JMIR Publications

ABSTRACT

Background:

Global Positioning System (GPS) alarms aim at supporting users in independent daily indoor and outdoor activities. GPS alarms are implemented in social care, particularly in Nordic countries. Previous systematic reviews report lack of clear evidence of the effectiveness of GPS alarms on the health and welfare of users and their families, as well as social care provision. Evidence on effectiveness can support informed decision on implementation of health and welfare technologies. Standardized evidence frameworks have been developed to ensure that new technologies are clinically effective and offer economic value. However, systematic reviews seldom assess identified evidence using the frameworks.

Objective:

This study provides an up-to-date systematic review on evidence from existing studies of GPS-based alarms’ effects on health, welfare and social provision in elderly care, compared to non-GPS standard care. Moreover, the study findings are assessed against the evidence standard framework for digital health technologies (DHTs) established by the National Institute for Health and Care Excellence (NICE) in UK.

Methods:

The review was conducted according to recommended guidelines. Primary studies published in peer-reviewed and grey literature between January 2005 and August 2020 were identified through searches in 13 databases and several sources of grey literature. Articles were included if the studied population was persons 50 years and older, who either received social care for elderly or social care for persons with dementia; employed GPS devices that enabled the users to initiate alarms and/or localization of user position and/or geofencing functions as an intervention; were performed in Canada, US, EU, Singapore, Australia, New Zealand, Hong Kong, South Korea, or Japan; and addressed outcomes related to health, welfare and social care outcomes by use of quantitative methods. Study findings were categorized and summarized according to the requirements for “active monitoring” DHTs (i.e. tier 3b) of the NICE evidence standard framework.

Results:

16 of the 986 screened records met the eligibility criteria. 7 peer-reviewed publications and 9 grey literature studies contributed with information. Best practice evidence was identified according to standards for tier 1 category “Relevance to current pathways in health/social care system” and minimum standard evidence was identified according to standards for tier 1 category “Credibility with health, social care professionals” of the NICE framework. However, several evidence categories in tiers 1 and 2 could not be assessed and no clear evidence demonstrating effectiveness in outcomes or improvements in outcomes could be identified. The evidence required for DHTs tracking patient location (tier 3b) in the NICE framework was therefore insufficient.

Conclusions:

The evidence in current grey and peer-reviewed literature for GPS-based mobile alarms’ beneficial effects on health and welfare of older adults and social care provision is insufficient. Future research should utilize knowledge produced in previous studies and systematic reviews. Clinical Trial: Not required, no primary study.