protect retail products and prisoners, should not be transferred to people with dementia without considering the civil liberties issues outline above. In addition, Alzheimer’s Society suggests that the term “safer walking technology” should be used instead of “tagging” because of its association with the criminal justice system and that devices should be as discrete as possible.
- Support for people who live alone. About one-third of all people with dementia live on their own (Mirando-Costillo, 2010). Safer walking technology can help people with dementia to remain independent for longer and help carers monitor the person that they are caring for. However, use of this technology to support individuals who live alone is complex. Consideration must be given to what support a person with dementia would need to use the equipment properly and who would respond to an incident. It is vital that the use of technology is not a substitute for the provision of good quality, dementia-specialist home care services.
- Provision of high-quality care and support. The overarching principle of assistive technology is that it should be in the individual's best interests and personalised to meet their needs. It is vital that the use of technology is not a substitute for the provision of good quality, dementia-specialist home care and residential care services. This is a particular concern in care homes where cost pressures, and staffing levels, could result in the use of safer walking technology as a cost-saving measure.
- Effective response infrastructure. Effective use of safer walking technology requires an effective response infrastructure. This includes clear incident response plans and consideration of data protection and safeguarding issues. Standards for specialist telecare response services, such as the Telecare Services Association’s Code of Practice, establish standards for telecare response services. Purchasers and commissioners of safer walking technology should ensure that providers comply with all appropriate standards.
3. Sources and further reading
Robinson, L., Hutchings, D., Dickinson, H.O et al. (2007). Effectiveness and acceptibility of non-pharmacologica interventions to reduce wandering in dementia: a systematic review. International Journal of Geriatric Psychiatry, 22, 9-22
McShane, R., Gedling, K., Keene, J., Fairburn, C., Jacoby, R. & Hope, T. (1998). Getting lost in dementia. A longitudinal study of a behavioural symptom. International Psychogeriatrics, 10, 253-260
Coltharp, W. J., Richie, M. F., & Kaas, M. J. (1996). Wandering. Journal of Gerontological Nursing, 22, 5-10
Cohen-Mansfield, J., & Werner, P. (1998). The effects of an enhanced environment on nursing home residents who pace. Gerontologist, 38, 199-208
Hughes, J. C. & Louw, S. J. (2002) Electronic tagging of people with dementia who wander. British Medical Journal, 325, 847-848
Welsh, S., Hassiotis, A., O'Mahoney, G., & Deahl, M. (2003). Big brother is watching you - the ethical implications of electronic surveillance measures in the elderly with dementia and in adults with learning difficulties. Aging & Mental Health, 7, 372-375
Mirando-Costillo et al (2010). People with dementia living alone: what are their needs and what kind of support are they receiving? International Psychogeriatics, 22(4) 607-617
Last updated: January 2015 by Laurence Thraves
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