2018 Projects

Spark Program – Round 2 Projects

A video-based reminiscence program to support quality of life in older adults in palliative care and their carers
Project Lead: Rebekah Hackbusch
Host Institution: Bruyere Continuing Care
This project will document the impact of LIFEView, a video-based integrative reminiscence program, with older adults in palliative care at home and in inpatient palliative care. Discussion of past activities, events and experiences will be aided by personalized video and audio memory triggers. The study will evaluate the impact of our individualized, personalized structured program on levels of depression, boredom and self-worth.

Aging Out: Replicating Best Practices in LGBT Aging, Health, and Dementia Care
Project Lead: Sara Paasche-Orlow
Host Institution: Hebrew Rehabilitation Center
Hebrew Rehabilitation Center (HRC) proposes to leverage our expertise in LGBT aging, partnering with Baycrest and other long-term care facilities to improve the culture of care for LGBT seniors. Efforts will include education and training of front-line staff and targeted workshops for key management leaders. Chaplaincy staff and students will learn to address the spiritual care needs of LGBT seniors more appropriately and effectively.

An exercise and socialization-based intervention for couples affected by young-onset dementia (YOD)
Project Lead: Elaine Kohn
Host Institution: Baycrest Health Sciences
This program will have couples affected by early-onset dementia (YOD) first participate in an instructor-led cycling class together, followed by refreshments and the opportunity to socialize with other couples affected by YOD.

Community ASAP – A localized area alert system for missing individuals with dementia or older adults
Project Lead: Lili Liu
Host Institution: University of Alberta
This project aims to implement a software platform that allows first responders (e.g., police, community coordinator) to trigger alerts of missing older vulnerable adults to community volunteers. The app will be tested in three cities.

CONNECT POET APP: Connecting On-Call Physicians with Residents’ Health Care Directives Using Prevention of Error-Based Transfers (PoET) App
Project Lead: Paula Chidwick
Host Institution: William Osler Health System
The CONNECT PoET App is intended to ensure that on-call physicians and other off-site personnel have access to residents’ Individualized Summaries to easily access vital, real-time information about older adults’ health directives. This project will include the beta testing of the app.

Dementia communication workshop for nursing students
Project Lead: Benjamin Hartung
Host Institution: Baycrest Health Sciences
To enhance the learning experience and increase nurse turnover in dementia care areas, a workshop will be created to discuss therapeutic lying and dementia care for nursing students and reduce reality shock as they enter the profession.

Dysphagia Friendly Cooking Series
Project Lead: Maria Piccini
Host Institution: Baycrest Health Sciences
This project will conduct “dysphagia-friendly cooking classes” which include education about dysphagia and related nutritional issues, introduce a new international food/liquid texture standardization and share tested and validated recipes that were previously developed by our team at the Food Innovation & Research Studio at George Brown College. Caregivers will experience the modified textures and will learn how to make safe to swallow foods that are appetizing and appealing.

Ease e-Home: Plug and Play Technologies Support Carers and Older Adults with Dementia
Project Lead: Marilyn Malone

Host Institution: Island Health
This study is designed to develop a customizable and low-cost “smart home” using plug and play technologies for older adults with dementia and their caregivers. It will install Amazon Echo connected to other smart devices that address the needs of the older adult with dementia and their caregiver.

Effect of meditation and hyperbaric oxygen therapy on cognition, healing and overall well-being in elderly patients with chronic wounds
Project Lead: Ray Janisse
Host Institution: Toronto General Hospital
The project leads aim to investigate whether the combination of hyberbaric oxygen therapy (HBOT) and meditation improves the healing of chronic ulcers in diabetic patients with dementia compared to HBOT alone.

Enabling Advance Care Planning in Dementia Care: A Primary Care Approach
Project Lead: Linda Lee
Host Institution: The Centre for Family Medicine Family Health Team
In this project, healthcare professionals, persons with dementia and care partners will evaluate this Advance Care Planning (ACP) framework tool in six family practice memory clinics in Ontario. The tool will be refined based on results and shared across Canada to enable front-line healthcare professionals to have timely, effective ACP discussions with persons with dementia and care partners, ensuring healthcare provided is person-centered and aligned with personal goals and preferences until end-of-life.

Geriatric Pharmacology Infographics: Efficient Knowledge Translation of Medication Optimization for Clinicians Caring for Seniors
Project Lead: Joanne Ho
Host Institution: Schlegel Villages/Schlegel Research Institute for Aging
The project leads will be developing infographics to convey prescribing information efficiently and effectively to clinicians. Key features of the infographics include: reasons for use of the drug, dose, interactions, and potential side effects, particularly those affecting memory and falls.

Improving Dementia Caregiver Support
Project Lead: Susan Kennedy
Host Institution: The Dementia Society of Ottawa and Renfrew County
The proposed project seeks to evaluate the impact of two newly updated caregiver support programs at the Dementia Society of Ottawa intended to increase service output and quality.

In-Home Recreation Therapy Project
Project Lead: Jenn Pruder
Host Institution: Alzheimer Society London and Middlesex
Alzheimer Society London and Middlesex will conduct a one-year pilot program to provide individualized recreation plans for persons with dementia who are still living in a community setting to evaluate overall improvement in quality of life for the family.

iTAV- It Takes A Village
Project Lead: Chanile Vines
Host Institution: Baycrest Health Sciences
iTAV- It Takes A Village is an app that will allow caregivers to source additional care support, train and manage care.

Lingo: An Augmentative and Alternative (AAC) Communication System Designed to Replace Spoken Communication for Non Verbal Individuals
Project Lead: Ling Ly Tan
Host Institution: Seneca College
There is a growing need for effective and affordable Augmentative and Alternative Communication (AAC) systems for non-verbal individuals. Lingo is an AAC mobile application that incorporates machine learning to adapt to the individual by learning their daily needs, preferences and social activities while promoting written communication.

Medication Adherence Products and Strategies: Clinician Tool to Guide Use
Project Lead: Tejal Patel
Host Institution: The Centre for Family Medicine Family Health Team
The goal of this project is to develop a validated tool that enables a clinician to assess limitations in medication management capacity among older adults and recommend an appropriate medication adherence product to address these limitations.

More than Motor: The Memory and Language Program for Seniors with Parkinson’s Disease
Project Lead: Tasneem Dharas
Host Institution: Baycrest Health Sciences
The Assistive Technology Clinic’s memory and language program will integrate memory and language rehabilitation strategies with cognitive training to target cognitive, communicative and even physical goals specific to seniors living with Parkinson’s disease.

MouvMat: An interactive gaming surface designed for older adults
Project Lead: Charlene Chu
Host Institution: AGE-WELL NCE
MouvMat is an interactive digital gaming surface co-created with stakeholders including older adults living in long term care homes. It promotes brain health by providing an immersive, multi-player gaming experience featuring LED backlights and pressure sensors that allow players to physically interact with the game by walking on the mat, tapping the surface with their feet, or using an assistive device.

Multilingual Communication Tool for Point of Care Staff Working with Non-English-Speaking Older Adults Including Dementia Patients
Project Lead: Tanya Klochkov
Host Institution: Apotex JHA
This multilingual software tool aims to bridge language and communication barriers between point of care staff and non-English-speaking patients, including older people with dementia. This software application will be used by the formal caregivers providing routine daily tasks for seniors residing in long term care facilities, hospital units and community.

Object Alternation and Delayed Reaction Suite of Cognitive Tests: A Novel Clinical Application for Assessment of Frontotemporal Dementia
Project Lead: Morris Freedman
Host Institution: Baycrest Health Sciences
Frontotemporal dementia (FTD) is a common cause of early onset dementia but also occurs in the elderly. A challenge for diagnosis is that patients tend to perform well on standard cognitive tests because those tests do not measure functions related to the critical brain areas. The objective of this project is to develop an easy-to-administer computerized version of an Object Alternation (OA) test which assists with the diagnosis of frontotemporal dementia.

Remote Self-Reporting of Symptoms by Patients with a Palliative Care Designation (RELIEF)
Project Lead: Martin Chasen
Host Institution: William Osler Health System
RELIEF will develop a patient self-reporting mobile application to provide more frequent and temporally integrated e-monitoring of symptoms for palliative care patients. An algorithm will assess the reported data and generate a green, yellow, red, alert system to notify clinicians of changes to their patients’ status.

Repetitive Transcranial Stimulation to Treat Depression and Anxiety in Senior Inpatients
Project Lead: Hubert Kammerer
Host Institution: Alberta Health Services/Glenrose Rehabilitation Hospital
Trans-cranial direct current stimulation (TDCS) has been proposed as a potential innovative adjunctive treatment modality for seniors with depression. This project aims to determine if using adjunctive TDCS to treat seniors admitted with symptoms of depression and anxiety reduces length of stay in long term care and improves quality of life.

Reversing dementia in patients with chronic subdural hematomas
Project Lead: Douglas Cook
Host Institution: Kingston Health Sciences Centre
Patients with dementia are at higher risk for bleeding in the brain. However, cognitive symptoms that result from dementia may disguise symptoms arising from a hemorrhage and result in lack of treatment. This project will implement a unique imaging solution, with the capacity to identify chronic brain bleeds in dementia patients in the community setting.

Senior Helping Seniors – the Montessori Way
Project Lead: James Cohen
Host Institution: Support for Memory Loss Foundation
The goal for this project is to pair up well seniors with seniors that have dementia. The well seniors will volunteer by visiting the seniors with dementia on a bi-weekly basis and engaging them in various real-life activities that have been proven to work using a Montessori approach.

The Glendon Repeatable Executive Attention Tests (GREAT)
Project Lead: Kristoffer Romero
Host Institution: York University, Glendon Campus
The GREAT is a series of computerized tests that measure different facets of attention (selective, dividing, and switching attention). These tests use cutting‐edge, automatically processed metrics of performance that can detect subtle changes in attentional control. The tests are designed using visual stimuli, removing language as a barrier of use. The project focus is on developing the tests further, validation them and testing them.

The Glenrose Grocery Game for Geriatric Cognitive Rehabilitation
Project Lead: Quentin Ranson
Host Institution: Glenrose Rehabilitation Hospital, Alberta Health Services
Occupational therapists (OTs) work with geriatric clients who may have dementia and associated cognitive impairment. This project is the creation and implementation of a “grocery game” which assesses baseline function, tracks progress, as well as provides appropriate stages, from easy to difficult, based on a client’s abilities.

The Second Heart: Active compression for the maintenance of blood pressure and brain blood flow in the elderly
Project Lead: James Milligan
Host Institution: Schlegel Villages/Schlegel Research Institute for Aging
When standing up, gravity pulls blood towards the feet and away from the brain which in some individuals, particularly the elderly, can result in confusion, dizziness, loss of balance, and falls. The proposed intermittent compression system will help the body combat gravity to bring blood back to the heart and brain to reduce the risk of falls, increase mobility and independence, and promote aging in place while still being comfortable for patients. The project goal is to develop a system for effective, comfortable, individualized compression therapy with simple set-up and an easy to put on.

The Sleep Kit: Alternative Sleep Therapies for Those Living with Dementia
Project Lead: Eve Baird
Host Institution: York Care Centre
The Sleep Kit is a small box of alternative therapies based upon the benefits of individualized social interaction and therapeutic recreation. It is a non-pharmacological, person-centered approach, and is designed for use by care partners of individuals living with dementia. Research has shown that one-on-one activities before bed can improve sleep by 30%. This project will deliver sleep kits and evaluate its efficacy.

The Storycare Project:  Enriching healthcare for seniors through the use of storytelling
Project Lead: Melissa Tafler
Host Institution: Baycrest Health Sciences
The Storycare Project will create and disseminate an e-learning module that offers training in a story-based approach to enriching the quality of the care experience for elders, and the communities of carers around them.

User-centered design and development of a dementia observations (DObs) mobile application
Project Lead: Andrea Iaboni
Host Institution: Toronto Rehab Institute, UHN
The project leads have developed a web-application based upon the Dementia Observation System (DOS), a tool used widely as part of the PIECES approach. Using this application, front-line care staff can set up and enter observational data using a mobile device. This project will evaluate the clinical use of this application in long-term care facilities.

Validation of a subjective memory assessment tool (SuMA) to identify older adults at risk for Alzheimer’s disease
Project Lead: Linda Mah
Host Institution: Baycrest Health Sciences
The project leads have developed a subjective memory assessment tool (SuMA), a brief questionnaire consisting of specific memory concerns in everyday life. This project study will validate the SuMA as a screening tool to detect preclinical AD by establishing 1) concurrent validity—the extent to which the SuMA predicts amyloid burden on neuroimaging, the “gold standard” in AD prevention trials, and 2) the extent to which the SuMA predicts current memory and future cognitive decline.

Virtual counselling for dementia family caregivers
Project Lead: Susana Braslavski
Host Institution: Baycrest Health Sciences
The goal of this pilot project is to develop virtual counselling services for dementia family caregivers living in the community. Partnering with the Ontario Telehealth Network (OTN), this mode of intervention will offer a flexible and secure platform for caregiver support.

Virtual reality interventions on negative mood
Project Lead: Sherry Law
Host Institution: York Care Centre
The project goal is to provide a means to improve well-being among long term care residents by running sessions of virtual reality (VR) exposure to residents. This will help evaluate its effect as a treatment on adverse moods.

Virtual Ward Medicine – Improving Care Transitions on Geriatric Hospital Units
Project Lead: Richard Sztramko
Host Institution: Juravinski Hospital; operated by Hamilton Health Sciences
Virtual Ward is an electronic web-based tool providing a standardized handover process and workflow management functions for medical professionals. The main goal of the SPARK project is to establish a successful implementation of the software on the Geriatric Rehabilitation Unit at Juravinski Hospital, Hamilton with the objective of facilitating the provision of streamlined care for elderly individuals.

Words at Your Fingertips: A website for improving word finding in aging
Project Lead: Regina Jokel
Host Institution: Baycrest Health Sciences
Everyone over the age of 40 experiences so-called tip-of-the-tongue phenomenon, which is a frustrating instance of an inability to retrieve a desired word. The main goal is to design and provide free access to a website that offers information, self-assessment, and practical solutions to word-finding problems in healthy older adults.

Your Path to Home – Have you got your Passport App?
Project Lead: Debbie Gravelle
Host Institution: Bruyere Continuing Care
Returning home from a hospital stay in rehabilitation and remembering all the advice and instructions is overwhelming to patients with dementia and their caregivers. This project is developing an app that provides easy-to-use discharge instructions which may be shared with the primary care team.

Industry Innovation Partnership Program – Round 2 Projects

Boosting Cognitive Reserve through Adult Second Language Acquisition with Duolingo
Company: Duolingo
Lead SCP: Baycrest
Duolingo is a software platform for teaching languages to adults outside of a classroom or immersion setting. This project will use Duolingo software to teach a new language to older adults over three months and evaluate the impact on executive function and attention; as well as evaluate the user-satisfaction with the app as a life-enhancing tool for seniors.

SWORD Phoenix – The Standard of care for the next 50 years of the rehabilitation
Company: Sword Health
Lead SCP: CBI Health Group
SWORD Phoenix is an integrated software to optimize at-home rehabilitation.  With SWORD Phoenix, patients perform their therapy at home, maximizing engagement and clinical outcomes while ensuring full data accountability.  SWORD Phoenix uses AI and motion tracking to understand the performance of each patient, providing real-time feedback during treatment, under remote guidance from clinical teams. This project will aim to validate the usability and shape the product-market fit; clinically validate the solution; and evaluate the market and commercial viability for further market scale-up.

Telemedicine as a supporting technology to outpatient care
Company: RightHealth
Lead SCP: Baycrest
Akira MD is a service for patients and clinicians to help manage their health information and engage in secure text and video with primary care and health professionals. This project will seek to enable virtual care to homebound geriatric patients; build capacity to disseminate best practices for a virtual care environment; and evaluate patient and provider adoption and experience with the solution.

Tess – A Digital Health Companion for Older Adults
Company: X2AI Inc
Lead SCP: Saint Elizabeth Healthcare
The Tess artificial intelligence chat bot will deliver on-demand coaching to relieve social isolation and loneliness in older adults with dementia.  This project will seek to obtain evidence of efficacy at reducing isolation and loneliness in older adults with dementia; evaluate efficacy of delivering Tess coaching service; and evaluate the right price point for direct consumer access to Tess service.

Using Gait Robotics to Improve Mood and Cognition in Seniors with Parkinson’s Disease
Company: B-Temia
Lead SCP: Assistive Technology Clinic
B-Temia has developed a robotic dermoskeleton used for gait training of patients with Parkinson’s Disease.  This project plan will measure the safety and usability of the Keeogo Rehab for use as a mobility aid and therapeutic tool in clients with PDD; develop and evaluate specific protocols for exoskeleton rehabilitation practice; develop recommendations and guidelines on the use of this technology for general rehabilitation practice; and  prepare for future studies on the use of Keeogo Rehab in non-clinical environments.

Connected meditation assistance tools for brain health and quality of life, in high-risk older adults and caregivers
Company: Interaxon
Lead SCP: Baycrest
Interaxon’s Muse is a consumer EEG technology, designed for use in acquiring the skills and realizing the brain health benefits associated with meditation practice. The Muse headband connects to a smartphone and engages users in an immersive audio brain-feedback experience to develop a healthy habit of mindfulness.  This projects will test utility of Muse as an intervention in older adult patients and caregivers; and help to develop better brain health markers for use with Muse.

Deployment and Pilot of a Video-based Safety System for Individuals with Alzheimer’s Disease and Related Dementias
Company: SafelyYou
Lead SCP: Baycrest
SafelyYou deploys wall-mounted cameras, enabled with artificial intelligence to evaluate falls in long-term care homes. This project will seek to improve system metrics, such as detection accuracy and false detection rate; measure the number of falls, ER admissions, caregiver and family engagement; and measure patient satisfaction with the product.

Improving Lives: A study on the impact of Virtual Reality cognitive therapy on Long term care residents with moderate to severe dementia
Company: Crosswater Digital Media
Lead SCP: Primacare Living Solutions
Crosswater has developed a Virtual Reality cognitive therapy to enhance the quality of life of long-term care residents. Project objectives for participation in this round of I2P2 include: evaluating the viability of the solution as an alternative therapy; developing the most effective positive outcome scenarios; evaluating the most effective immersion time; and evaluating the economic benefit and stress effects on the system and caregivers.

Pressure Injury management system for individuals living with dementia in LTC and Acute Care Institutions
Company: Curiato Inc
Lead SCP: Toronto Grace Health Centre
The Ceylon smart system is a smart biological sensor math and remote web interface portal placed on the surface of existing mattresses to help evaluate pressure injury forms. This project plan includes the development of a prototype; determining the economic viability of the solution; and an effort to improve the technical data evidence by successfully integrating with EHR software.

Empowering Modern Healthcare Teams
Company: Careteam Technologies
Lead SCP: Mackenzie Health
Careteam is a care coordination and navigation platform designed to bring together the multidisciplinary modern team for patients with complex care needs.  Project objectives include the evaluation of client satisfaction; determining patient outcomes; and evaluating the use of system resources.

Researcher-Clinician Partnership Program – Round 2 Projects

Multimedia e-Learning to Improve Quality of Life for Family Caregivers of People with Dementia:  the iGeriCare Initiative
Lead Clinician: Richard Sztramko
Co-Investigator: Anthony J. Levinson
Host Organization: McMaster University
The iGeriCare platform is a website with multimedia lessons and resources to help educate informal family caregivers of people with dementia. iGeriCare is a technology-enhanced educational prescription to help with patient and family-centred care.  This project seeks to enhance the solution by testing it with live expert sessions; promote it to both caregivers and health care teams for further sector adoption; conduct detailed interviews and evaluation with key stakeholders; perform an economic analysis to help explore business models for ongoing funding and commercialization.

Enhancing and Standardizing Care for Agitation and Aggression in Alzheimer’s Disease
Lead Clinician: Sanjeev Kumar
Co-Investigator: Tarek Rajji
Host Organization: Centre for Addiction and Mental Health (CAMH)
This project team has developed and implemented an Integrated Care Pathway (ICP) to treat agitation and aggression in dementia at CAMH and a partner long term care facility. The ICP resulted in better outcomes lowered medication use.  In this study, the team will standardize and evaluate the behavioral intervention aspect of the ICP to further decrease medication use and study predictors of response to behavioral interventions and medications. This group will enroll 220 participants across 7 sites (4 academic hospitals and 3 long term care homes across Canada). Data will be collected on clinical parameters such as agitation, falls, medication use, caregiver burden as well as about economic impact of care before and after the structured behavioral interventions. If successful, this project will minimize medication use and improve the quality of life for patients with dementia and their caregivers.

Oasis Senior Supportive Living: A Model for Active Aging-in-Place
Lead Clinician: Catherine  Donnelly
Co-Investigator: Vincent DePaul
Host Organization: Queen’s University
Oasis is an innovative seniors-driven Aging-in-Place model that provides a supportive living environment within an existing naturally occurring retirement community. Oasis is an exemplar of a seniors-led collaboration among public, not-for-profit, charitable and private-sector organizations and is run by a volunteer board of directors who are directed by, and responsive to, the senior tenant-members it serves. This model enables active-aging through provision of group exercise, recreation, communal meals, resource navigation, social engagement and community partnerships. It brings together preexisting community, social and health services, and volunteers, to deliver practical support (e.g. meals, resource navigation) and social network building. The aim of this project is to develop and evaluate a process to guide scale-up of the Oasis model to other naturally occurring retirement communities.

GERAS Dancing For Cognition and Exercise (DANCE): A Mind-Body Health Platform for Frail Seniors
Lead Clinician: Alexandra Papaioannou
Co-Investigator: Courtney Kennedy
Host Organization: Hamilton Health Sciences – St. Peter’s, GERAS Centre for Aging Research
GERAS DANCE (Dancing for Cognition and Exercise) is an evidence-based program for older adults with cognitive and physical impairments. The program was developed by geriatricians, rehabilitation therapists, psychologists, and dance professionals and combines the latest evidence for mild cognitive impairment, with a safe, progressive approach that incorporates music and social interaction. This social enterprise will provide an accessible, standardized program that is effective, safe and can be delivered in a variety of settings. The team’s vision is to create a sustainable platform of products and services that can be implemented across Canada and globally. This includes in-person and on-line training, high-quality manuals, comprehensive support and establishing a community of practice.  The project will engage 600 older adults across 12 YMCAs located across the Hamilton, Burlington, Brantford, Niagara region

Risk Evaluation for Support: Predictions for Elder-life in the Community Tool Dementia (RESPECT: Dementia)
Lead Researcher: Doug Manuel
Co-Investigator: Peter Tanuseputro
Host Organization: The Ottawa Hospital
‘RESPECT: Dementia’ is a tool that provides personalized, precision risk estimates and reliably identifies future health and health care needs. It estimates when people will reach end-of-life and other health outcomes such as ER visits, hospitalization, long-term care, etc. This RCP2 project will implement and evaluate a web-based platform that enables informal caregivers of people with dementia to identify risk for cognitive or health decline that leads to institutionalization. Through focus groups, surveys, user analytics, and evaluation of health care services and outcomes, this project aims determine if the tools accurate, if it can improve decision making around care, identify unintended adverse effects, and whether it can reduce hospitalization, ER visits, and increase a person’s time living at home.

Brain stress test for assessing cerebrovascular reactivity in the aging brain
Lead Researcher: David Mikulis
Co-Investigator: Lakshmikumar Venkat Raghavan
Host Organization: Joint Department of Medical Imaging (JDMI), Toronto Western Hospital
The brain stress test is comparable to the cardiac stress test. It examines abnormalities in brain blood vessel function thought to be a major contributor to cognitive decline and vascular dementia. Physicians currently rely on vascular risk factors, including diabetes, smoking etc., to assess an individual’s risk of future brain injury. This project aims to improve on this indirect assessment by providing direct measures of blood vessel performance using the brain stress test.  The solution objective is to provide physicians with a tool that can provide a better estimate of a decline in brain function. If successful, this innovation will significantly improve how physicians are able to manage aging patients who are at greater risk of developing cognitive decline and dementia.

VRx: Design & Evaluate Virtual Reality based therapy for people living with dementia & mild cognitive impairment
Lead Researcher: Lora Appel
Co-Investigator: Christopher Smith
Host Organization: OpenLab, University Health Network
Virtual Reality (VR) presents a unique opportunity to transport people to a world outside of their confined spaces, into calming and/or stimulating settings (green forest, peaceful beach, cheerful playground). This project team has created a library of VR “experiences” as prototype for introducing immersive VR-therapy, with the goal of stimulating psychological/cognitive health and engagement, decreasing depression, anxiety, reducing the need for neuroleptic drugs, and increasing feelings of independence, personhood, and happiness. Informed by a CABHI-funded pilot study via the Spark Program, the project team improved the VR-therapy and plan to conduct a large Randomized Controlled Trial (RCT) including measuring physiological (e.g. heart and respiration rates) and clinical outcomes (e.g. wandering incidents).