Table 2.

Ethical Considerations and Recommendations in Electronic Tracking of Cognitively Impaired Individuals

Ethical PrincipleConcerns in Electronic TrackingBest Practices for Developing Care Plans
Liberty151718∙ Virtual boundaries or alarms may function as restrictions on movement
  • ∙ Consider how electronic tracking may obviate or postpone the necessity of more restrictive care settings17

  • ∙ Assess how remote monitoring may replace physical barriers and enhance freedom of movement18,19

  • ∙ Incorporate tracking into care plans to promote, rather than restrict, independence18

    ∙ Susceptibility of tracking technology to overuse
    ∙ Appropriate balancing of technological intervention against safety risk
    ∙ Constraining effect on choices and activities
∙ Remote monitoring may prolong independent living
    ∙ Enables less restrictive care settings
    ∙ Less intrusive than physical obstructions
    ∙ Reassuring safety net for individuals
Privacy15,16,18,20∙ Devices enable constant surveillance
  • ∙ Consider whether lower-technology solutions that invade privacy less may be sufficient (eg, registration systems, personalized identification cards, emergency response services that can be activated by phone)

  • ∙ Limit access to tracking data to only those who need it and/or those whom the individual wants to receive it15

  • ∙ Ensure tracking system is secure17

    ∙ May conflict with individual's past/present views on privacy
∙ Monitoring can facilitate care in more private settings (eg, home vs nursing home)
    ∙ Individual may value privacy differently depending on the actor (eg, caregivers, family, fellow patients)
Dignity15,16,18,20
  • ∙ Tracking devices may have negative connotations (eg, criminal justice, animals, packages, “big brother”)18

  • ∙ Perceptions of tracking devices may be shaped by their association with wandering or dementia

  • ∙ Electronic monitoring may help prevent stigmatizing episodes of wandering14

  • ∙ Differentiate “best interests” and “best medical interests,” especially where the latter may impinge on the former14

  • ∙ Ensure devices are discrete18 and part of an overall plan that is individualized and consistently reassessed17

Respect for persons, including autonomy18,2022
  • ∙ Individual's capacity to consent may be compromised and fluctuating15

  • ∙ How and when the cognitively impaired individual is engaged in discussion can be critical20

  • ∙ Efficacy of the device may rely on the cognitively impaired person remembering or choosing to affix it before walking

  • ∙ Avoid deception, in terms of both hiding the device or concealing its purpose from the cognitively impaired individual18

  • ∙ Assess acceptable levels of risk to the cognitively impaired individual, loved ones, and caregivers23

  • ∙ Convene the cognitively impaired person, loved ones, and caregivers as a collaborative team when feasible and as early in the stages of degenerative impairment as possible

  • ∙ Maximize the cognitively impaired person's involvement and input, irrespective of ability to consent17,24

Beneficence21
  • ∙ Wandering poses significant risks of morbidity and mortality to cognitively impaired persons but can also be beneficial

  • ∙ Mitigating risks for cognitively impaired persons may necessitate foregoing benefits valued by the individual20,23

  • ∙ Concerns about wandering may compromise caregiver well-being15,18

  • ∙ Consider reasons for the cognitively impaired person's wandering, including whether it is a manifestation of an unmet need (eg, exercise, companionship)15

  • ∙ Counsel that surveillance is not a quick fix or substitute for personal care, but part of a comprehensive care plan15,17