Out-of-home behavior and cognitive impairment in older adults: findings of the SenTra Project.

This study explores differences in the out-of-home behavior of community-dwelling older adults with different cognitive impairment. Three levels of complexity of out-of-home behavior were distinguished: (a) mostly automatized walking behavior (low complexity), (b) global out-of-home mobility (medium complexity), and (c) defined units of concrete out-of-home activities, particularly cognitively demanding activities (high complexity). A sample of 257 older adults aged 59 to 91 years (M = 72.9 years, SD = 6.4 years) included 35 persons with early-stage Alzheimer's disease (AD), 76 persons with mild cognitive impairment (MCI), and 146 cognitively healthy persons (CH). Mobility data were gathered by using a GPS tracking device as well as by questionnaire. Predicting cognitive impairment status by out-of-home behavior and a range of confounders by means of multinomial logistic regression revealed that only cognitively demanding activities showed at least a marginally significant difference between MCI and CH and were highly significant between AD and CH.

Identifying Mobility Types in Cognitively Heterogeneous Older Adults Based on GPS-Tracking: What Discriminates Best?

Heterogeneity in older adults' mobility and its correlates have rarely been investigated based on objective mobility data and in samples including cognitively impaired individuals. We analyzed mobility profiles within a cognitively heterogeneous sample of N = 257 older adults from Israel and Germany based on GPS tracking technology. Participants were aged between 59 and 91 years (M = 72.9; SD = 6.4) and were either cognitively healthy (CH, n = 146), mildly cognitively impaired (MCI, n = 76), or diagnosed with an early-stage dementia of the Alzheimer's type (DAT, n = 35). Based on cluster analysis, we identified three mobility types ("Mobility restricted," "Outdoor oriented," "Walkers"), which could be predicted based on socio-demographic indicators, activity, health, and cognitive impairment status using discriminant analysis. Particularly demented individuals and persons with worse health exhibited restrictions in mobility. Our findings contribute to a better understanding of heterogeneity in mobility in old age.

Cognitive status moderates the relationship between out-of-home behavior (OOHB), environmental mastery and affect.

Studies on the relationship between behavioral competence, such as the competence of exerting out-of-home behavior (OOHB), and well-being in older adults have rarely addressed cognitive status as a potentially moderating factor. We included 35 persons with early-stage dementia of the Alzheimer's type (DAT), 76 individuals with mild cognitive impairment (MCI) and 146 cognitively healthy (CH) study participants (grand mean age: M=72.9 years; SD=6.4 years). OOHB indicators were assessed based on a multi-method assessment strategy, using both GPS (global positioning system) tracking technology and structured self-reports. Environmental mastery and positive as well as negative affect served as well-being indicators and were assessed by established questionnaires. Three theoretically postulated OOHB dimensions of different complexity (out-of-home walking behavior, global out-of-home mobility, and out-of-home activities) were supported by confirmatory factor analysis (CFA). We also found in the DAT group that environmental mastery was substantially and positively related to less complex out-of-home walking behavior, which was not the case in MCI and CH individuals. In contrast, more complex out-of-home activities were associated with higher negative affect in the DAT as well as the MCI group, but not in CH persons. These findings point to the possibility that relationships between OOHB and well-being depend on the congruence between available cognitive resources and the complexity of the OOHB dimension considered.

Can global positioning systems quantify participation in cerebral palsy?

This study examined whether motor-related participation could be assessed by global positioning systems in individuals with cerebral palsy. Global positioning systems monitoring devices were given to 2 adolescent girls (14-year-old with diplegic cerebral palsy and her 15-year-old healthy sister). Outcome measures were traveling distances, time spent outdoors, and Children's Assessment of Participation and Enjoyment questionnaires. Global positioning systems documented that the girl with cerebral palsy did not visit nearby friends, spent less time outdoors and traveled shorter distances than her sister (P = .02). Participation questionnaire corroborated that the girl with cerebral palsy performed most activities at home alone. Lower outdoor activity of the girl with cerebral palsy measured by a global positioning system was 29% to 53% of that of her sibling similar to participation questionnaires (44%). Global positioning devices objectively documented low outdoor activity in an adolescent with cerebral palsy compared to her sibling reflecting participation reported by validated questionnaires. Global positioning systems can potentially quantify certain aspects of participation.

Interplay of cognitive and motivational resources for out-of-home behavior in a sample of cognitively heterogeneous older adults: findings of the SenTra project.

OBJECTIVES: We examined in this study the hypothesis that cognitive resources are more closely linked with out-of-home behavior than motivational resources. METHOD: A cognitively heterogeneous sample of 222 older adults aged 59-91 years (M = 72.7; SD = 6.2), including 146 cognitively healthy persons and 76 persons with mild cognitive impairment-recruited in the German and Israeli arm of the SenTra project-was used for the analysis. Out-of-home behavior was assessed by means of global positioning system technology (time out of home; number of nodes visited) as well as by questionnaire (out-of-home activities). Mini-Mental State Examination and trail-making tests A and B were used to assess cognitive resources. Well-being, depression, and environmental mastery were assessed as motivational resources. RESULTS: Findings at the zero-order and latent variable levels confirmed that cognitive resources were more closely linked with out-of-home behavior than motivational resources. DISCUSSION: Findings support the view that well-being-related motivations to exert out-of-home behavior may become less important in old age because of the increasing cognitive resources required by such behavior.

Caregiving burden and out-of-home mobility of cognitively impaired care-recipients based on GPS tracking.

BACKGROUND: Out-of-home mobility refers to the realization of trips outside the home, by foot or by other means of transportation. Although out-of-home mobility is important for the well-being of older people with cognitive impairment, its importance for their caregivers is not clear. This study aims to clarify the relationship between caregiving burden and out-of-home mobility of care-recipients using Global Positioning Systems (GPS) technology. METHODS: Seventy-six dyads (care-recipients and caregivers) were recruited from a psychogeriatric center, where they underwent cognitive assessment, followed by psychosocial interviews at home. Care-recipients received GPS tracking kits to carry for a period of four weeks, whenever they left home. Mobility data and diagnostic and psychosocial data were examined in relation to caregiver burden. RESULTS: The strongest predictors of burden were care-recipients' lower cognitive status and more time spent walking out-of-home. An interaction was found between cognitive status and time spent walking in relation to caregiver burden. The relationship between walking and burden was stronger among caregivers of care-recipients with dementia than caregivers of care-recipients with no cognitive impairment or mild cognitive impairment. Care-recipients' behavioral and emotional states were also positively related to caregiver burden. CONCLUSIONS: The findings stress the importance of maintaining older persons' out-of-home mobility during cognitive decline.

Who should make the decision on the use of GPS for people with dementia?

OBJECTIVES: In recent years advanced technologies, such as Global Positioning Systems (GPS), allow for tracking of human spatial activity and provide the ability to intervene to manage that activity. The purpose of this study is to examine the issue of who should decide about the use of electronic tracking using GPS for people with dementia. METHODS: Based on quantitative data collected from 296 participants comprising cognitively intact elderly, family caregivers of people with dementia, social workers, other professionals, and social work students, study participants were asked to rate nine different potential decision-makers to make this decision. RESULTS: The results show that figures inside the family, particularly the spouse or the most involved family caregiver, were perceived more important in the decision-making process than figures outside the family, whereas the person with dementia was ranked third in the order of the figures. Since the decision to use GPS for tracking raises the ethical dilemma of personal safety versus autonomy and privacy of people with dementia, the findings seem to indicate that the reluctance of professional caregivers to assist family caregivers to make this decision is experienced as frustrating. CONCLUSIONS: The findings imply that in order to reach a balance between the wishes and interests of both people with dementia and their family caregivers, there is a need for more active involvement of the professional caregivers to facilitate the family decision-making process.

What do cognitively intact older people think about the use of electronic tracking devices for people with dementia? A preliminary analysis.

BACKGROUND: The issue of using advanced tracking technologies such as Global Positioning Systems (GPS) is part of a wider debate on the acceptability of assistive technology to older people with dementia. The use of GPS can enhance the personal safety of older people by alerting caregivers to potential dangers or adverse events that might threaten the individual's health and safety, but at the same time it raises ethical concerns. This study examines the attitudes of cognitively intact older people toward the use of tracking devices for people with dementia. METHODS: The analysis is based on quantitative data from a convenience sample (n = 42) and qualitative data gathered from two focus groups of cognitively intact older people in Israel. RESULTS: Whereas cognitively intact older people clearly differentiate between themselves and people with dementia, they support the use of tracking devices when dementia is either formally diagnosed or its signs are evident. They value the safety of people with dementia above preserving their autonomy. Although they perceive the decision to use tracking devices as an intra-family issue, they expect guidance from professional caregivers of people with dementia. The acceptability of tracking devices is dependent on their appropriate weight, size and ease of use. CONCLUSIONS: Cognitively intact older people favor the idea of tracking people with dementia. To facilitate family decision-making on the use of tracking devices, structured meetings guided by professionals and including persons with dementia and their family caregivers are suggested.

Families' and professional caregivers' views of using advanced technology to track people with dementia.

in this study we examined the ethical aspects of the use of the Global Positioning Systems (GPS) to track people with dementia. The findings are based on qualitative data gathered from focus groups of family and professional caregivers. The most important theme was the need to balance patients' need for safety with the need to preserve their autonomy and privacy. The main potential benefit of the use of GPS was related to the peace of mind of the caregivers themselves. The findings also suggest that caregivers' views change according to the locus of responsibility of the caregivers for the safety of people with dementia. The caregivers give preference to patients' safety more than autonomy when they are responsible for the patients. When the patients are under the responsibility of other caregivers, they give preference to patients' autonomy more than their safety. Overall, the variety and the depth of the views of different stakeholders toward the use of electronic tracking for people with dementia presented in this article provide a meaningful contribution to the ethical debate on this topic.

The use of advanced tracking technologies for the analysis of mobility in Alzheimer's disease and related cognitive diseases.

BACKGROUND: One of the more common behavioral manifestations of dementia-related disorders is severe problems with out-of-home mobility. Various efforts have been attempted to attain a better understanding of mobility behavior, but most studies are based on institutionalized patients and the assessment usually relies on reports of caregivers and institutional staff, using observational approaches, activity monitoring, or behavioral checklists. The current manuscript describes the research protocol of a project that measures mobility in Alzheimer's disease and related cognitive disorders in an innovative way, by taking advantage of advanced tracking technologies. METHODS/DESIGN: Participants are 360 demented persons, mildly cognitively impaired persons, and unimpaired controls aged > or = 65 in Israel and Germany. Data regarding space-time activities will be collected via a GPS tracking kit for a period of 4 weeks in 3 waves (one year apart) with the same participants (using a repeated measures design). Participants will be interviewed by use of a battery of instruments prior to and following GPS data collection. Further, a family member will complete a questionnaire both before and after data tracking. Statistical analyses will strive to explain differences in mobility based on a wide range of socio-structural, clinical, affect-related and environmental variables. We will also assess the impact of the use of advanced tracking technology on the quality of life of dementia patients and care givers, as well as its potential as a diagnostic tool. Systematic assessment of ethical issues involved in the use of tracking technology will be an integral component of the project. DISCUSSION: This project will be able to make a substantial contribution to basic as well as applied and clinical aspects in the area of mobility and cognitive impairment research. The innovative technologies applied in this study will allow for assessing a range of dimensions of out-of-home mobility, and provide better quality data.