Sandra Zwijsen March 8th, 2012 Surveillance technology as an alternative to physical restraints in nursing homes for people with dementia S.Zwijsen, M. Depla, S. Te Boekhorst, A. Francke, C. Hertogh

2 Surveillance Technology Surveillance technology (ST) is proposed as an alternative to restraint use For example, bed alarms, chip use and acoustic monitoring In the Netherlands, most nursing homes already use some form of surveillance technology (although the amount of ST and the policy on ST use greatly varies)

3 Research How is surveillance technology used? How do professional caregivers perceive the utility of surveillance technology? Methods: * Interviews with family, professional caregivers and physicians *Focus groups with professional caregivers * Questionnaire for professional caregivers

4 Results: uses of surveillance technology Surveillance technology can provide more freedom Surveillance technology is being used to provide safety Surveillance technology is often used supplemental to restraints, not as an alternative Manager: That’s a new development, because it enhances freedom of movement compared to before, because you simply couldn’t get through the door. People are now able to walk independently to the smoking room. And then walk back. And you know they won’t be able to get out.

5 Results: limitations of surveillance Technology Surveillance technology does not prevent falling Surveillance technology does not guarantee quick help Care professionals have to trust the technology, but it is not always working properly Phycisian: It’s really those kinds of people who are still thinking “I want to get up”. I know for sure that they can’t (...) and I also know that a sensor wouldn't be sufficient: once they get up it's too late, you can only pick them up again

6 Results Because the use of surveillance technology provides a feeling of security and is thought to be harmless, surveillance technology is used excessively Some professionals worried about privacy, although no actions were being taken to minimise invasion of privacy Physician: Well, you know, the ethical aspect sometimes strikes me...if you don’t need it and someone’s fast asleep in bed, then I think it’s not really my business what he’s doing or wants to do in bed...I think that’s on the boundaries of privacy whether it’s ethically responsible in terms of someone’s privacy.

7 Research on QOL Question: Do residents for whom surveillance technology is being used have a higher quality of life (QOL) than residents on whom restraints are being used? Method: QOL questionaire about the residents, filled in by nurses

8 Results: Quality of life Physical restraints were almost exclusively used in residents with low ADL independency Residents for whom surveillance technology was used had higher ADL independency and a less advanced stage of dementia After adjustment for age, sex, ADL independency and stage of dementia, no differences were found

9 Conclusions surveillance technology is currently being used supplemental rather than as an alternative Although some people worrie about ethical issues like privacy, the legal position of surveillance technology is still unclear and devices are used on large scale surveillance technology is being used on an other group of residents than restraints Implementation of surveillance technology is mostly ill- considered and unspecified.

10 Thank you! Sandra Zwijsen, MSc. Department of Nursing Home Medicine Institute for Research in Extramural Medicine (EMGO+) VU University Medical Center T /