EDITOR'S PEN

Caregiver Thought Leader Interview: 
Andy Carle

Andy Carle is an award-winning professor, Executive-in-Residence and Founding Director of the Program in Senior Housing Administration at George Mason University in Fairfax, Virginia.  The program offers the first curricula in the nation dedicated exclusively to the rapidly growing senior housing field. As part of his work in technology, he’s served as an advisor to the development of the first GPS shoe for individuals with Alzheimer’s at risk of wandering. His book, Moments, Memories and Missions: Stories from the Field of Assisted Living, received a Silver Award during the 15th Annual National Mature Market Media Competition. Mr. Carle was recognized by Senior Living Executive magazine as one of six people with influence for the senior living industry. 

Gary:    Let’s start talking about something that I think is such an incredibly important issue for caregivers of people whose loved ones have cognitive challenges, such as Alzheimer’s. Current statistics indicate that about 60 percent of people living with Alzheimer’s are going to wander. And, of those who are lost over 72 hours, only 20 percent survive. These are really sobering statistics.

Andy:    It’s really exponential in terms of those that do wander. It’s something that the caregivers in particular are dealing with all the time. In fact, one study showed that the number one cause of stress for caregivers of people with Alzheimer’s related dementia, other than the disease itself, is the fear of that person wandering off and becoming lost. 

Gary:    And, once they get out of the bubble of security of your home or their home, that clock is really ticking for their survival.

Andy:    If you think about it, these are typically older, frail adults. Whether it’s exposure or injury or dehydration, it’s not a good thing when they become lost. And then the compounding factor, Gary, is that they’re not easy to find. They will not respond to calling out their name. In fact, sometimes, they will actually hide from the people calling their name because of paranoia; they’re afraid that someone’s after them. They may not even recognize their own name and just keep wandering and walking. So, it’s not the same as looking for someone else. These folks often don’t respond.

Gary:     Can you tell me about the GPS SmartSole that you helped create? 

Andy:     GTX Corp, the company that makes the GPS SmartSole, and Patrick Bertagna, who actually invented it, did two things that were unique. One, they were able to miniaturize it enough to fit inside of an insole, looking like an insole you’d buy at any pharmacy. But, the second component may be more important; it allows you to then hide it on the person. The two primary manifestations of Alzheimer’s related dementia are confusion and paranoia. In the early stages, they’re going to be confused and they will routinely remove anything placed upon them with which they’re not familiar. It doesn’t matter if it’s on their wrist or around their neck or even tagged onto their sweater. If they feel it and discover it, they’ll remove it. In the past, we’ve had these devices and the manufacturers will tell you to lock it onto their wrist or their ankle. That flies in the face of what clinicians know would be the appropriate thing to do with these folks because they will, in fact, hurt themselves up to the point of breaking their wrist to get that thing off. So, it is important that we’re able to hide it and, obviously, placing it in their shoe is the ideal place.

Gary:    And, it doesn’t have to be new shoes.  It could be their shoes that they’re comfortable with because, for the most part, if you’re running around outside, the last thing you’re going to take off is your shoes.

Andy:    A lot of people don’t realize there are three types of memory.  The one that’s most relevant with Alzheimer’s is procedural memory, also known as habitual memory. It retains things that we do out of habit, and getting dressed is one of those things.  It’s actually the last type of memory that’s retained in individuals with Alzheimer’s. So, even into the later stages of the disease, even if their caregiver dresses them, they will typically stay dressed and that includes, of course, their shoes. They’ve owned dozens, sometimes hundreds of pairs of shoes throughout their life. Putting on their shoes is literally part of their procedural memory. They’re perfectly comfortable doing it. 

Gary:    So, the  GPS SmartSole—how does it work? What happens?  

Andy:    It’s really pretty easy. You put it in their shoe. It uses the same technology as cell phone, cellular tracking GPS and cellular tracking. You place it on a little static charging pad overnight, the same way you charge your cell phone. In the morning, when they get dressed, you slide it into their shoes. The only one you need to charge is the one in the right shoe. 

The caregiver or family member and authorized user has access to a website. These come fully activated with a web account and it allows you to log on at any time and check the status and charge of the shoe. But, most important, it allows you to locate them at any time simply by logging on to your smart phone or your computer and sending a signal. In about 30 seconds, it’ll locate them for you using GPS or cellular and, typically, within as little as ten feet from where they’re standing.