Gail K. Auslander

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

BackgroundOne 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 Alzheimers disease and related cognitive disorders in an innovative way, by taking advantage of advanced tracking technologies.Methods/designParticipants are 360 demented persons, mildly cognitively impaired persons, and unimpaired controls aged ≥ 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.DiscussionThis 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.

Social Networks, Social Support, and Self-Ratings of Health among the Elderly:

Social networks and the support they may provide have been shown to be important determinants of the health of the elderly. This study compares structural and support aspects of those networks in their relationship with self-latings of health among 200 elderly residents of the city of Jerusalem. Perceived social support was found to be a more important predictor of health than were measures of network structure. Further, the relation between support and health was a function of the relation between support and both psychological state and functional status.

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.

Sociability and Patterns of Participation: Implications for Social Service Policy

In policy circles, a response to meeting human needs through social networks and voluntary organizations is increasingly viewed as a substitute for publicly provided services. While prior research suggests that participation in these two types of voluntary activity may be related, the relationship is little understood. A secondary analysis of national survey data was carried out using bivariate and multivariate techniques to ascertain the relationship between indicators of voluntary organiza tion participation and close personal ties, as well as certain demographic charac teristics. Findings suggest that persons with a greater number of close personal ties will also participate in more voluntary organizations. Implications for policymaking are discussed.

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.

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.

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 individuals 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.

Disability terminology in the media: a comparison of newspaper reports in Canada and Israel

The terminology used to refer to persons with disability may both reflect and influence attitudes towards them. Negative references may perpetuate negative attitudes and stereotypes. This is of particular importance in the mass media which reaches a broad spectrum of the population. This study looked at disability terminology used in major newspapers in Canada and Israel. It focused on the nature of that terminology and whether its use was related to other factors, such as the disability model reflected in the article, the content of the article (e.g. attributes of the disabled person) and its context (e.g. type of newspaper, feature versus news items). Overall, the use of inappropriate terminology of varying types was quite prevalent in both countries. In addition, in Canada there were a considerable number of articles which had no direct reference to the disability. In general, the terminology used was considerably more positive in articles dealing with individual persons with disabilities (as opposed to groups), with disabled children and with problems of mobility and rights. The results of the study indicate that the choice of terminology cannot be explained by journalistic expedience and conciseness alone.

The Use of Tracking Technologies for the Analysis of Outdoor Mobility in the Face of Dementia: First Steps into a Project and Some Illustrative Findings From Germany

As people age in place, cognitive impairment is a major threat to maintaining out-of-home mobility. The SenTra project measures outdoor mobility by taking advantage of tracking technology in an interdisciplinary project involving researchers from geography, social work, gerontology, psychology, and medicine disciplines. The project assesses mobility patterns of urban-dwelling demented and mildly cognitively impaired elders and cognitively intact persons over a period of 3 years in Israel and Germany. The main objectives are to learn more about out-of-home mobility by means of global positioning system/geographical information system technology, to analyze the relationships between cognitive functioning, mobility behavior, and well-being, to examine the ethical implications of the use of advanced tracking technologies in this population, and to assess the potential of tracking technologies in the diagnosis of various types of cognitive impairment. The article presents preliminary findings to illustrate the potential of interdisciplinary data analyses to be performed later in the project. Pilot data were drawn from a combined psychiatric, psycho-social, and tracking data assessment of a group of 19 men and women between 63 and 80 years of age (7 who were healthy, 6 who were mildly cognitive impaired, 6 who were demented) living in Germany. The findings revealed that healthy participants have better health and higher levels of well-being and smaller networks compared to elders who are cognitively impaired. Examples of daily outdoor trips indicate meaningful mobility patterns and the need to combine psycho-social and geographical data to understand the relationships between outdoor mobility, socio-structural dimensions, behavior patterns, and well-being. By achieving its aims, the project will be able to make a substantial contribution to basic, applied, and clinical knowledge gaps in the area of mobility and cognitive impairment research.

Newspaper Coverage of People with Disabilities in Canada and Israel: An international comparison

In this research study we compared how three Canadian and three Israeli newspapers wrote about people with disabilities over a 3-month period. The comparison included structural variables, such as the length of the articles, where they appeared, whether photographs were used, etc. We also examined content variables, such as who the main character was, the details used to describe this individual or group, and what governmental agencies, service providers and problems were mentioned. Finally, we looked at whether the article was progressive, traditional or mixed in its perspective. Our findings showed a number of significant differences between Canada and Israel. Equally noteworthy, however, were the considerable similarities, such as frequent problems with finances and services, and most of the articles being traditional in focus. The paper concludes with an analysis of the newspaper business and the implications of this for altering the image of disabled people in the media.