Tracking Options Using Gps For Alzheimers Patients - Coursework Example

? TRACKING OPTIONS USING GPS FOR ALZHEIMER’S PATIENTS By First MI. IS566 – Informatics and Application Systems in Health Care DeVry University Month Day, Year Abstract This article concerns the inherent challenges involved with caring for elderly patients and family members suffering from Alzheimer’s disease. The healthcare situation and ramifications are depicted initially, with a description of the difficulties faced by both families and patients. A detailed analysis of the problem is given addressing certain of the ethical implications of monitoring, or choosing not to monitor. The presumption exists that as a dementia worsens some form of GPS monitoring will be utilized by family members, or the staff of an assisted living facility. A physiological description is given briefly describing the biochemical markers of Alzheimer’s disease, as well as the symptomatic criteria used in a positive diagnosis of dementia as a result of Alzheimer’s disease. Warning signs and the prognosis of the condition are given. While no organic treatment exists, the advantages of GPS monitoring are discussed, including the implications and questions that must be addressed prior to choosing an option. Advantages and disadvantages of tracking strategies are discussed in addition to three information systems which are compared in accordance with a list of five practical criteria. Finally, recommendations are provided in the interest of dignity for the Alzheimer’s patient, but with respect towards the needs of family members and the likely inevitability of assisted care. An option of a monitoring service utilizing the expertise of a professional Corporation is concluded to be the most valuable and practical option for the protection and dignity of Alzheimer’s sufferers. Table of Contents Health Situation 02 Detailed Analysis of the Problem 05 Discussion of Health Care Application Systems’ Solutions 09 Recommended Solution and Implementation Issues 11 References 14 Appendix A: Strategic Information Systems Grid 15 Appendix B: Comparison of Solutions 17 Healthcare Situation As modern medicine continues its advance, human populations must invariably live longer, with all the concomitant complications and challenges that entails. Foremost among these is the maintenance of dignity in aging populations. With longer lifespans common, and aging of the population is inevitable. As a greater proportion of that population grows elderly, pathologies associated with aging will become of paramount importance. Some theorists may reason without sympathy for the humanity of those suffering from elderly dementia, or other forms of neurological illness similar to Alzheimer's disease. There may be some question as to whether the afflicted truly have dignity in the first place. There may be some that like an Alzheimer's patients to some form of devolved animal, lacking a human consciousness and the ability to plan for the future. Under this context both safety and convenience of care must be Paramount. Towards this end various forms of restraints, and/or monitoring technologies may be devised as a way to control the movements of elderly patients. In the twilight of human existence, those suffering from neurological diseases may seem to be struggling through a fog confusing memory with present reality. For a fleeting moment, it might make sense to seek out people and places long past, to resume old routines and see familiar faces without the cognizance of what lives on only in the past. An elderly person trying to return to a familiar setting that may not have existed for decades could easily wander away from caregivers and placed themselves in peril. Time and money must be spent tracking their movements and gently returning them to locations that seem wildly at odds with the fragmentary grip on reality that motivates the mentally diseased elderly. Estimates indicate that 60% of Alzheimer’s patients will become lost wandering away from their homes or places of care at some point during the progression of their illness. (Wong, 2009) How should society weigh the convenience and self-interest of caregivers against the interest of compassion towards our elders? Alzheimer’s patients could be fitted with tracking bracelets, not unlike methods used to keep track of the felons under house arrest. These tracking bracelets will transmit global positioning satellite coordinates accessible through a police database. In the minds of certain civil rights advocates, this might also raise questions with respect to privacy and the possible danger of a slippery slope towards ubiquitous government monitoring. All too often, carried younger relatives as well as bioethicists think only in terms of immediate convenience, giving tacit support to a paradigm that would equate dementia patients on a level with animals or possibly very young children. The practicalities of caring for elderly patients might encourage concerns of universal human dignity and value to fall by the wayside. Detailed Analysis of the Problem Experts report a worldwide figure of 26 million Alzheimer’s sufferers as of 2009. And as the populations as a whole continues to age, some estimates project a figure as high as 106 million by the year 2050. (Wong, 2009) Among the possible variants of GPS technologies are specialized shoes implanted with tracking technology. The mobility and independence also serve as important benchmarks for the elderly, and those with disabilities as a symbol of their ability to manage their condition and take charge of their life despite the challenges posed to them as a consequence of their disease. Even in cases of mild dementia, where the elderly person is attempting to go about a normal, logical routine – the probability still exists that they will become lost and confused even if they remain lucid most of the time. More severe cases include senior citizens who engage in aimless wandering. As Alzheimer’s disease progresses further, sufferers will engage in activities where no other person would be able to determine whether there was any logical purpose originally behind. It is worthwhile to cultivate a detailed understanding of the challenges posed by Alzheimer’s disease, the most common cause of geriatric dementia. (Schneider et al. 2009), (Wong, 2009) Although it is common for more than one type to exist in severely debilitated patients. (Viswanathan, et al. 2009), (Jellinger, 2007) Dementia itself is something of a catchall term; a convenient summary for a cascading process of mental deterioration. Over the course of the disease, damage and eventual death occurs within the brain’s neurons, leading to a slow decline in cognitive capabilities and memory aptitude. Initially the symptoms manifest as forgetfulness, but as more neurons suffer death and impairment the bodies autonomic functions will eventually be affected. End stage Alzheimer’s will have sufferers unable to walk on their own, or even swallow nourishment. This ultimate progression is fatal. (Schneider et al. 2009), (Kibayashi et al. 2007) According to the diagnostic and statistical manual of mental disorders – fourth edition, memory loss as a result of Alzheimer’s disease must entail impairment in any one of the following cognitive functions: (APA, 1994) 1.) Decline in the ability to recognize the identity and function of common objects previously known to the individual, with no evidence of corresponding sensory organ degradation. 2.) Degradation of the individual’s ability to perform common motor functions, such as activities they were once fully competent at. This assumes otherwise intact physical capability to perform a previously mastered motor function. 3.) Decline in the ability to recognize and comprehend once familiar motor functions in themselves and others. 4.) Speech impediment or impairment, with no corresponding damage or degradation in vocal structures. This includes the ability to generate coherent speech, as well as recognize familiar words spoken by others. 5.) Loss of the ability to perform abstract reasoning necessary to make objective judgments. This also includes an inability to carry out complex tasks that would have been possible before the onset of the memory loss. 6.) Inability to perform normal functions and chores that were once a part of daily life as a result of one or more of these symptoms of mental degradation. An inability to remember names and events occurring relatively recently is an early warning sign of Alzheimer’s disease. While such a memory lapses may be viewed colloquially as being “natural”, the loss in memory will worsen until the manifestation of one of the hallmark symptoms listed above. The progression can continue over the course of many years and clinical measures are recommended long before debilitating symptoms become apparent. While there is no definitive treatment for the reversal of Alzheimer’s disease, it should be recognized as a disease before severe impairment sets in. In terms of the neuropathology, visible manifestations of beta amyloid plaques will be found in the brains of long-term sufferers. Contortions of the Tau protein are also clinically significant. More research is necessary to determine precisely whether these biochemical manifestations are the ultimate origin of the neuron damage triggering memory loss, or if they are side effects of an as yet unknown organic trigger. Although these protein aberrations do appear to contribute to neuron damage. (Alzheimer’s Association, 2012) In the short term, it should be appreciated that the illness is essentially incurable, and the point of progression to its ultimate state it will culminate in death. Until such time as the situation changes it becomes a question of therapeutic options to delay the progress of the disease, and ways to make the fatal transition as comfortable as possible for victims and family members. Another concern is the issue of stress. It would be ideal if families and caregivers of Alzheimer’s patients were willing and able to give proper care and attention with total emotional equanimity at all times. Yet even the most cursory analysis of such a statement will make its probability vanishingly small. Middle-aged family members of Alzheimer’s sufferers may be overburdened with, to say nothing of the demands of their own careers. Thus there is a considerable risk of abuse and neglect as a reaction to caregiver’s stress. If the elder is accustomed to a daily routine that involves mobility outside the home, or even in cases where a patient with advanced Alzheimer’s is persistently prone to wander off, the legitimate need for safety can precipitate harm, as well as physiological strain to the caregiver. (Von Kanel, et al. 2006) Overworked family and uncaring staff members may feel driven to their wit’s end to employ dangerous restraints and prison-like restrictions upon the sufferer that seem unconscionable at first glance. But if it is not possible to reason with an individual engaged in dangerous behavior, then that rightly or wrongly – some level of force will be employed to restrain that individual. The ethics of forcible restraints are highly suspect, but demands placed on the caregiver make drastic measures all the more likely regardless of morality. A GPS tracking system will allow for greater ease in the recovery of Alzheimer’s patients while not causing further health damage through some form of restraint, or greater emotional stress as a result of confinement. A discussion of ethics must necessarily be informed by the likelihood and consequences of a breach of such ethics. A tracking system is hardly a universal solution, but it could serve to impart peace of mind towards family members and caregivers, and while the middle-aged family members of Alzheimer’s patients are not afflicted with amyloid plaques in their brains, caregivers are also suffering from the disease. Does that peace of mind compensate for a perceived loss of dignity as experienced by early victims of Alzheimer’s? Discussion of Health Care Application Systems’ Solutions Pertaining to any decision concerning a possible tracking option for Alzheimer’s patients, a series of criteria must be established by which to judge possible monitoring options with respect to practicality, privacy, and other concerns. A monitoring system to assure security of loved ones suffering from dementia must provide for security in more than one way. While it should be possible to track the actions and movements of an Alzheimer’s sufferer, it should not be too easy for unauthorized personnel to locate said individual. An indiscriminate system able to alert too many people too easily could open up vulnerabilities for crime and exploitation. If the Alzheimer’s sufferer is mobile, and expects to remain so, it may be possible for undesirable individuals to illicitly acquire access to the patient’s place of residence. Ease and utility is another concern. With forgetfulness the primary issue, a system that does not require continuous maintenance in order to function would have considerable advantages. Automation becomes a sought after objective, along the caregiver to pay attention to career and children (or other patients in some form of assisted living facility) while secure in the knowledge that a tracing system provides continuous information regarding the location of a dementia sufferer. This factors in to ease of use for any proposed system. If a desired option has been chosen, what will be the challenges in purchasing the system or device and successfully implementing it for use? How long until the system is functional, and are there any logistical limitations in acquiring the system? Are there difficulties or delays in purchasing and having the device shipped where it is needed? Are the instructions accessible and comprehensible to the caregiver establishing the tracking system? This factors into cost as well. Is the tracking system prohibitively expensive? And does it represent a good value for the available price? With respect to logistical concerns, if the technology or particular software is a relatively new, and yet seems ideal for monitoring/tracking functions, the systems’ time to market is also a factor. How long is a caregiver prepared to wait for an ideal solution to become available? Should other intermediate options be employed until the most efficient solution comes on the market? Recommended Solution and Implementation Issues THREE INFORMATION TECHNOLOGY SOLUTIONS In light of the above criteria, three possible monitoring options are presented for the purpose of creating a network of tracking coverage. Essentially, the options available would seem to fall into three discrete categories: using the service provided by a professional Corporation, usually an ancillary healthcare company, such as CIGNA.com. This has certain advantages in terms of professionalism, and establishing a customized service suitable to the needs of the individual caregiver can be facilitated by trained experts. Seeking monitoring services from a company already established does have the advantage of less time necessary to bring any potential monitoring/tracking technology to market. Although in the case of a large corporation, the number of individuals involved who might have direct access to tracking information, or sensitive personal data is greater. To seek a monitoring option from a large corporation one must trust in the professional competence of that company. For greater privacy and ease, it may be possible to supplement tracking services through the use of an online community such as Yahoo groups. Considerable personal attention is required, but the circle of individuals with access to personal information should theoretically prove smaller than with any healthcare Corporation. Establishing such a community to the point where it can prove an acceptable supplement could prove time-consuming, however. But the costs of this option are low, and the service is designed with a user-friendly ease. The possibility also exists to design one’s own website. If done correctly, this could minimize exposure to personal information, although without professional assistance, there may be the possibility of weak points that unscrupulous individuals might exploit to acquire personal information. An option personally designed by the caretaker is customizable to suit individual needs, and the degree of automation can be fine-tuned, as warranted by the situation at hand. But designing any such option with minimal external, professional assistance entails many unknowns. Designing a quality website that fulfills complex requirements could be done for free by an individual with proper software, and suitable experience. Otherwise the caregiver must hire a designer to create a website, adding more individuals into the loop. If wise choices are not made with consultation and design, this option may prove more costly in the long run than attaining the services of a well-established, stable corporate entity. Other disadvantages with some form of simpler, do-it-yourself online support for any highly technical endeavor is the prospect of legality. What are the requirements, and limitations concerning the caregiver’s ability to provide some form of tracking? While these concerns are of special relevance in the case of ankle monitors for criminal offenders, there could be unforeseen legal issues with securing tracking technology for an aging relative. Consultation should be secured in order to determine whether or not the party must be declared legally incompetent prior to such monitoring becoming a daily fixture of their lives. This is a concern that might not be adequately resolved through some form of cost cutting measure with respect to monitoring services. These concerns could be adequately addressed by a corporate entity equipped with a fully staffed legal department able to field such questions, and give up-to-date answers. Several factors must be considered with respect to an ultimate recommendation. While the dignity of our loved ones is a relevant concern, one can make the case that dignity only matters if the individual is able to understand the concept. The wishes of the patient should be taken into account during the early stages of dementia, where some functionality still exists – and if the idea of some sort of electronic tether causes embarrassment or distress. But as symptoms of Alzheimer’s disease worsens, the burden on families grows greater. An individual lost to severe mental deterioration may no longer have the capacity to perceive embarrassment, or understand the dignity. In this case, the question of rights and dignity must fall to those family members, or assisted-living employees capable of comprehending these concepts. In cases of severe incompetence, GPS monitoring would prove a far more humane option. Then any form of captivity or restraint. In terms of the most ideal option for such a service, strongest consideration must be given towards a professional Corporation with a proven track record. It is a corporate entity with experience in the healthcare field will have an in-depth understanding of the challenges facing caregivers of Alzheimer’s sufferers. They are more likely to have the most advanced technology presently available, and while the cost may be greater working with a professional agency, there is also the question of value. If using a cheap alternative of a particular service results in poor functionality and failure, then the investment becomes wasted. It could prove more cost-effective to spend more money in the initial phases of a technical project rather than attempt to recoup losses and search out other suppliers for services at a later date. For monitoring services, the professional entity with the longest experiential and legal track record would seem the superior choice. References Adomeit, A., Baur, A. & Salfeld, R. (2001). A new model for disease management. McKinsey Quarterly, 4, 92-101. Alzheimer's Association, 2012. Alzheimer's Disease Facts and Figures, Alzheimer's & Dementia, volume 8, Issue 2. American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, D.C.: American Psychiatric Press, 1994. Ernst & Young LLP. (2002, October). P3P Dashboard Report. Retrieved January 2, 2003, from http://www.ey.com/global/download.nsf/US/P3P_Dashboard_-_October_2002/ Griffin, R.W. (2008). Management. Boston, MA: Houghton Mifflin. Jellinger, K.A. 2007. The enigma of mixed dementia. Alzheimer’s & Dementia 2007;3(1):40-53. Kibayashi, K., Sumida, T., Shojo, H., Hanada, M. 2007. Dementing diseases among elderly persons who suffered fatal accidents: A forensic autopsy study. American Journal of Forensic Medicine and Pathology 2007;28(1):73–9. Schneider, J.A., Arvanitakis. Z., Leurgans, S.E., Bennett, D.A. 2009. The neuropathology of probable Alzheimer disease and mild cognitive impairment. Annals of Neurology 2009;66(2):200-8. Viswanathan, A., Rocca, W.A., Tzourio, C. 2009. Vascular risk factors and dementia: How to move forward? Neurology 2009;72:368–74. Von Kanel, R., Dimsdale, J.E., Mills, P.J., Ancoli-Israel, S., Patterson, T.L., Mausback, B.T., et al. 2006. Effect of Alzheimer caregiving stress and age on frailty markers interleukin-6, C-reactive protein, and D-dimer. Journal of Gerontology: Medical Sciences 2006;61A(9):963–9. Wong, G. 2009. GPS shoe to track Alzheimer's patients. Vital Signs. CNNhealth.com. http://www.gpsshoe.com/images/Clip_GTX_CNN.PDF. Accessed: 5/14/2012. Appendix A Strategic Information Systems Grid BUSINESS CHALLENGES: Lack of visibility of CIGNA Healthcare of AZ Patients requesting access to information MANAGEMENT ISSUES: Costs of traditional communications Patients Moving to Competitors INFORMATION SYSTEMS SOLUTIONS: Build community on Yahoo Establish Own Internet Site Pilot community on CIGNA.com TECHNOLOGY ISSUES: Lack of Web Expertise Existing IT Problems BUSINESS BENEFITS: Improved Communication with Patients Easy Access to Information Provide Services Online ORGANIZATION ISSUES: Resistance of Staff Privacy Concerns Appendix B Comparison of Solutions Objectives Option 1 Build Community on Yahoo Option 2 Establish own Internet Site Option 3 Pilot Community at CIGNA.com Avoid Privacy/ Security Risk Low Medium High Full Automation Low High Medium Ease of Implementation High Medium Medium Ease of Use Low High Medium Cost Low Medium Medium Time to Market High Medium Low Read More