JMIR Publications

ABSTRACT

Background:

As the aging population continues to grow, the number of adults living with dementia or other cognitive disabilities in residential long-term care homes is expected to increase. Technologies such as real time locating systems (RTLS) are being investigated for their potential to improve the health and safety of residents, as well as the quality of care and efficiency of long-term care facilities.

Objective:

The aim of this study was to identify factors that impact the implementation, adoption, and use of RTLS for use with persons living with dementia or other cognitive disabilities in long-term care homes.

Methods:

We conducted a systematic review of the peer-reviewed, English language literature indexed in Medline, Embase, PsycINFO, and CINAHL from inception up to and including May 5, 2020. Search strategies included keywords and subject headings related to cognitive disability, residential long-term care settings, and RTLS technologies. Study characteristics, methodologies, and data were extracted and analysed using constant comparative techniques.

Results:

Twelve publications were included in the review. Most studies were conducted in the Netherlands (n=7, 58.33%) and utilized a descriptive qualitative study design. We identified three themes from our analysis of the studies: barriers to implementation, enablers of implementation, and agency and context. Barriers to implementation included lack of motivation for engagement; technology ecosystem and infrastructure challenges; and myths, stories and shared understanding. Enablers of implementation included understanding local workflows, policies, and technologies; usability and user-centred design; communication with providers; and establishing policies, frameworks, governance, and evaluation. Agency and context were examined from the perspective of residents, family members, care providers, and the long-term care organization.

Conclusions:

There is a striking lack of evidence to justify the use of RTLS technologies that improve the life of residents and care providers in long-term care settings. More research related to RTLS use with cognitively impaired residents is required and should include longitudinal evaluation of end-to-end implementations that are developed using scientific theory and include rigorous analysis of its functionality, efficiency, and effectiveness. Future research is required on the ethics of monitoring residents using RTLS technology and its impact on the privacy of residents and healthcare workers.