The Design, Development, and Use of Electronic Tracking Devices in Dementia Care: An Ethical Analysis

Dementia causes progressive cognitive impairment that erodes an individual’s ability to carry out normal life activities, eventually requiring admittance into an institutional care facility. A movement within dementia care, and more broadly within gerontology, seeks to extend the ability for a person with dementia to remain living at home in the community where they have cultivated interpersonal relationships. Wandering is a particular symptom of dementia that poses a grave challenge to safely maintaining a person with dementia at home. Dementia related wandering involves persons eloping from homes, institutional care facilities, or caregivers, subsequently being placed into situations with high risk for serious injury or death. Incidences of wandering often precipitates placement into institutional care facilities even when a person with dementia expresses a strong desire to remain at home. Recently, there has been a turn towards electronic tracking devices to manage wandering. These technology based devices —such as GPS watch or shoe sole, RFID bracelet, or mobile phone application— allow for a range of real-time tracking, monitoring, or locating capabilities. These powerful capabilities have raised serious ethical questions (e.g. related to privacy or informed consent) regarding their use on a vulnerable population. This research project aims to analyze the ethical issues surrounding electronic tracking devices and develop an ethical framework in response to the issues posed by the introduction of these devices into dementia care. A unique approach guiding this project is the recognition that many ethical questions raised in the use of electronic tracking devices are already present, and perhaps being decided upon, during the design stages of these devices (e.g. data collection policy). Thus, the resulting ethical framework will serve as a guide for the design, development, and use of electronic tracking devices, providing ethical orientations for the continuum of design to use.