Miyae Yamakawa

Feasibility study of the integrated circuit tag monitoring system for dementia residents in Japan.

Videotaping, direct observation, and biomechanical devices have been used to measure the wandering behavior of institutionalized people with dementia and to identify patterns of movement. Owing to technical limitations, the variability in movement patterns or the distance traveled could not be examined. The present study examined the feasibility of an integrated circuit tag monitoring system to monitor the movement patterns of Japanese dementia residents. This system generated the following data: the frequency of detection by each receiver, the duration of stay in each location, the cumulative distance walked per day, and the graphic display of the movement pattern. This new system offers objective measurements of ambulation in time and space, which can be used to characterize demented patients and to evaluate the effects of treatment and care.

Temporal Patterns of Movements in Institutionalized Elderly With Dementia During 12 Consecutive Days of Observation in Seoul, Korea:

Background: The availability of increasingly sophisticated technology has meant that ambulation can be measured with precision over an extended period. Methods: An integrated circuit tag-monitoring system was set up to measure the distance moved in a dementia care unit in Korea in 2006. Various indicators were developed to measure temporal patterns of ambulation over time, such as the median distance moved per hour and the percentage of hours moved. Results: 12 consecutive days of movement data were available for 8 subjects. The mean age of the subjects was 76 ± 5.3 years. The median distance walked per day ranged from 206 to 976 m, and the percentage of hours with movement ranged from 28% to 81%. The changes in the activity level during daytime, evening, and nighttime also differed among the 8 subjects. Discussion: The indicators developed appeared to differentiate temporal patterns of movement in demented persons.

Pacing and lapping movements among institutionalized patients with dementia.

Wandering is a complex behavior, and defining wandering has been challenging. The current study used the integrated circuit (IC) tag monitoring system to describe the distance moved per day and the spatial movements of patients with dementia. The study was conducted in a 60-bed semiacute dementia care unit in a general hospital in Japan over a 3-month period in 2006. The distance moved per day, the numbers of pacing and lapping movements, and the proportions of the distance moved that was paced or lapped were tabulated in 23 patients diagnosed with dementia. The distance moved per day and the numbers of pacing and lapping movements varied greatly within and among study participants. The median distance moved per day was inversely correlated with participants’ age and Mini-Mental State Examination (MMSE) scores (adjusted r2 = .34, P = .01). Consecutive lapping and pacing movements were rare patients with in Alzheimer’s disease (AD), while 2 patients with frontotemporal dementia paced or lapped repeatedly.

Comparing dementia patients’ nighttime objective movement indicators with staff observations

Background:  Pharmacological and non‐pharmacological approaches are commonly used to treat patients’ institutionalised for nighttime wandering. Actigraphy and other scales have been used to evaluate the efficacy of these treatments. However, in clinical settings, nursing records are often the sole source of daily observation of nighttime wandering. Thus, physicians rely on nursing records to evaluate pharmacological and non‐pharmacological treatments. This study examined nighttime movements of patients with dementia, comparing the results of integrated circuit tag monitoring with hourly nighttime nursing records. We tested which factors were associated with agreement rates between the two data sources.

Automatic Identification of Apnea Through Acoustic Analysis for At-Home Screening

OBJECTIVE Although many studies have analyzed breathing sounds in the diagnosis of obstructive sleep apnea syndrome, the recording of snoring sounds at home is hampered by the various background noises of daily life. Recordings also frequently include talking during sleep, which may infringe the privacy of patients. MATERIALS AND METHODS A recording system used a bone conduction microphone to record snoring sounds. This microphone reduced background noise. A simple system transmitted recorded breathing sound data for screening at a hospital as envelope data instead of complete sound recordings, thereby decreasing data volume and protecting privacy. RESULTS In periods in which blood oxygen levels (SpO₂) were drastically decreased, the probability of apnea as deduced from the envelope curve of breathing sounds was consistent with SpO₂ values. CONCLUSIONS This method provides a basis for telemonitoring of sleep apnea syndrome.

Association between activity level and changes in bodyweight in dementia patients

Introduction:  Bodyweight is routinely used as an important health assessment measure in care facilities. Recently, the integrated circuit (IC) tag monitoring system became available for measuring the distance walked by patients with dementia (PsWD) over an extended period. The main objective of the present study was to examine an association between the distance walked and changes in bodyweight in PsWD.

Changes in activity patterns after the oral administration of brotizolam in institutionalized elderly patients with dementia

Background:  Little is known about the side effects of sedative‐hypnotic agents in elderly dementia patients with sleep disorders. The present study describes activity pattern changes after a single dose of brotizolam in elderly patients with dementia.

Potential underreporting of medication errors in a psychiatric general hospital in Japan.

The purpose of this study was to explore a pattern of underreporting within a psychiatric general hospital in Japan. All the medication errors reported online in 2010 were analysed. This research was approved by the university and the study hospital. There were 651 incidents related to medication errors. Medication error rate per 1000 patient days was 2.14 (range: 0.45-6.05). Medication error rates between two acute care wards with comparable case and staff mix differed. A low proportion of intercepted near-misses and low medication error rates around mealtime in acute care 1 were suggestive of under-reporting. Two dementia care wards with low medication error rates had no report of intercepted errors, which was also suggestive of underreporting. Ward-specific medication error rates and patterns are useful to identify wards with potential underreporting of medication error within the hospital.The purpose of this study was to explore a pattern of underreporting within a psychiatric general hospital in Japan. All the medication errors reported online in 2010 were analysed. This research was approved by the university and the study hospital. There were 651 incidents related to medication errors. Medication error rate per 1000 patient days was 2.14 (range: 0.45–6.05). Medication error rates between two acute care wards with comparable case and staff mix differed. A low proportion of intercepted near-misses and low medication error rates around mealtime in acute care 1 were suggestive of under-reporting. Two dementia care wards with low medication error rates had no report of intercepted errors, which was also suggestive of underreporting. Ward-specific medication error rates and patterns are useful to identify wards with potential underreporting of medication error within the hospital.

Caring for early-onset dementia with excessive wandering of over 30 kilometres per day: a case report

Excessive wandering in people in dementia is associated with a severe care burden. However, the quantification of excessive wandering has not been described, and its cause and treatment have not been evaluated with objective measurements to date. The purpose of this study was to evaluate pharmacological treatments and non‐pharmacological interventions to reduce excessive wandering in an early‐onset Alzheimer disease patient with objective indicators. Wandering was quantified using an integrated circuit monitoring system that measured the distance moved and the location of the patient. Monitoring was conducted in the dementia ward of a general hospital in 2012. Sleep quality was measured by non‐wear actigraphy. The study was approved by the ethics committees of the Osaka University School of Allied Health Science, and of the study hospital. The case involved a 62‐year‐old woman diagnosed with early‐onset Alzheimer disease and hospitalized in 2012 because of irritability and agitation; her Mini‐Mental State Examination score was 5/30 and her Clinical Dementia Rating score was 3. When olanzapine (2.5 mg) was prescribed, she developed insomnia, and her wandering movements increased from 10 to 20 km/day. On some days, it exceeded 30 km/day, and she walked most of the night. She did not experience weight loss or physical exhaustion, but she sustained a minor injury in her left sole. Olanzapine was increased to 7.5 mg, but these problems persisted. Nursing staff discovered triggers for wandering and insomnia, including high sensitivity to odour and noise in the living room or her room. When the environment was changed to meet her needs, the distance moved per day decreased to <15 km and the sleep disturbances disappeared. This case demonstrated the difficulty in assessing the degree of ambulation and sleep disorder. Objective indicators are essential in evaluating the effectiveness of pharmacological and non‐pharmacological interventions.

Discrepancy between subjective and objective assessments of wandering behaviours in dementia as measured by the Algase Wandering Scale and the Integrated Circuit tag monitoring system.

Although wandering is one of the major research focuses of the behavioural psychological symptoms of dementia, assessment of wandering has mostly relied on caregiver‐administered questionnaires. The purpose of this study was to compare staff‐administered Algase Wandering Scale outcomes with objective temporal and spatial movement indicators obtained from the Integrated Circuit (IC) tag monitoring system.