Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults
February 8th, 2019
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.
Healthcare staff cannot distinguish between physical activity and wandering, and only identify wandering when a patient is at risk for leaving the facility. Changes in walking activity are associated with cognitive impairment, falls, wandering, and other poor health outcomes. The real-time locating system continuously and objectively tracks walking activity.
This includes beneficial physical activity as well as wandering. Wandering is pattern walking that's associated with poor health outcomes. Before assigning a tag to a resident, open the Tag Association tab in the real-time locating system graphic use interface and assign a unique patient ID number to each consenting ambulatory or foot-propelled resident at random.
Use the number provided on each tag to link a tag with each patient ID for wireless tracking, leaving the tag positions at origin and confirming that Allowed tag swaps is selected. Choose the type of tag, the mini tag, and click Save. In Location System Config, click View trace messages.
Then, Get trace messages to make sure the system is recording events from the tags. Under the Sensor status tab, confirm that all of the sensors are running. In Location System Config, click Review location events.
In the window, click Start listening to gather data in real time from tags. To turn on a tag, hold the magnet under the right side of the tag until the light begins to continuously blink. Then attach the activated tags to an area of the body of each resident with a small cross-sectional area for a more limited absorption of the radio frequency energy and to provide a better tracking accuracy.
Once a day, visually check all of the sensor light indicators on the real-time location system sensors and tags and all of the system supplementary equipment, and confirm that the tags have not been submerged in water. Also daily, open the Map tab in the graphic user interface of the system and check that all of the tagged residents are visible and being tracked. To view more immediate events, use the Used last button in the Location System Config to adjust the amount of trace data.
Set the time to the last 10 or fewer minutes, and click Start listening. When batteries are replaced, click on the associated tag and the Tag battery replaced button in the right-hand corner of the Smart Space Config. If a resident is missing from the tracking area and they are wearing an active tag, the report function can be used to determine the last time the resident was seen by the system by clicking on the daily, weekly, and monthly reports.
Here, the travel of one resident over the course of a 24-hour period is shown. It is important to check that there are no jumps through walls and that all of the stationary activity is recorded without jumps. Given that the walking distance is a measure of all of the walking activity and that the sustained walking distance is measured only when the resident walks for at least 60 seconds, it is important to confirm that the walking distance mean data is higher than the sustained walking means for all of the tracked residents.
Supplemental paper and pencil, cognitive, and getting balance tools can be used to further refine patient risk profiles. Real-time locating systems can provide continuous and objective measures of walking activity, predictive of falls, wandering, and other adverse events in high-risk patient populations.
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Overview
This paper discusses the use of a continuous and objective real-time locating system to measure walking activity associated with wandering behaviors in older adults with cognitive impairment. It assesses walking distance, sustained walking distance, sustained gait speed, gait quality, and balance ability.
Key Study Components
Area of Science
- Neuroscience
- Behavioral Health
- Geriatrics
Background
- Healthcare staff often struggle to differentiate between physical activity and wandering.
- Wandering is linked to cognitive impairment and poor health outcomes.
- Changes in walking activity can indicate risks such as falls and wandering.
- A real-time locating system can track walking activity continuously and objectively.
Purpose of Study
- To measure walking activity in older adults with cognitive impairment.
- To differentiate between beneficial physical activity and wandering behaviors.
- To assess the impact of walking activity on health outcomes.
Methods Used
- Implementation of a real-time locating system for tracking walking activity.
- Measurement of walking distance, sustained walking distance, and gait speed.
- Assessment of gait quality and balance ability.
- Tagging residents with unique patient ID numbers for tracking.
Main Results
- The system provides continuous data on walking activity.
- It helps identify patterns of wandering associated with cognitive impairment.
- Walking metrics can inform healthcare staff about patient risks.
- Data can be used to improve patient care and safety.
Conclusions
- The real-time locating system is effective in monitoring walking activity.
- It aids in distinguishing between beneficial activity and wandering.
- Findings can enhance understanding of health outcomes in older adults.
Frequently Asked Questions
Executive Industry Relevance
Objective, continuous measurement of walking activity enables differentiation between beneficial physical activity and pathological wandering in cognitively impaired populations. This supports early risk stratification for falls, hospitalization, and disease progression in aging research. Real-time locating systems provide quantifiable endpoints for evaluating interventions targeting mobility-related adverse outcomes in long-term care settings.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Scientific Value: Enables interrogation of therapeutic hypotheses linking sustained walking activity to cognitive decline and adverse health outcomes.
- Operational Value: Provides continuous, unbiased behavioral phenotyping to reduce reliance on subjective staff observations prone to recall bias.
Screening & Assay Development
- Scientific Value: Generates standardized, high-resolution walking distance and sustained walking metrics for assay validation in geriatric models.
- Operational Value: Supports scalable, reproducible tracking across cohorts for longitudinal screening of mobility-associated risk factors.
Translational & Preclinical Research
- Scientific Value: Facilitates disease-relevant system validation by correlating RTLS-derived gait and balance metrics with cognitive impairment progression.
- Operational Value: Enables translational continuity from observational aging studies to preclinical models of neurodegeneration through standardized activity quantification.
Pipeline & Workflow Integration
The method positions within discovery biology to support hypothesis testing of wandering as a biomarker of neurodegenerative risk, informing go/no-go decisions in target validation.
- Discovery Biology: Supports pathway clarification by quantifying walking patterns associated with cognitive impairment and fall risk.
- Screening: Delivers assay-ready, quantitative walking activity outputs for high-throughput behavioral screening in aging models.
- Analytics: Provides sustained walking distance and gait speed readouts that enable statistical comparison of intervention effects on mobility.
- Translational Research: Connects to biomarker alignment by linking RTLS measures to gait quality and balance assessments for risk profile refinement.
- Enterprise Reuse: Establishes a reusable platform for continuous behavioral monitoring across aging, neurology, and geriatric pharmacology programs.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in target validation by reducing mechanistic ambiguity in wandering behavior etiology.
- Operational Value: Ensures standardization and reproducibility of walking activity measurement across sites and studies.
- Strategic Value: Improves go/no-go decisions by enabling early detection of mobility-related risk signals in preclinical and clinical cohorts.
- Portfolio Impact: Supports risk-adjusted prioritization of compounds targeting neurodegenerative pathways through objective functional endpoints.
Implementation Considerations
- Requires expertise in geriatric behavioral assessment and sensor-based tracking systems.
- Needs infrastructure for wireless tag deployment, signal validation, and continuous data monitoring.
- Demands cross-team standardization of tag attachment protocols and data interpretation between care staff and researchers.
- Involves adaptation considerations for varying resident mobility levels and environmental constraints in long-term care facilities.
- Includes practical limitations such as signal interference in complex indoor environments and tag durability during daily resident activities.
