Tagging Alzheimer's patients causes a rift

by Eilish O Regan, Health correspondent-Health & Living Irish Independent-Monday 15th July 2013

Electronic tagging has been put forward as a solution to reduce the risk of harm among people with Alzheimer’s disease who wander. However, it could provide a false sense of security, according to Dublin Geriatrician Prof. Des O Neill.

Prof. Des O Neill described it as a "quick fix" for carers and said that they could also impinge on a patient's autonomy. He argued against the use of electronic tagging in a debate on the issue with another expert in the "British Medical Journal". He said the measures must be patient-centred rather than looking for quick fixes to suit carers. The acceptability of tagging "has generally been researched among formal and informal carers only, with the views of those with dementia relegated to the sidelines".

He pointed to an evolving body of work on technology and dementia "that has led to a range of assistive technology-such as picture telephones, lamps, lost item locators-which is genuinely enabling and supportive if independent living".

The positive and person-centred approach needs to be pursued with wandering.

Tracking devices could also give a false sense of security while traditional methods such as identity bracelets "may be equally effective and less costly" he said.

Prof. O Neill said the police force involved in implementing a tagging programme for people with dementia in the UK had quoted money-saving as a primary objective and that the practice appeared to be increasingly widespread among UK councils.

"Is the impetus for shaping policy for a complex and common syndrome to be driven by policing, putative cost effectiveness and ethical insensitivity, or can we use this debate to reclaim a person-centred approach that embraces the person with dementia as the lead collaborator in a coalition of care?" he asked.

Meantime Rupert Mc Shane, a Consultant in old-age psychiatry at Oxford Health NHS Foundation Trust, said that while these electronic trackers were not a panacea, they did mean that the patients could be found more quickly.

He argues that rapid recovery reduced risk. Half of all people with dementia who are missing for more than 24 hours die or are seriously injured, yet carers often delay calling for help, wanting to avoid involving the police if at all possible. When someone with dementia gets lost, it at least doubles the risk of admission to a care home. "It is therefore surprising that there has not been more attention paid to ways of reducing this".

The ethical challenges are surmountable and he points to several examples where tracking devices can help in balancing safety and autonomy for vulnerable patients. "The evidence that patients are given more freedom once they start using a tracker is contradictory, but finding that the device can reduce conflict between patient and carer is plausible and useful" he said.

He stressed the need for privacy but said that "the desire for privacy and isolation should not be confused with getting lost". He added "It is time to move on-and we should begin by abandoning the term "tagging" which has stigmatising associations".