The CAREPATH platform integrates geofencing functionalities to monitor patients’ movements and alert the caregivers when and where polygonal boundaries are trespassed.

The CAREPATH project is an innovative initiative aimed at enhancing health outcomes of multimorbid patients with Mild Cognitive Impairment or Mild Dementiacare, through the integration of personalized health pathways, like tailored care plans, patient engagement in physical activities, playing games and social activitie, interdisciplinary collaborations, and others. Among them, automatic data gathering from wearable sensors and deivces and data analytics to monitor patient health and track progress, and geofencing.

Mild dementia, characterized by cognitive decline that interferes with daily life but does not fully incapacitate individuals, presents unique challenges for caregivers. Geofencing technology, which uses GPS and other location-based services to create virtual boundaries, offers innovative solutions to enhance the safety, independence, and overall quality of life for this vulnerable population.

This blog explores the applications, benefits, challenges, and future potential of geofencing technology in the care of older adults with mild dementia and multimorbidity, and the exploitation of this technology in the CAREPATH project.

Understanding Geofencing

Geofencing is a location-based service that utilizes GPS, RFID, Wi-Fi, or cellular data to establish virtual boundaries in real-world locations. When a device—such as a smartphone or wearable tracker—crosses these predefined boundaries, it triggers alerts to caregivers or family members. Geofencing can significantly enhance the management of older adults with cognitive impairments by providing real-time location tracking and monitoring capabilities.
Geofencing works in the following way.

First, the operator (caregiver) establishes safe zones around specific locations such as home, parks, or healthcare facilities (setting of the boundaries).

When the individual enters or exits these zones, the system sends notifications to caregivers via mobile apps or SMS.

Many geofencing applications provide a history of the individual’s movements, allowing caregivers to understand patterns in behavior and activity.

The Need for Geofencing in Dementia and Multimorbidity Care

Older adults with mild dementia often experience symptoms such as disorientation, forgetfulness, and impaired judgment. When combined with multimorbidity, the risk of complications increases, particularly related to medication management, healthcare appointments, and daily activities. Traditional monitoring methods, such as constant supervision, may infringe upon the individual’s autonomy and lead to increased stress for both caregivers and patients. Geofencing technology provides a balance between safety and independence, allowing older adults to navigate their environments more freely while ensuring that caregivers can intervene when necessary.

Furthermore, older adults with multimorbidity face additional complexities that can impact the effectiveness of geofencing technology. These individuals often require careful management of medications, regular medical appointments, and lifestyle adjustments. Geofencing can play a crucial role in managing these aspects. For instance, caregivers can receive alerts if an individual has not taken their medication while away from home, allowing them to intervene as needed. Also, Geofencing can facilitate transportation to and from healthcare appointments by alerting caregivers when an individual is en route to or from a medical facility. This feature ensures that caregivers can offer assistance or support as necessary, especially for individuals who may struggle with navigating public transportation. Finally, social engagement is crucial for mental and emotional well-being. Geofencing technology can help caregivers monitor participation in social activities, ensuring that individuals remain engaged with their communities while being safe.

The benefits of Geofencing in Dementia and Multimorbidity Care are many:

• Enhanced Safety Monitoring: Geofencing technology enables caregivers to monitor the locations of individuals with mild dementia effectively. For example, if an older adult wanders away from a safe zone—such as their home or a familiar community space—caregivers receive immediate alerts, allowing them to act quickly and prevent potential harm.
• Reduced Caregiver Stress: The anxiety associated with caring for a loved one with dementia and multimorbidity can be overwhelming. Geofencing offers caregivers peace of mind by providing real-time tracking capabilities. Studies show that caregivers of individuals with dementia often experience higher levels of stress and depression (Pinquart & Sörensen, 2003). Knowing that they can monitor their loved one's location can help alleviate some of this burden.
• Promotion of Independence: Geofencing technology empowers older adults to maintain a degree of independence while ensuring their safety. Caregivers can feel comfortable allowing their loved ones to engage in social activities or attend medical appointments, knowing they can be alerted if the individual strays from designated areas.
• Customized Alerts and Notifications: Geofencing systems can be tailored to meet the specific needs of each individual. Caregivers can create multiple safe zones and receive notifications based on personalized parameters, such as when an individual is late returning home from an appointment.
• Facilitated Emergency Response: In cases where an individual with mild dementia and multimorbidity wanders or faces a medical emergency, geofencing technology can significantly reduce response time. Caregivers can quickly locate the individual and provide necessary assistance or contact emergency services.

Implementation of Geofencing Technology in CAREPATH

In CAREPATH the integration of geofencing into care for older adults with mild dementia and multimorbidity is accomplished through various technological solutions.

First of all, the caregivers can access a Web UI to draw and manage the geofences, and assign them to each of their patients (see figure above).

The patient is equipped with a GPS-enabled weaeable tracker (a bracelet or a pendant), which tracks her/his movements outside (the tacker has the accuracy of a GPS dewvice in standard operational conditions, meaning that the individual's position is given within 5 -10 m).
The tracker sends the position to the CAREPATH home-based system, and stores the geo-position in the central database, so that the track is preserved for future analyses.
The smart technology implemented in the platform complements geofencing by monitoring movement outside the home. A separate scheduler periodically checks if the individual crossed a geofence (also called “perimeter”), and in that case it sends a message to the caregiver by displying an alert on the CAREPATH Web Monitoring User Interface with the position of the crossing, enabling her/him to promptly react (figure below).

Challenges and Ethical Considerations

Despite its numerous benefits, there are some challenges and ethical considerations that need to be addressed when applying geofencing in elderly care.

• Privacy Concerns: Geofencing involves continuous tracking of an individual’s location, which raises questions about privacy. Even if the system is put in place for the person’s safety, it may be seen as an invasion of their personal autonomy. Consent is crucial, and elderly individuals or their legal guardians must fully understand how the technology works and agree to its use.
• Technological Barriers: Not all elderly individuals are comfortable with or capable of using technology, which could hinder the implementation of geofencing systems. Moreover, the reliance on mobile devices or wearable technologies may pose challenges for individuals with disabilities or cognitive impairments who may not always remember to carry the necessary devices.
• False Alarms: Geofencing systems are not perfect, and there is the risk of false alarms. For example, an elderly person might step slightly outside a geofence but remain in a safe environment. Such false alarms could lead to unnecessary anxiety for both the individual and their caregivers. Fine-tuning the system is essential to prevent unnecessary interventions.

Conclusion

Geofencing represents a significant innovation in the realm of elderly care, offering a mix of safety, independence, and peace of mind. While challenges remain, particularly in terms of privacy and technological accessibility, the benefits of geofencing in preventing wandering, enhancing emergency response, and supporting independent living are undeniable. As healthcare continues to embrace technology, geofencing will likely become a standard tool in caring for elderly individuals, especially those with cognitive impairments.