Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults

Summary

This paper discusses the use of a continuous and objective real-time locating system to measure walking activity associated with wandering behaviors, focusing on older adults with cognitive impairment. Walking activity is measured by walking distance, sustained walking distance, and sustained gait speed. Also assessed are gait quality and balance ability.

Abstract

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for wandering behaviors. The benefits of a RTLS are objective and continuous measurements of activity. Self-report methods of activity, especially wandering, by health care staff are vulnerable to floor effects and recall bias, and continuous clinical or research observation over the long-term can be time-consuming and expensive. Health care staff also fail to recognize the onset and/or duration of wandering behaviors, which are associated with a variety of adverse health outcomes in this population but amenable to intervention. RTLS technologies can measure the walking activity of institutionalized residents with cognitive impairment over time with a high degree of accuracy. This is particularly useful for the study of wandering, defined as walking for at least 60 seconds with few (if any) breaks in activity. Wandering is associated with disease progression, hospitalizations, falls and death. Previous work suggests older adults with poor balance ability and high sustained walking activity may be particularly susceptible to poor health outcomes. RTLS's are used to assess cognitive impairment and factors associated with gait and balance; however, supplemental paper and pencil gait/balance tools may be used to further refine risk profiles. This project discusses the use of a RTLS to measure walking activity and also gait quality and balance ability measures on this population.

Introduction

An older adult's ability to perform daily activities of daily living and be physically active is associated with gait quality and balance ability.¹ Previous work shows correlations between balance ability and self-reported physical activity among sedentary older adults.² These correlations remain across older adult populations. For example, among older adults in the community, self-reported activity levels are significantly correlated with balance³ and walking capacity;⁴ the physical activity of ambulatory long-term care residents is positively correlated with both gait....

Protocol

All methods described here have been approved by the Institutional Review Board at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia, PA.

1. Installation and Set-Up of a Real-Time Locating System (RTLS)

1. Review facility policies, safety, and personal information protections for residents with facility stakeholders. Determine whether written or verbal support on the use of RTLS in the facility is required. In discussions with stakeholders include local protocols and procedures (e.g., local facility technology waivers, union sign-off, etc.) and a project timeline.¹²
   NOTE: Upd....

Results

RTLS raw data require smoothing to improve the location data's precision (see protocol step 9 under the section, "Use the RTLS Tags to Locate and Track Residents in Real-Time"). Though controlled with default settings in the power plot tab during installation and set-up (see step 1.6.3 in the associated protocol), without additional smoothing there will continue to be noise and jumps. With regard to noise, even when sedentary for several hours, the active RTLS tag continues to log motion—.......

Discussion

There are several critical steps to be followed prior to beginning the RTLS project that are worth discussion. While a typical common area in a long-term care facility (about 10m x 13m or 1,000 square feet) requires four sensors, this varies based on the environment and the number of sensors required for the project are based on the level of precision required and the environment. Protrusions and glass walls, for example, will require additional sensors. If there are no line of sight issues, four sensors will cover an ev.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
UWB Sensor	Ubisense		There are two product lines to choose from; IP30 is the latest
Tags	Ubisense		There are two types of tags to choose from; if IP30 sensors are chosen, use DFLAT33 mini tags
Timing Distribution Unit	Ubisense	UBITIMING
Network and Timing Combiner	Ubisense	UBICOMSPL21
Home Base License	Ubisense	HOMEBASE
Expert Support	Ubisense	MANDS2
Project Implmentation Services	Ubisense	PROJSERV
Smart Factory	Ubisense		specialized software designed to manage the RTLS
Server	Any		Laptop with at least 8MB RAM
Network Cabling	Any		3rd party or subcontract
Tinetti Performance Oriented Mobility Assessment			Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. The American journal of medicine. Mar 1986;80(3):429-434
The Montreal Cognitive Assessment			https://www.mocatest.org