| Liberty1517–18 | ∙ 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
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| ∙ 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
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| ∙ 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
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| Respect for persons, including autonomy18,20–22 | ∙ 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
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| 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
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