Alzheimer Disease (AD) has major implications on patient safety and care. The elderly Alzheimer’s patient encounters risk of losing their memory capabilities and are unable to live a normal life accordingly. The short memory may lead them to wander aimlessly and danger. Hence, the Alzheimer’s patients need to be monitored closely to ensure their safety. In this paper, an assistive technology tool called Alzheimer’s Real Time Location System (ARTLS) was developed. The system tracks all the patients instantaneously in real time and helps in analyzing patient spatial movement for enhancing their care management. As a general result, ARTLS relieves the caregiver’s burden and enhances patient’s safety by close monitoring of the wandering movements of the patients in real time.
KeywordsAlzheimer’s patients, assistive technology, care management, real time monitoring, safety.
1. Institute of Gerontology, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
2. Department of Biological and Agricultural Engineering, Faculty of Engineering, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
3. Department of Civil Engineering, Faculty of Engineering, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
RecievedSep 24 2013 AcceptedNov 6 2013 PublishedNov 13 2013
CitationMohd Fadhil Abuhan, Abdul Rashid Mohamed Shariff, Azadeh Ghiyamat, Ahmad Rodzi Mahmud (2013) Tracking Elderly Alzheimer’s Patient Using Real Time Location System. Science Postprint 1(1): e00005. doi:10.14340/spp.2013.11A0002
Copyright©2013 The Authors. Science Postprint published by General Healthcare Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 2.1 Japan (CC BY-NC-ND 2.1 JP) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
FundingThis research was supported partially by the UPM Research University Grants Scheme (RUGS) number 05-04-08-0547RU.
Abdul Rashid Mohamed Shariff: Supervisor of the research.
Ahmad Rodzi Mahmud: Co-supervisor of the research.
Azadeh Ghiyamat: Assisting the project and preparing it for submitting to this journal.
Mohd Fadhil Abuhan: The person who have done the research.
Competing interestThe authors declare no conflict of interest.
Ethics statementThis research protocol has been approved by UPM medical research ethics committee for not involving any ethics issues.
Corresponding authorAzadeh Ghiyamat
AddressInstitute of Gerontology, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
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Nowadays, elderly aged 60 and over is a fastest growing age group. This is due to the life expectancy of those age groups is increasing by years. According to World Health Organization (2002), in between the years 1970 and 2025, a growth of about 223% or 694 million elderly is expected globally. It is also expected by the year 2025, elderly aged 60 years old and above will total up to 1.2 billion people and by the year 2050 this will be up to 2 billion people. 80% of these elderly populations are expected to come from the developing countries.
The rising number of elderly also contributes to the rising of a number of chronic diseases affecting the elderly such as Alzheimer Disease (AD) that can lead a person to gradually lose his basic abilities to live the daily life accordingly. The basic abilities include the short and long term memory, orientation, judgement, thinking and concentration (Gruetzner, 2001). One of the effects of AD patients is in jeopardy as the patients tend to wander aimlessly in worst scenario.
It was reported by Prince, Bryce, & Ferri, (2011), 36 million people worldwide are estimated to be affected by AD. The numbers will double every 20 years to 66 million by 2030 and 115 million by 2050. Low and middle income countries have higher increases of AD numbers with 58% and expected to rise up to 71% by 2050. Malaysia is listed as the middle income country and thus Malaysia is an aging country that has many elderly Alzheimer’s patients.
According to Department of Statistics Malaysia (2010), the total population in Malaysia based on 2010 census is 28.3 million. World Health Organization (2012), reported that the elderly aged 60 years old and above make up to 8% of Malaysia’s population, and the annual growth rate from 2000 to 2010 of this group was 1.9%. According to World Health Organization (2009), Malaysian life expectancy at 60 years old is 18 years. This means that on average, the elderly can live up to 18 years old.
The prevalence rate of dementia or AD was at 14.3% based on population studies of 2,980 people Malaysian communities aged 60 years and over (Hamid, Krishnaswamy, Abdullah, & Momtaz, 2010). According to World Health Organization (2008) that about 28 elderly out of 1,965,462 elderly aged 60 years and above in Malaysia is estimated to have died due to AD and other dementia.
Elderly Alzheimer’s patients and their caregivers will encounter extreme challenges as the disease progressively deteriorates with time. Many challenges must be faced such as the cost of AD care. The quality of life also diminishes such as the ability for both patients and caregivers to socialize with others. For the community and the country, the AD is a public health problem that may affect the economy and advancement of the nation.
This enormous public health problem needs to be surmounted wisely. The elderly Alzheimer’s patients face many problems and need to be assisted by the caregiver for their life survival. Monitoring the movements of the Alzheimer’s patients by the caregiver is very important.
Some Alzheimer’s patients are sent by the primary caregiver such as the patient’s family members to the Alzheimer day care center for day care to reduce the primary caregiver’s burdens. The day care center cannot always give good and close care services to the residents because the number of day care center personnel is outnumbered by the entire residents in the day care center. So, the crucial measure in helping the caregiver in caring the patient closely is to provide an assistive technology for the caregiver to monitor closed the patients in real time. This is the gap that can be filled and can help to improve the quality of life of the caregiver and the AD patient.
A tracking system meant for real time monitoring in preventing the Alzheimer’s day care center residents from danger can be a solution in reducing these caregiver burdens. The tracking system should be suitable to support the residents and not interfere with the resident’s daily routine and privacy.
It is common in our society that elderly people would have memory problems due to age. The memory problem is called a dementia. Dementia can lead to the intellectual capabilities losses, disabilities of occupational and social functioning. The dementia can be caused by the most common neurological disease known as the Alzheimer’s disease (AD) (Gruetzner, 2001). The AD was named after an AD founder, a German neurologist named Alois Alzheimer (Terry, Katzman, & Bick, 1994).
Elderly aged 60 years old and above is a common group age affected by AD. The Alzheimer’s patient will have impairments of memory, emotional decline and cognitive disorientation. Alzheimer’s disease is a disease that can lead a person to gradually lose his basic abilities to live the daily life accordingly.
The AD patients will have deficits in many areas. The patients will lose their long term and short term memory capabilities that lead to behavior problems such as wandering. In the worst scenario, the patient may wander around without an awareness of danger in their surroundings and it may endanger their life. The patients’ judgement may drastically diminish and the intellectual abilities gradually lost. This will lead to reasoning problems among these patients. Ultimately the patients will suffer from depression and hallucination (Gruetzner, 2001).
The AD has no recovery and the rate of deterioration of patient cognitive abilities is slow and varies. An in-depth understanding of AD can help in the preparation of adjustments to be made for the patient by the caregiver. Through this understanding, the caregiver can have better expectation to ease the patient adjustment as the disease progresses. This would help the caregiver to gradually accept the effect of the disease on the caregiver themselves.
Wandering can be a crucial issue facing the Alzheimer’s patient. The Alzheimer’s patient would wander aimlessly because of the impairments they have. The AD causes the patients having difficulty in determining the purpose of the wandering activity they do. This wandering behavior may lead to dangerous outcomes of the patients over time. The patient may wander for common responses or because of being disoriented and lost (Gruetzner, 2001).
Real Time Location System (RTLS) is a system using a device in tracking and locating of tagged items wirelessly in real time (Lee, Liu, Chong, Tay, & Leong, 2009). The tagged items would either be the people or assets that are being attached with a tag or known as a transponder. RTLS can be used to track those tagged items at several levels such as at local, national and global level (Malik, 2009).
The RTLS can locate people in demand, protect people, monitor people’s movement, provide emergency responses, managing evacuations, improving workflows, restricting an area, improving customer services and response times, and improving the structure and facilities. For the use in the healthcare sector, the RTLS can be used to locate the healthcare personnel, tracks the patient’s movements, improve throughput management, track healthcare equipment, improve productivity of caregivers and nurses, improve patient’s family satisfaction and improve patient and staff safety.
RTLS consists of several components such as the tags, location sensors, a location engine, middleware and also end-user software (Malik, 2009). The tags are small wireless mobile devices with enabled location technology functions. The user may attach the tags to items for tracking.
Through this methodology section, the paper will overview the implementation of ARTLS at the selected study area. The methodology section will discuss the study area selection process, system deployment process involved, system implementation and methodology to gather valuable information that can be retrieved from the system implementation at the day care center.
The area selected for this study is the Alzheimer’s day care center located in the Federal Territory of Kuala Lumpur. The day care center is chosen because it is a pioneer day care center established in Malaysia that special care for Alzheimer’s patient only. Furthermore, all the residents at the day care center are already diagnosed as Alzheimer’s disease by the medical doctor. Hence, it was a suitable area to gather a number of Alzheimer’s patients in one area for tracking many instantaneously. The center has been established and has operated for six years and is handled by a non-governmental organization, Alzheimer Disease Foundation Malaysia (ADFM).
The day care center is occupied by 25 residents who are elderly Alzheimer’s patients aged between 65 to 92 years old. The operating time of the day care center would be from 8 am until 5 pm on weekdays only. The day care center is being led by two professional nurses and three assistants as a permanent caregiver of the day care center. The caregivers and residents ratio is 1:5 that means each caregiver is responsible to take care of five residents.
In this research, we develop the Alzheimer’s Real Time Location System (ARTLS) which is a localization system that can send Alzheimer’s patient location feedback to caregiver in real time. The system is meant for monitoring the Alzheimer patient in real time to safeguard the patient’s safety.
The system is equipped with automatic implements recording the patient’s movement sequence for caregiver references in enhancing the care management quality provided for the patient in the future. The recording resident movement data can be useful for the medical practitioners in studying the patient behavior and disease development based on movement sequence patterns shown by each resident.
Active-RFID Localization System (ARFIDLS) is the reliable radio frequency localization system in enabling the RTLS. The RFID uses radio wave to transmit signal from the transponder (transmitter) or commonly known as tags to the RFID reader (Zhou & Shi, 2009). The RFID allows us to identify objects or subjects with neither physical contact nor without line of sight (Hung & Wang, 2010). Figure 1 shows the ARTLS architecture using the ARFIDLS deployed in Alzheimer’s day care center.
The reader then collects the signal and send it to the computing engine to compute the localization with the establish localization algorithm. RFID localization uses the same triangulation technique as GPS. RFID localization has significant advantages over GPS; the technology can be adopted for both indoor and outdoor.
ARFIDLS is an ideal localization system in accommodating the RTLS for tracking the Alzheimer Disease. The major advantages of ARFIDLS are the nature of RFID that is automated identification or can be called as auto-ID (Cyplik & Patecki, 2011), can detect many tagged items instantaneously, non-line of sight, wireless communication and wider coverage. The active tags are cheap and have a long life lasting battery up to one year life time which makes this system more reliable rather than using other localization system.
In this paper, an existing tracking system available in the market is being adopted for tracking the elderly Alzheimer’s patient (residence) at day care center. The tracking system adopted is an Active Radio Frequency Localization system. The ARFIDLS is adapted accordingly based on suitability specification needed in tracking the residents. The tracking system consists of a transponder (tags) and interrogators (reader), location engine middleware and end user application software.
One reader has a receptive field of 40,000 m3 coverage areas for outdoor tracking and 6,400 m3 for indoor tracking. The reader is capable of receiving and processing localization data for more than ten thousand tags per second with an accuracy of 1 to 3 meters. The reader receives signals from the tags through the two independent tracking antennas at radio frequency of 5.8 GHz which is meant for Ultra Wide Band (UWB) RTLS applications. Each of these two antennas can be oriented in different directions to cover a wider tracking area. The reader is the only system hardware infrastructure required to be installed in the day care center for tracking the residents. The tags used are an active RFID tag with operation radio frequency of 5.8 GHz. It is a tag with an accuracy of 1 to 3 meters. The tags can be used to locate the residents for outdoor and indoor environment at the day care center. The tag and reader are shown in Figure 2.
For ARTLS deployment, there were three steps to be followed accordingly as in Figure
For the first step of ARTLS deployment, communication network and power network were deployed. The communication network deployment used a wired LAN network fixed around the tracking area as a basic connection of data communication system infrastructure. Power supply network was deployed around the tracking area to supply electric power to the tracking system reader. The deployment of the communication and power network is shown in Figure 4.
For the second step, system hardware was deployed by setting up the system computer inside the day care center building. The placement of the reader at the day care center was based on advice by system manufacturer technical support team. The system reader was deployed at 2 meter high from the ground at the day care center roof trusses. The reader was installed at 4 different corners of the day care center. The reader was put at the corner because to have a good geometry of the reader antenna focuses on the tracking area.
The high elevation and good reader antenna placement geometry will let a good triangulation algorithm technique in localizing the tags in tracking area. The triangulation was a technique in estimating the position of the tags by knowing the line angle between the tags and three different locations of the reader with respect to a common reference line (Malik, 2009).
Furthermore, based on manufacturer technical support team advice, the reader needs at least 25 meter lengths in between each reader for the system localization algorithm used function optimally. The placement of the reader at the day care center was shown in Figure 5.
The third step, involved deploying the tracking system software by installing the location engine, server and end-user software.
The real time monitoring of many residents instantaneously using an end user application software is shown in Figure 6.
The spatial movement of the resident is automatically recorded by the tracking system in the system server. Monitoring resident’s movement pattern history can be done by using the review history application in the end user application software is shown in Figure 7.
Taking only residents at the day care that agrees with the analysis inclusion criteria for the analysis purpose that result 9 out of 25 residents selected for the analysis. The criteria include the residents must have affected by Alzheimer disease, male or female, older than 60 years old, mobile residence (resident that able to walk independently without assistantship by a caregiver), not blind, and lastly permission is given by the residence caregivers.
For this paper, the tracking duration for each resident is 5 days. During tracking the residents, the spatial movement route history is automatically recorded and saved in the system database. The spatial movement recorded starts at 10 am and ends at 4 pm per tracking day. The spatial movement data collected is a sub room level localization data with an accuracy ±3 meter and below.
The spatial data analysis process that can be done using the ARTLS is analyzing the common interest place visited by the patient every day. The analysis will be differentiate the movement pattern of the patient in particular time such as what place they go for 9 am to 10 am in different day. For the analysis purpose, the sub room level localization data collected is converted to room level localization data. This will make the resident localization point inside a particular room will be generalized to the location of the residence such as the residence is inside the room. For room level localization, the day care area is divided into 10 visit area is shown in Figure 8.
Thirty hours spatial movement sequence data per residents was collected during the data collection process. The six hours spatial movement data for a day was divided into six time frames. This means each timeframe represents an hour. The visiting area visited by the resident A in one time frame from 10 am to 11 am for five days of tracking is shown in Table 1.
Then, the movement sequence by resident A for the remaining time frame such as 11am until 12pm, 12pm until 1pm, 1pm until 2pm, 2pm until 3pm, and 3pm until 4pm is gathered together such in Table 1. From this movement sequence data, the caregiver can analyze the resident’s movement sequence based on visiting area visited by the residents. The summarized visiting frequency for the whole five days of tracking on the resident A is shown in Table 2. Table2
From this summarized visiting frequency data, the caregiver can acknowledge which visiting area has a higher frequency of visit by the resident. Hence, it may help the caregivers planning in enhancing the care management quality provided for the residents. The caregivers may have more attention and awareness with higher frequency area visited and less aware with low frequency area visited by the resident. For example, the caregiver can be more watchful for resident A at location dining area zone with percentage of visiting frequency for 5 days tracking was 20.5% and less aware on toilet 2 area zone with percentage of visiting frequency for 5 days tracking was 0.5%.
Then, total visiting frequency by the resident A, B, C, D, E, F, G, and I to the visiting area zone for five days of tracking are shown in Figure 9. The caregiver and resident ratio was 1:5 that means one caregiver need to take care of five residents. The residents were free to wander around the day care center. There were ten visiting area zones in the day care center. The caregivers were outnumbered by the residents and have difficulties in managing the residents who always wander around at the day care center instantaneously. So, the day care center management can plan accordingly the duty roster and placement of the caregiver at the strategic visiting area zone to maximize the close care giving services by the caregiver for all the residents at a day care center.
The information regarding highest and lowest visited places for each resident is crucial for the caregiver to provide effective care management to the residents. The visit frequency to toilet 1 and toilet 2 by the resident are highlighted and included in Table 3.
This crucial information helps the caregiver to be more cautious for those residents that has a higher frequency of visits to toilets as the resident could be facing a severe health problem. These residents need extra attention and closely monitored by the caregiver in providing a better health care management for those residents.
ARTLS may help the caregiver in providing high quality care management in caring the entire residents involved. The day care center management can plan in deploying their caregiver in caring resident in certain high visiting frequency visited area by the residents. Furthermore, the caregivers only need to monitor the residents in other less visiting frequency visited area zone using the ARTLS in real time. This may help improve the care quality as the caregiver can closely monitor their residents by focusing monitoring in certain visiting area zone.
In this study, the Active Radio Frequency Identification Localization System (ARFIDLS) is successfully supporting the Alzheimer’s Real Time Location System (ARTLS) functionality. ARTLS is a relieve tool in reducing the caregiver burdens in a closed monitored wandering resident. The ARTLS also helps the caregiver in monitoring the resident movement for their safety and enhances the security by alerting the caregiver with resident location at the day care center in real time.
The caregiver can plan a good management for each resident by knowing the resident visiting frequency of visiting place zone in the day care center. Hence, the care for resident will be more efficient and enhanced with better management by the caregiver. The proposed analysis process eases the caregiver in determining the residents spatial movement for behaviour study and planning residents care management plans.
The authors would like to thank the Institute of Gerontology (IG), Universiti Putra Malaysia (UPM), Institute of Advanced Technology (ITMA), Special Graduate Research Allowance schemes (SGRA) and Alzheimer Disease Foundation Malaysia (ADFM). Special thanks also to the late Dr. Zaiton binti Ahmad for her contribution as one of the co-author for this paper. This research was supported partially by the UPM Research University Grants Scheme (RUGS) number 05-04-08-0547RU. This research protocol has been approved by UPM medical research ethics committee for not involving any ethics issues.