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Strategies to Locate Lost Persons with Dementia: A Case Study of Ontario First Responders

Strategies to Locate Lost Persons with Dementia: A Case Study of Ontario First Responders Hindawi Journal of Aging Research Volume 2021, Article ID 5572764, 9 pages https://doi.org/10.1155/2021/5572764 Research Article Strategies to Locate Lost Persons with Dementia: A Case Study of Ontario First Responders 1,2 1,2,3 1 N. A. Neubauer , A. Miguel-Cruz , and L. Liu School of Public Health and Health System, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada Department of Occupational "erapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada Glenrose Rehabilitation Research,Innovation & Technology (GRRIT) Hub, Edmonton, Alberta, Canada Correspondence should be addressed to N. A. Neubauer; nneubaue@uwaterloo.ca Received 24 January 2021; Accepted 6 May 2021; Published 15 May 2021 Academic Editor: He´lio J. Coelho-Ju´nior Copyright © 2021 N. A. Neubauer et al. )is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Informationonstrategiesandpracticesinthesearchofmissingpersonswithdementiaisinconsistentwhichcreateschallengesfor first responders, such as police, when they choose appropriate search and rescue approaches. )e purpose of this study was to describe current strategies among police services in Ontario. Telephone interviews with police were conducted. Questions included what strategies were used for locating missing persons living with dementia, and what gaps exist in search practices. Participants described they used high- and low-tech solutions in search and rescue. )ey identified gaps in education and awareness, proactive strategies, resources, and funding. Information collected from the interviews was used to develop a practice guideline for police in partnership with the Alzheimer Society of Ontario. groups. As a result, search and rescue (SAR) strategies for 1. Introduction persons with dementia may differ from other populations. )e rates of dementia are on the rise as populations age. Tracking or locator technologies, such as wearable global More than 747,000 Canadians are living with dementia [1] positioning systems (GPS) [11] and radio frequency iden- with the prevalence expecting to more than double every 5 tification (RFID) [12], for example, may offer options for years [2]. One significant concern is when persons with mitigating risks while providing a person with dementia dementia become lost and go missing, especially when they autonomy to go about safely outside of their home. Other are alone or in unfamiliar environments [3]. )e adverse strategies such as MedicAlert Connect Protect [13] and consequences of getting lost include high search and rescue vulnerable persons registries [14] may also provide the in- costs [4], injuries [5], and death [6]. )e average cost es- formation needed to police services in a timely manner to timates of missing person investigations can range from assist them in their search. $2,294 to $4,181 CAD [7], and if a person with dementia is While alternative SAR strategies to address missing notfoundwithin24 hours, upto halfwillexperience serious personsincidentsinvolvingindividualslivingwithdementia injury or even die [8]. have become increasingly available in recent years, the lit- It is estimated that approximately 40% of those diag- erature suggests that the information describing such nosed with dementia will become lost at some point in their strategies is limited and their overall scientific evidence is disease progression [9]. )us, searches that involve missing low[15].Inaddition,SARpersonnelmayremainunawareof persons with dementia in Canada will increase with the the behavioural differences that occur in persons with de- rising national prevalence of dementia. It has been reported mentiawhobecomelost[16].Asaresult,policeservicesmay thatmissingpersonswithdementiatypicallycontinueto“go resort to using traditional SAR strategies. Such strategies untiltheygetstuck”[10]whichdiffersfromothervulnerable may include the use of helicopters andtracking dogsinstead 2 Journal of Aging Research of focusing on strategies specific to a missing person’s an- operations centre, duty inspector, involvement in ground ticipatedbehaviour,ortheuseofmediareleasestonotifythe searches, and media releases of missing persons to the public [15]. In addition to a higher success in locating a public. missing person with dementia, targeted strategies may also mitigate the costs of search and rescue for this population. 3.2. Search and Rescue Practices for Missing Persons with )e cost to operate a standard helicopter alone averages Dementia. Table 2 presents a total of 14 types of strategies $1,600 US/hour [17]. described in the interviews with police in SAR. )e most )e lessened awareness of dementia-related behaviours frequently reported strategies across all six regions in among SAR personnel could be attributed to a lack of Ontario were search tactics (i.e., drones, dogs, helicopters) available education materials and resources [15]. )is can (100%), Project Lifesaver® (40%), MedicAlert® (40%), edu- create challenges for police services to identify specific SAR cationandawareness(33%),andvulnerablepersonregistries strategies that are appropriate for locating missing persons (33%). Participants reported that these strategies were with dementia. )us, this study aimed to describe existing typically learned through formal training (100%), resources strategiesandgapsthatexperiencedamongpoliceservicesin such as SAR related textbooks and information made Ontario, Canada, used to search for missing persons with available from local Alzheimer Societies (13%), conventions dementia to help inform the development of a practice or conferences (13%), and experiential learning (13%) (Ta- guideline for this population. ble 3). Most interviewees referred to Robert Koester’s book “Lost Person Behaviour” as their primary reference material 2. Methods for search tactics for missing persons with dementia [21]. In particular, they referred to a chapter from this book that 2.1. Participants. Participants for this study were a purpo- describes how to determine the direction of travel of the sive sample recruited via word of mouth. One to two media person with dementia. According to this chapter, persons officers and one to two officers with experience in SAR were withdementiagenerallygountiltheygetstuck.Basedonthis recruited from each respective region of Ontario, Canada observation, SAR managers can expect to find this pop- (North, East, Central, South Central, greater Toronto, and ulationinareaswhereothermissingpersonsdonotventure, South West) (n �30). All participants had experience in such as near or in bodies of water, marshes, wooded areas, media releases or search and rescue of missing persons with and bushes. Additional search tactics that were used within dementia, were English speaking, and at least were 18 years police services in Ontario include training members of the of age. Ethical approval was obtained from the University of search to start looking for identification bracelets due to the Alberta Research Ethics Board 2 (Pro0076365). raising implementation of strategies such as MedicAlert® Depending on the resources available to each department, 2.2. Data Collection and Analysis. A qualitative description these strategies were either purchased or rented from [18] approach was used for this study. We used an inductive vendors. data collection approach and a constant comparative In terms of search tactics of SAR, police referred to method [19]. One-time, semi-structured telephone inter- search urgency policies that determine how quickly search views with individual participants were 60 minutes in du- teams need to be dispatched. Across all regions within ration and included 12 questions. Interview questions with Ontario,policeprioritizemissingpersonswithdementiaasa policecovered three maincategories: (1)strategies related to highest urgency due to the missing persons’ inability to care SAR and media releases among missing persons with de- for themselves. Other methods above and beyond search mentia;(2)tippingpointrelatedtotheuseofthesestrategies; tacticsinclude educationandawarenesswithlong-termcare and (3) strategy gaps. and the public in terms of understanding dementia and the All interviews were digitally recorded and transcribed necessitytocallthepoliceassoonassomeonewithdementia verbatim.Transcriptsandfieldnoteswerereadandreviewed is believed to be missing. Locating technologies such as multiple times to ensure accuracy of codes assigned to short Project Lifesaver , identification methods such as Medi- segments of text. We used Excel and NVivo to organize the cAlert®, alerting public transit personnel, and use of vul- dataforanalysis.Weuseddirectedcontentanalysis[20]and nerable persons registries were also discussed as proactive developed an initial coding scheme based on an interview strategies that should be investigated and incorporated guide. We summarized and cross-referenced the data for within police practices. each semi-structured interview in a table. 3. Results 3.3. Practices for Media Release in Cases of Missing Persons with Dementia. For media releases, three categories of 3.1.ParticipantDemographics. )esamplecomprisedpolice strategieswereidentified:(1)processes,(2)socialmedia,and officers in SAR and media from 16 police services across (3) disclosure about dementia (Table 4). Ontario (n �27) (Table 1). Participants varied in types of experiences working with missing persons who have de- mentia.Amongthepoliceparticipants,experiencesincluded 3.4.Processes. Mostmediaofficersspokeabouttheprocesses SAR manager roles, vulnerable missing persons or emer- necessary for media releases of missing persons with de- gency services coordinators, watch commander of an mentia(Table2).Ingeneral,thetypeofinformationreleased Journal of Aging Research 3 Table 1: Participant characteristics (n �27). Police officer Years of experience Region in Ontario Age (years±SD) Gender type (years±SD) North (3); South West (4); South Central (5); Male (21); SAR (17); media (10) 15±7 45±8 Central (8); East (4); Toronto (2); Provincial (1) female (6) Note. SAR refers to police search and rescue, and media refers to police media. Each checkmark represents one participant. Table 2: Strategies used by police for lost persons with dementia. Total number of participants Strategy type Region(s) that used the strategy that used the strategy Search tactics 15 North; South West; South Central; Central; East; Toronto; Provincial Project lifesaver® 6 Central, North MedicAlert 6 South Central; Central, East; Toronto Education and awareness 5 Central, South West Vulnerable persons registry 5 South Central; Central, South West Alerting public transit 4 South Central, Central, South West; Toronto Media releases 2 North; South West; South Central; Central; East; Toronto; Provincial Label clothing 1 East Table 3: Modes of educating police on strategies for lost persons For other police services, drafted media releases are with dementia. required to be sent to their portal first before it can be released to the public. )is portal is then responsible for Education type Total number of participants sending the release across the entire province to media Formal training 15 outlets rather than to specific underlying regions. Conventions/conferences 2 Experiential learning 2 “Whenever a media release is drafted up and ready to go Resources 2 out,Idonotsendittothemoranymediaoutletdirectly;it gets posted to what’s called a provincial portal. . .From was reported to be specific to each individual incident. thereitgetsdistributed.AssoonasIhitthesendbutton,it Picture, age, clothing, last known location, and medical pretty much distributes rightacrossthe entireprovince to condition were standard information across all cases. )e media outlets, you know, newspapers and radio stations endgoalofasocialmediareleasewastogetmoreeyesonthe and whatever–and they all have access to that portal ground to keep a look out for the missing person. To engage (media police officer 2).” in this practice, police highlighted the importance of getting these releases out to the public as soon as possible. Search tactics across all services indicated that media 3.5. Social Media. Social media was identified as the most releaseswereonlydraftedafterpolicehadbeendispatchedto common and effective method to alert the public of missing the home and were able to confirm that the person is persons, with police resorting to Twitter, followed by missing.Initialreleasesweresentoffwithvagueinformation Facebook as the main platforms. Mainstream media will and follow-up releases were sent out with more detail as the then gain further information from these platforms and will investigation transpired. Processes were dependent on release it through the news. )e reason for this shift away whether the police service was run through regional mu- fromemphasizingnewspapersandothertraditionalformsof nicipalities, or provincial. With regional services, for ex- media is because social media has the capacity for the re- ample, multiple media officers were trained on media leases to be immediate. releases. For some services, this has enabled officers to send these releases at home or work through mobile platforms. “IsentthatoutasaTweetfromourTwitteraccount–we’ve got like 10 000 followers which is pretty special. )ing “Yeah, and the neat thing when I was there is my about social media is to provide a meaningful and almost BlackBerry was always on. Initially it took a while just to immediate opportunity for two-way communication open up this new type of thought process but now your between the police and the communities they serve. media officer is basically going to be at home or working Twitterispreferredashasthefastestresponseandeasyfor and as soon as the missing person comes in and it’s a headline searches due to 140 characters being available at quality-of-life issue, they’re going to contact the media a time. 99% of the time people are going to Tweet it officer and say “Look, we want to get this out immedi- because it’s immediate and we can get that out as soon as ately” (media police officer 1).” possible (media police officer 2).” 4 Journal of Aging Research Table 4: Practices for sending an alert about a missing person on social media, by region. Region in Practice Ontario Policeordersstipulatewhatcanandcannotbereleasedtothepublic.Guidelinesexistfordraftingreleases.Draftrelease North issentupchainofcommandtobereviewed.Dependingonhowserioustheeventis,releaseneedstogotoheadquarters for approval before it can be released Typeofinformationthroughmediareleaseisdictatedbyeachscenario.Officersaretrainedonwhattheycanandcannot South West release.Willnotreleasethatthepersonhasdementiaunlessthisinformationplaysaroleinhowtodealwiththemissing person Will double-check the place last seen before sending a release. Goes through chain of demand. By the time the media release comes to media officer, it is immediate. Information is screened beforeit gets to the mediaofficers. Social media South central alert includes photo, clothing worn when last seen, where they were last seen, other descriptive information like height, and hair color. )is information is deleted after the person is located. After the person has been found, the public is updated Do a search of the area. If not found, a picture of the person is obtained, age, last whereabouts, and other information. Social media releases do not say that missing person has dementia in order to respect individual’s privacy. Alert does state that the police is concerned for the missing individual’s wellbeing. From there, it goes to website, and is posted on Central Twitter and Facebook. Release can be posted in 10–15 minutes. At most, it has taken 30 minutes because family did not have a picture or were trying to look for a picture. Social media release is kept posted until person is found. After an extended period of time, police will post under missing persons page Gathers the information from on-site investigators (i.e., picture, description of person, direction of travel). Send to Twitter, Instagram and Facebook, but Twitter is more effective. Time to media release depends on urgency of the East investigation; if there is medical danger, it is sent out immediately. Weather is also a factor. Picture release is important as it clarifies identity of missing person. Every case is individual. If there is imminent danger, and depending on points they have, it gives authority to pursue further Information released is specific to individual incident. Approvals go through command and through investigation. If thereis concern about criminality,then theyneed toinvolve CriminalInvestigationsBureau. Itis case specificbut need to make sure the proper approvals are in place through the local area. Missing person must be verified by police officer. Toronto Callbasedonpriorityresponsewhichisinfluencedbyweatherandmissingperson’smedicalconditions.Oncepersonis confirmed missing, then corporate communications is informed, and the police will report back to their station. Media relations will send photo, and gain authorisation. Social media alert will include information on dementia with permission of the family, so it gains sympathy from the public Note. PWD refers to persons with dementia. Other services, however, still resort to using media person. Police are obligated to gain consent from the family outletsastheirmainstrategy.)isisbecauseeachindividual ofthemissingpersonastowhatinformationcanbereleased detachment does not have access to social media, as they to the public, in order to respect people’s privacy. With the have only one larger regional twitter account. Due to the stigma still evident around dementia, police services get varying responses, dictating whether they can disclose in- time sensitivity of these releases, for these services, local media is the fastest way they can get the information to the formation that the missing person has dementia in their public. media releases. “So,forusthough,unlikesomeotherpoliceservices,each “So, if the family says, no, I do not want that going out, individual station or detachment does not have social there’s nothing we can do, yeah, supposedly. We always media, we have one larger regional twitter account. So encourage it [including ‘dementia’ in media releases] yeah, for us, I mean without having the ability to post it (media police officer 1).” ourselves, then a call or a post, you know. If it’s super “In circumstances where a family is against releasing that urgent, yeah, we have the local say radio station that we the missing person has dementia, police will phrase the can call and say, can you post this on your Facebook page releasetothefollowinginhopesofgainingattentionfrom or can you Tweet this out and they’ll do that on our ask the public.” (media police officer 4).” “Police are very concerned for their wellbeing and any- body that has seen whomever, please contact police im- 3.6. Disclosure of Dementia. Identification of a missing mediately (SAR police officer 5).” person as having a cognitive impairment in these media releases was also brought up by media officers. In general, Media and SAR officers thought that the use of media to police thought if there was concern for the missing person’s alert the public was critical for rapid search of a missing safety, including the term ‘dementia’ in media releases can person with dementia and its overall potential should not be assist in generating sympathy from the public which may ignored.Socialmediahasthepotentialandrecruitmoreeyes result in more eyes on the ground looking for the missing on the ground. It can inspire communities to dedicate Journal of Aging Research 5 “)e reluctance to call immediately, the feeling that with resources, such as volunteers, to offer help in the search process. some people because especially with the older generation thattheyfeellikethey’rewastingourtime.I’mworkingin moreofaruraldivisionnowupinourservicewegetthata 3.7. Tipping Point for the Implementation of SAR and Media lot. Like I literally was just dealing with a case this ReleaseStrategies. )eincreasednumber of casesof missing morningandallIgoteverysecondsentencefromhimwas persons with dementia was the tipping point for SAR to use really sorry to waste your time. And you just reassure social media strategies. One of the interviewees from the them that you know, this is where we want to be, we want South-Central region commented: tobeinvolvedearlyandoftenifwehavetoinordertostop the tragedy from happening (SAR police officer 5).” “For us it was actually physically getting the increase of calls specifically towards whether they’re elderly or they In some situations, multiple missing occurrences took are diagnosed with dementia. Not all of them result in a place before families contact police after they have not been full out search but the divisions they are dealing with, I’d able to locate the missing person after their own extensive almost say on a weekly basis where they have elderly searches. Care facilities were also known to delay contacting people gone missing and whether it’s just they’ve over the police about a missing person with dementia. extended themselves on a walk that they normally do or Perhaps reporting, in the first instance, from care pro- whether this is just the onset of some sort dementia that viderswhodonotnecessarilyseethegravityofthesituation, they have not been diagnosed with, and we’re seeing it callinatimelyfashion.Butthere’snothingwe’regoingtobe (SAR police officer 1).” able to do about that. You get the odd instance where somebody has waited–it’s almost like they’re–they’ve been )ese findings were further supported by interviewees caught with their hand in the cookie jar, and they’re hoping when asked questions regarding the collection of missing to solve it themselves before calling (SAR police officer 12). persons with dementia data. For example, across all Ontario regions, between 10 and 50% of missing persons calls in the “In some circumstances, care facilities were unable to last 5 years have involved a person with dementia, with provide the information necessary for police to carry increases in the incidents of these missing persons calls through withtheir investigationsuchas pointof lastseen, reported ranging from a 1% increase per year to the inci- and what the missing person was wearing, which may dence doubling over the last 5 years (Table 5). contribute to the delay in reporting. Police suggested that care facilities need to keep records that contain the de- mentia resident’s most recent photo, and clothing de- 3.8. Gaps in Practice. Two general categories arose in terms scriptions.Oneparticipantdescribedasimplestrategy for of gaps in practice for the rapid search of missing persons facilities to keep a binder on residents that is kept up to with dementia among police services: (1) community edu- date.” cation and awareness and (2) proactive strategies and “So, what we find is the facilities are not–it’s hard to say available resources. likeit’snotliketheycankeeptrackofalltheofthepatients 24/7 but at the same time you know we should be able to 3.9. Community Education and Awareness. All participants narrow it down within an hour or so. What we also see withthefacilityisthattheyarenotabletoprovideuswith highlighted that there was a misconception that care part- ners must wait 24 hours to call the police after a person with clothing descriptions on a regular basis which means that they are not even sure what is in the person’s closet–like dementia goes missing. When an incident is reported later, the search radius is typically greater, further reducing their anyofthosedetailsareimportantforus.Severalyearsago, we tried to get an initiative going where all the facilities ability to locate missing persons in a timely manner. had a binder for each of their residences, especially those “We also heard that, you know, “We are not allowed to identified with dementia which was helpful (SAR police call the police, unless it’s been 24 hours with a missing officer 3).” person.”Idonotknowifthat’sjustsomemisinformation, Othereducationandawarenessgapsincludealackofbasic you know, that they hear, whether it’s through the TV or not. )ey have this feeling there is a waiting period for SAR training and education on dementia signs and symptoms forallofficers,andthewidereducationtothepubliconhowto missing persons where we try to say “Absolutely not, call us as soon as possible” because that just gives us a better determine whether an older adult with potential signs of dementia is missing. Interviewees emphasized that many in- time for us to get out there (SAR police officer 10).” dividuals in the community, including some members of police services, are not aware that an older adult is lost. )is is Another reason for this delay is a fear that care partners are wasting the police’s time, resulting in families conducting understandable because a person with dementia could look their own ground search prior to initiating the call to police. like any person. Education is significant to help with this and OneintervieweefromtheCentralRegionstatedthefollowing. help people be aware of what signs to look for. 6 Journal of Aging Research Table 5: Trend of calls about missing persons with dementia, by region. Region in Range (% of missing persons calls that involved Frequency Trend over the last 5 years Ontario persons with dementia) North 30–50 N/A Drastic increase East 30–50 N/A Steadily increasing South Central 27–33 N/A >1% increase per year South West 10 N/A Steadily increasing 2–3 calls/12-hour Increased.Onedepartmenthasdoubledwithin Central 30–50 shift the last 5 years Toronto N/A 5–7 calls/24 hours Increased slightly “In the end, people are more likely to pay attention to a and vice versa. Within one of the other jurisdictions however, there was only one central twitter account from lost dog. )ey’re driving down the road and they see a lost dog and report it versus a random person that may where media releases were sent. As stated by the police, be elderly. )e assumption is that person wants to be this takes extra time, causing many detachments to resort there. )ere’s not necessarily anything wrong. When I to traditional modes of media rather than social media. spoke with that woman [that was lost], my assumption )is may have an influence on the level of effectiveness was, “Okay, she just does not speak English and that’s media releases can have for finding missing persons with why she’s confused.” When you’re dealing with dementia as soon as possible. )is can also be seen with someone with dementia there are key things that set SAR where in some regions the closest SAR teams are them aside from just someone who does not speak your more than an hour away. language.Ithinkthateducationcomponentneedstoget out there more so that people are more aware. A person “Our closest search and rescue is in London. So, our team is a 13-man team and they can hit the ground really quick could look dishevelled, dirty, elderly and confused and, “You know what, maybe they’re just homeless. I do not and they can be effective, but obviously we’re limited by really care.” )ey move on not realizing that person has numbers, right? So, to have a trained qualified large beenmissingforfourorfivedays,suffersfromdementia number search and rescue team here there would pro- and they’re dirty because they’ve just been wandering bably...by the time we decide that we want to activate the streets for the past five days. If I had known more them, get them to Sarnia, get coordinated, we’re probably thenIprobablywouldhavecontactedourpoliceservice. three to four hours before they’re on route. . .so, yeah, At least I could’ve got some attention there sooner, but that’sprobablyourbiggestgap,isgettingthemtogooutin itcamedowntosimplynotknowingandanassumption a timely way, but I do not know how to deal with that becausewejustdonothavethatvolunteerbasehere(SAR that she just does not speak English (SAR police officer 9).” police officer 2).” Whileproactivestrategiesmayreducethetimeittakesto 3.10. Proactive Strategies and Available Resources. find missing persons with dementia and prevent future Proactive strategies and available resources were another incidences, participants stated that everything comes down common gap noted by the interviewees. For most regions, to costs. Strategies such as Project Lifesaver® are expensive there was a need to promote more proactive strategies such for police services to integrate, and locator devices may be as vulnerable persons registries to assist police services in associated with purchase and subscription costs to families, operating within existing department budgets. inhibiting some individuals from having access to these strategies. “Intermsofyouknowhowwearegoingtogoforwardasa government how are we going to sustain long-term “It’s a subscription amount [locator devices and Medi- searches and you know and still operate within budgets ® cAlert ],youknow,andit’ssignificant.So,it’sdifficultfor that we have for policing services in our you know, re- usto,youknow,wecannotpushthatonanybody.Wecan spective jurisdictions. So, anything we can do to try and suggest it and obviously, it helps us significantly but the mitigatesomeofthoseexpensesandalsoaregoingtobea families maybe, you know, constrained for cost. Cell- benefit for each municipality and region in the province phones for us is a big thing, you know, if we can find out and so forth going forward (SAR police officer 6).” that person is carrying a cellphone and we’ll reached out to local cellphone companies and do what’s called a ping Other gaps in available resources include the number in order to try to triangulate a position where that person of media and SAR officers that are available within certain was or is. But again, not all people especially in that jurisdictions. In one of the regions in northern Ontario, demographic are carrying cellphones. So, [Project] Life- for example, there was only one media officer for the saver is something that is always at the back our minds, entire area. )erefore, when the officer was off duty, their it’s just something that is not feasible right now due to area must be covered by a neighbouring police service, costs (SAR police officer 1).” Journal of Aging Research 7 According to the participants, a means to subsidize time delay between when the person with dementia was last proactivestrategiesisessentialtoensureeveryonehasaccess seen and when the police are notified. Suggested reasons to these resources and services. were care partner’s fear of wasting the police’s time. In the case of a facility, staff would not report a missing person to “Ithinksubsidywouldbeamazingbecausetherearesome the police immediately for fear of litigation and judgement. families that cannot afford it or are not even aware of Some care partners may not appreciate the gravity of the sometheseresources.Andthenthepoliceservicesthatwe situationuntilitistoolate.)esefindingswerealsoreported have,Seniorsupportofficersemployedhereattheservice, by Shalev Greene et al. [23], who described that the most that is a resource that at the front end that can push that common andimportant factors influencing the delay calling information out. So that, you know, those tools can be the police were caregiver’s sense of embarrassment, guilt, utilized prior to somebody going missing. As much as we and fear of disapproval or judgement by the police because like, you know, we definitely would hand out these re- they were unable to keep the person with dementia safe. sources afterwards but let’s try to stop it right from the Participants in this study also suggested that a fear of negative reactions by a person with dementia after finding front end and give out these resources so that, you know, wedonotevencomeintothesituationwhereoneofthese out their care partner called the police, a caregiver’s distrust people have gone missing (SAR police officer 8).” of thepolice, and a desireto protect their relative wereother reasons for not notifying the police immediately. Older adults who are lost are not always recognizable by 4. Discussion the public, nor by the police themselves. )is was confirmed )e purpose of this study was to determine what existing by the participants of this study. It is not uncommon for the strategies were being used by first responders in Ontario, public and police to mistake a lost person with dementia as Canada, that focused on missing persons with dementia. To someone who is either homeless or simply out engaging in ourknowledge,thisisthefirststudytoexamineanddescribe regular activities, not requiring assistance. While topics of strategies used by police services within Canada to find this nature underlying education and awareness have been broughtforward withintheliterature[24–26],fewresources missing persons with dementia. In terms of existing practices among police, currently are available within the grey literature, where police and communities can seek information of this nature [15]. )e used strategies involved the use of search tactics, notifica- tions to the public through media channels, vulnerable inclusion of awareness campaigns and publicly available personsregistries,andseveralstrategiesnotedby(Neubauer education resources could be used to describe how missing et al.) [15], such as locator devices and identification incidents occur among persons with dementia. In turn, it methods. )ese strategies were used in part due to tipping could assist in informing the public why wandering be- points that were incurred by each police service, such as haviour is not always related to these occurrences [27], nor individualcasestudies,theinfluxinthenumberofcasesand are they a result of poor caregiving [25]. )is highlights the callsofmissingpersonswithdementia,andtheawarenessof importance of alerting a community or reporting missing the urgency necessary to find this population due to their older adults and demonstrates the need for a greater em- phasis and implementation of strategies and subsequent inability to survive for long on their own. While several strategies were already incorporated within police depart- guidelinesthatcanfurtheraddresstheseeducationgaps[15]. ments throughout Ontario, there werestill gaps experienced )e description of a missing person as having dementia by police when responding to and dealing with missing or cognitive impairment was also inconsistently used in persons with dementia. One needed improvement would be media releases. While the use of the term “dementia” in to promote that one size does not fit all in terms of the media releases resulted in more members of the public adoption of police practices among varying police becoming engaged in keeping a lookout for the missing departments. person, police were required to obtain consent from the )e types of strategies were also associated with the missing person’s family. According to the participants, it is availability of resources. While Project Lifesaver was used common for family members to be against releasing this within several police jurisdictions, others were unable to information, primarily due to the stigma associated with dementia and the potential of making the missing person adopt it despite the high cost. We also do not know the effectiveness of these strategies [22]. )is was beyond the evenmorevulnerable,suchaspeopletakingadvantageofthe missing persons who are described as vulnerable and cog- scope of this project but would warrant a separate study; nevertheless, cost spending on strategies should be sup- nitively impaired [28]. ported by evidence that the strategy or program is effective or makes a difference. )e availability of police officers that 5. Conclusion and Recommendations can take on the role of media or SAR officer varied across jurisdictions, and chosen strategies depended on human In conclusion, there is a variation of certain practices and resource capacity. strategies and there are also some consistent approaches in An issue identified by the interviewees was the common searching for missing persons with dementia. )ese strat- belief among the general public that care partners must not egies can be related to available resources. Evidence on the call the police immediately when a vulnerable older adult is effectiveness of these strategies however remains limited. missing. Participants explained that there was a significant )e development of a practice guideline of search strategies 8 Journal of Aging Research tofindmissingpersonswithdementiacouldreducethetime MitacsAccelerate,inpartnershipwiththeAlzheimerSociety to locate these individuals and reduce the cost on police of Ontario. resources. In addition to the development of such a guideline, we propose the following recommendations to References move the field forward: [1] Alzheimer’s Association, Alzheimer’s and Dementia in Can- (1) Create education and awareness campaigns, and ada,Alzheimer’sAssociation,Chicago,IL,USA,2021,https:// practice guidelines for police. Delays in the time it www.alz.org/ca/dementia-alzheimers-canada.asp. takes to call the police of a missing person with [2] Public Health Agency of Canada, Dementia in Canada, In- dementia and the ability to recognize whether a cluding Alzheimer’s Disease, Public Health Agency of Canada, person with dementia is missing remains the largest Ottawa, Canada, 2017, https://www.canada.ca/en/public- mostconcerningissueforpolice.Stigmaofdementia health/services/publications/diseases-conditions/dementia- is a barrier to using the term dementia in media highlights-canadian-chronic-disease-surveillance.html. [3] Y. J. Chang, Y. Y. Chu, C. N. Chen, and T. Wang, “Mobile releases. )ere is general unawareness of the general computingforindoorwayfindingbasedonBluetoothsensors public, including police, about whether an older for individuals with cognitive impairments,” in Proceedings of adult is lost. the 3rd International Symposium on Wireless Pervasive (2) Create provincial or national vulnerable persons Computing, pp. 623–627, IEEE, Santorini, Greece, May 2008. registries. )is collection of information ahead of [4] M. A. Rowe and V. Bennett, “A look at deaths occurring in time for vulnerable older adults at risk would help to persons with dementia lost in the community,” American Journal of Alzheimer’s Disease & Other Dementiasr, vol. 18, assist search and rescue personnel in timely media no. 6, pp. 343–348, 2003. releasesandsearches.)isstrategyhoweverwillonly [5] E. Bantry White and P. Montgomery, “Dementia, walking workifallindividualswithdementiaregisteranditis outdoors and getting lost: incidence, risk factors and con- free or affordable. Who would cover the costs and sequences from dementia-related police missing-person re- control the data would also need to be identified. ports,” Aging & Mental Health, vol. 19, no. 3, pp. 224–230, (3) )ere is a need for research to verify effectiveness of strategies recommended by the participants to in- [6] K. Kikuchi, M. Ijuin, S. Awata, and T. Suzuki, “Exploratory form allocation of funding resources. research on outcomes for individuals missing through de- mentia wandering in Japan,” Geriatrics & Gerontology In- (4) Establish consistent content and approaches to ternational, vol. 19, no. 9, pp. 902–906, 2019. creating media releases through some of the police [7] K. Shalev Greene and F. Pakes, “)e cost of missing person services, as well as the involvement of more trained investigations: implications for current debates,” Policing, SAR in all police services. vol. 8, no. 1, pp. 27–34, 2013. (5) Identifysearchandrescuetoolsthathaveevidenceof [8] AlzheimerAssociation, Alzheimer’s Disease Facts and Figures, Alzheimer Association, Chicago, IL, USA, 2016, http://www. success and make these tools affordable. Participants alz.org/facts/. recommended subsidization for proactive services [9] R. McShane, K. Gedling, J. Keene, C. Fairburn, R. Jacoby, and and strategies such as locating technologies. While T. Hope, “Getting lost in dementia: a longitudinal study of a some police services have been able to fundraise behavioral symptom,” International Psychogeriatrics, vol. 10, money to assist in their costs, it still limits many no. 3, pp. 253–260, 1998. organizations, families, and persons living with de- [10] CBCNews, 5 Tips for Tracking Missing Persons with Dementia, mentia to participate in some of these strategies, CBC News, Toronto, Canada, 2013, http://www.cbc.ca/news/ reducingthesheerpotentialtheseinitiativescanhave canada/british-columbia/5-tips-for-tracking-missing-persons- in terms of the rapid responses of finding this with-dementia-1.2460571. population as soon as possible. [11] L. Liu, A. Miguel Cruz, T. Ruptash, S. Barnard, and D.Juzwishin,“Acceptanceofglobalpositioningsystem(GPS) technology among dementia clients and family caregivers,” Data Availability Journal of Technology in Human Services, vol. 35, no. 2, pp. 99–119, 2017. 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Ontario, and the police departments across Ontario for [15] N.Neubauer,K.Laquian,C.Conway,andL.Liu,“Whatdowe recruiting participants. )is project was funded by the know about best police practices for lost persons with Journal of Aging Research 9 dementia?” A Scoping Review,” Neurodegenerative Disease Management, vol. 9, no. 6, pp. 319–330, 2019. [16] Alzheimer Society of Ontario, Dementia Training for First Responders, Alzheimer Society of Ontario, Toronto, Canada, 2021, http://findingyourwayontario.ca/first-responders/ dementia-training/. [17] T. Sharples, “Get into trouble outdoors – who pays for the rescue?,” 2009, http://content.time.com/time/nation/article/ 0,8599,1892621,00.html. [18] M. Sandelowski, “Whatever happened to qualitative de- scription?” Research in Nursing & Health, vol. 23, no. 4, pp. 334–340, 2000. [19] H. Boeije, “A purposeful approach to the constant compar- ativemethodintheanalysisofqualitativeinterviews,” Quality & Quantity, vol. 36, pp. 391–409, 2006. [20] H.-F. Hsieh and S. E. Shannon, “)ree approaches to qual- itative content analysis,” Qualitative Health Research, vol.15, no. 9, pp. 1277–1288, 2005. [21] R. Koester, Lost Person Behavior: A Search and Rescue Guide on where to Look – for Land, Air, and Water,dbSProductions LLC, Charlottesville, VA, USA, 2008. [22] L. Emrich-Mills, V. Puthusseryppady, and M. Hornberger, “Effectiveness of interventions for preventing people with dementia exiting or getting lost,” "e Gerontologist, vol. 61, no. 3, pp. e48–e60, 2021. [23] K. Shalev Greene, C. L. Clarke, F. Pakes, and L. Holmes, “People with dementia who go missing: a qualitative study of family caregivers decision to report incidents to the police,” Policing: A Journal of Policy and Practice, vol. 13, no. 2, pp. 241–253, 2019. [24] R. J. Koester and D. E. Stooksbury, “Behavioral profile of possible Alzheimer’s disease patients in Virginia search and rescue incidents,” Wilderness & Environmental Medicine, vol. 6, no. 1, pp. 34–43, 1995. [25] M. A. Rowe, “People with dementia who become lost,” AJN, American Journal of Nursing, vol.103, no. 7, pp. 32–39, 2003. [26] F. Sun, X. Gao, H. Brown, and L. T. Winfree, “Police officer competence in handling Alzheimer’s cases: the roles of AD knowledge, beliefs, and exposure,” Dementia, vol. 18, no. 2, pp. 674–684, 2019. [27] M. Rowe, A. Houston, V. Molinari et al., “)e concept of missing incidents in persons with dementia,” Healthcare, vol. 3, no. 4, pp. 1121–1132, 2015. [28] S. C. Burgener and B. Berger, “Measuring perceived stigma in persons with progressive neurological disease,” Dementia, vol. 7, no. 1, pp. 31–53, 2008. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Aging Research Hindawi Publishing Corporation

Strategies to Locate Lost Persons with Dementia: A Case Study of Ontario First Responders

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Hindawi Journal of Aging Research Volume 2021, Article ID 5572764, 9 pages https://doi.org/10.1155/2021/5572764 Research Article Strategies to Locate Lost Persons with Dementia: A Case Study of Ontario First Responders 1,2 1,2,3 1 N. A. Neubauer , A. Miguel-Cruz , and L. Liu School of Public Health and Health System, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada Department of Occupational "erapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada Glenrose Rehabilitation Research,Innovation & Technology (GRRIT) Hub, Edmonton, Alberta, Canada Correspondence should be addressed to N. A. Neubauer; nneubaue@uwaterloo.ca Received 24 January 2021; Accepted 6 May 2021; Published 15 May 2021 Academic Editor: He´lio J. Coelho-Ju´nior Copyright © 2021 N. A. Neubauer et al. )is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Informationonstrategiesandpracticesinthesearchofmissingpersonswithdementiaisinconsistentwhichcreateschallengesfor first responders, such as police, when they choose appropriate search and rescue approaches. )e purpose of this study was to describe current strategies among police services in Ontario. Telephone interviews with police were conducted. Questions included what strategies were used for locating missing persons living with dementia, and what gaps exist in search practices. Participants described they used high- and low-tech solutions in search and rescue. )ey identified gaps in education and awareness, proactive strategies, resources, and funding. Information collected from the interviews was used to develop a practice guideline for police in partnership with the Alzheimer Society of Ontario. groups. As a result, search and rescue (SAR) strategies for 1. Introduction persons with dementia may differ from other populations. )e rates of dementia are on the rise as populations age. Tracking or locator technologies, such as wearable global More than 747,000 Canadians are living with dementia [1] positioning systems (GPS) [11] and radio frequency iden- with the prevalence expecting to more than double every 5 tification (RFID) [12], for example, may offer options for years [2]. One significant concern is when persons with mitigating risks while providing a person with dementia dementia become lost and go missing, especially when they autonomy to go about safely outside of their home. Other are alone or in unfamiliar environments [3]. )e adverse strategies such as MedicAlert Connect Protect [13] and consequences of getting lost include high search and rescue vulnerable persons registries [14] may also provide the in- costs [4], injuries [5], and death [6]. )e average cost es- formation needed to police services in a timely manner to timates of missing person investigations can range from assist them in their search. $2,294 to $4,181 CAD [7], and if a person with dementia is While alternative SAR strategies to address missing notfoundwithin24 hours, upto halfwillexperience serious personsincidentsinvolvingindividualslivingwithdementia injury or even die [8]. have become increasingly available in recent years, the lit- It is estimated that approximately 40% of those diag- erature suggests that the information describing such nosed with dementia will become lost at some point in their strategies is limited and their overall scientific evidence is disease progression [9]. )us, searches that involve missing low[15].Inaddition,SARpersonnelmayremainunawareof persons with dementia in Canada will increase with the the behavioural differences that occur in persons with de- rising national prevalence of dementia. It has been reported mentiawhobecomelost[16].Asaresult,policeservicesmay thatmissingpersonswithdementiatypicallycontinueto“go resort to using traditional SAR strategies. Such strategies untiltheygetstuck”[10]whichdiffersfromothervulnerable may include the use of helicopters andtracking dogsinstead 2 Journal of Aging Research of focusing on strategies specific to a missing person’s an- operations centre, duty inspector, involvement in ground ticipatedbehaviour,ortheuseofmediareleasestonotifythe searches, and media releases of missing persons to the public [15]. In addition to a higher success in locating a public. missing person with dementia, targeted strategies may also mitigate the costs of search and rescue for this population. 3.2. Search and Rescue Practices for Missing Persons with )e cost to operate a standard helicopter alone averages Dementia. Table 2 presents a total of 14 types of strategies $1,600 US/hour [17]. described in the interviews with police in SAR. )e most )e lessened awareness of dementia-related behaviours frequently reported strategies across all six regions in among SAR personnel could be attributed to a lack of Ontario were search tactics (i.e., drones, dogs, helicopters) available education materials and resources [15]. )is can (100%), Project Lifesaver® (40%), MedicAlert® (40%), edu- create challenges for police services to identify specific SAR cationandawareness(33%),andvulnerablepersonregistries strategies that are appropriate for locating missing persons (33%). Participants reported that these strategies were with dementia. )us, this study aimed to describe existing typically learned through formal training (100%), resources strategiesandgapsthatexperiencedamongpoliceservicesin such as SAR related textbooks and information made Ontario, Canada, used to search for missing persons with available from local Alzheimer Societies (13%), conventions dementia to help inform the development of a practice or conferences (13%), and experiential learning (13%) (Ta- guideline for this population. ble 3). Most interviewees referred to Robert Koester’s book “Lost Person Behaviour” as their primary reference material 2. Methods for search tactics for missing persons with dementia [21]. In particular, they referred to a chapter from this book that 2.1. Participants. Participants for this study were a purpo- describes how to determine the direction of travel of the sive sample recruited via word of mouth. One to two media person with dementia. According to this chapter, persons officers and one to two officers with experience in SAR were withdementiagenerallygountiltheygetstuck.Basedonthis recruited from each respective region of Ontario, Canada observation, SAR managers can expect to find this pop- (North, East, Central, South Central, greater Toronto, and ulationinareaswhereothermissingpersonsdonotventure, South West) (n �30). All participants had experience in such as near or in bodies of water, marshes, wooded areas, media releases or search and rescue of missing persons with and bushes. Additional search tactics that were used within dementia, were English speaking, and at least were 18 years police services in Ontario include training members of the of age. Ethical approval was obtained from the University of search to start looking for identification bracelets due to the Alberta Research Ethics Board 2 (Pro0076365). raising implementation of strategies such as MedicAlert® Depending on the resources available to each department, 2.2. Data Collection and Analysis. A qualitative description these strategies were either purchased or rented from [18] approach was used for this study. We used an inductive vendors. data collection approach and a constant comparative In terms of search tactics of SAR, police referred to method [19]. One-time, semi-structured telephone inter- search urgency policies that determine how quickly search views with individual participants were 60 minutes in du- teams need to be dispatched. Across all regions within ration and included 12 questions. Interview questions with Ontario,policeprioritizemissingpersonswithdementiaasa policecovered three maincategories: (1)strategies related to highest urgency due to the missing persons’ inability to care SAR and media releases among missing persons with de- for themselves. Other methods above and beyond search mentia;(2)tippingpointrelatedtotheuseofthesestrategies; tacticsinclude educationandawarenesswithlong-termcare and (3) strategy gaps. and the public in terms of understanding dementia and the All interviews were digitally recorded and transcribed necessitytocallthepoliceassoonassomeonewithdementia verbatim.Transcriptsandfieldnoteswerereadandreviewed is believed to be missing. Locating technologies such as multiple times to ensure accuracy of codes assigned to short Project Lifesaver , identification methods such as Medi- segments of text. We used Excel and NVivo to organize the cAlert®, alerting public transit personnel, and use of vul- dataforanalysis.Weuseddirectedcontentanalysis[20]and nerable persons registries were also discussed as proactive developed an initial coding scheme based on an interview strategies that should be investigated and incorporated guide. We summarized and cross-referenced the data for within police practices. each semi-structured interview in a table. 3. Results 3.3. Practices for Media Release in Cases of Missing Persons with Dementia. For media releases, three categories of 3.1.ParticipantDemographics. )esamplecomprisedpolice strategieswereidentified:(1)processes,(2)socialmedia,and officers in SAR and media from 16 police services across (3) disclosure about dementia (Table 4). Ontario (n �27) (Table 1). Participants varied in types of experiences working with missing persons who have de- mentia.Amongthepoliceparticipants,experiencesincluded 3.4.Processes. Mostmediaofficersspokeabouttheprocesses SAR manager roles, vulnerable missing persons or emer- necessary for media releases of missing persons with de- gency services coordinators, watch commander of an mentia(Table2).Ingeneral,thetypeofinformationreleased Journal of Aging Research 3 Table 1: Participant characteristics (n �27). Police officer Years of experience Region in Ontario Age (years±SD) Gender type (years±SD) North (3); South West (4); South Central (5); Male (21); SAR (17); media (10) 15±7 45±8 Central (8); East (4); Toronto (2); Provincial (1) female (6) Note. SAR refers to police search and rescue, and media refers to police media. Each checkmark represents one participant. Table 2: Strategies used by police for lost persons with dementia. Total number of participants Strategy type Region(s) that used the strategy that used the strategy Search tactics 15 North; South West; South Central; Central; East; Toronto; Provincial Project lifesaver® 6 Central, North MedicAlert 6 South Central; Central, East; Toronto Education and awareness 5 Central, South West Vulnerable persons registry 5 South Central; Central, South West Alerting public transit 4 South Central, Central, South West; Toronto Media releases 2 North; South West; South Central; Central; East; Toronto; Provincial Label clothing 1 East Table 3: Modes of educating police on strategies for lost persons For other police services, drafted media releases are with dementia. required to be sent to their portal first before it can be released to the public. )is portal is then responsible for Education type Total number of participants sending the release across the entire province to media Formal training 15 outlets rather than to specific underlying regions. Conventions/conferences 2 Experiential learning 2 “Whenever a media release is drafted up and ready to go Resources 2 out,Idonotsendittothemoranymediaoutletdirectly;it gets posted to what’s called a provincial portal. . .From was reported to be specific to each individual incident. thereitgetsdistributed.AssoonasIhitthesendbutton,it Picture, age, clothing, last known location, and medical pretty much distributes rightacrossthe entireprovince to condition were standard information across all cases. )e media outlets, you know, newspapers and radio stations endgoalofasocialmediareleasewastogetmoreeyesonthe and whatever–and they all have access to that portal ground to keep a look out for the missing person. To engage (media police officer 2).” in this practice, police highlighted the importance of getting these releases out to the public as soon as possible. Search tactics across all services indicated that media 3.5. Social Media. Social media was identified as the most releaseswereonlydraftedafterpolicehadbeendispatchedto common and effective method to alert the public of missing the home and were able to confirm that the person is persons, with police resorting to Twitter, followed by missing.Initialreleasesweresentoffwithvagueinformation Facebook as the main platforms. Mainstream media will and follow-up releases were sent out with more detail as the then gain further information from these platforms and will investigation transpired. Processes were dependent on release it through the news. )e reason for this shift away whether the police service was run through regional mu- fromemphasizingnewspapersandothertraditionalformsof nicipalities, or provincial. With regional services, for ex- media is because social media has the capacity for the re- ample, multiple media officers were trained on media leases to be immediate. releases. For some services, this has enabled officers to send these releases at home or work through mobile platforms. “IsentthatoutasaTweetfromourTwitteraccount–we’ve got like 10 000 followers which is pretty special. )ing “Yeah, and the neat thing when I was there is my about social media is to provide a meaningful and almost BlackBerry was always on. Initially it took a while just to immediate opportunity for two-way communication open up this new type of thought process but now your between the police and the communities they serve. media officer is basically going to be at home or working Twitterispreferredashasthefastestresponseandeasyfor and as soon as the missing person comes in and it’s a headline searches due to 140 characters being available at quality-of-life issue, they’re going to contact the media a time. 99% of the time people are going to Tweet it officer and say “Look, we want to get this out immedi- because it’s immediate and we can get that out as soon as ately” (media police officer 1).” possible (media police officer 2).” 4 Journal of Aging Research Table 4: Practices for sending an alert about a missing person on social media, by region. Region in Practice Ontario Policeordersstipulatewhatcanandcannotbereleasedtothepublic.Guidelinesexistfordraftingreleases.Draftrelease North issentupchainofcommandtobereviewed.Dependingonhowserioustheeventis,releaseneedstogotoheadquarters for approval before it can be released Typeofinformationthroughmediareleaseisdictatedbyeachscenario.Officersaretrainedonwhattheycanandcannot South West release.Willnotreleasethatthepersonhasdementiaunlessthisinformationplaysaroleinhowtodealwiththemissing person Will double-check the place last seen before sending a release. Goes through chain of demand. By the time the media release comes to media officer, it is immediate. Information is screened beforeit gets to the mediaofficers. Social media South central alert includes photo, clothing worn when last seen, where they were last seen, other descriptive information like height, and hair color. )is information is deleted after the person is located. After the person has been found, the public is updated Do a search of the area. If not found, a picture of the person is obtained, age, last whereabouts, and other information. Social media releases do not say that missing person has dementia in order to respect individual’s privacy. Alert does state that the police is concerned for the missing individual’s wellbeing. From there, it goes to website, and is posted on Central Twitter and Facebook. Release can be posted in 10–15 minutes. At most, it has taken 30 minutes because family did not have a picture or were trying to look for a picture. Social media release is kept posted until person is found. After an extended period of time, police will post under missing persons page Gathers the information from on-site investigators (i.e., picture, description of person, direction of travel). Send to Twitter, Instagram and Facebook, but Twitter is more effective. Time to media release depends on urgency of the East investigation; if there is medical danger, it is sent out immediately. Weather is also a factor. Picture release is important as it clarifies identity of missing person. Every case is individual. If there is imminent danger, and depending on points they have, it gives authority to pursue further Information released is specific to individual incident. Approvals go through command and through investigation. If thereis concern about criminality,then theyneed toinvolve CriminalInvestigationsBureau. Itis case specificbut need to make sure the proper approvals are in place through the local area. Missing person must be verified by police officer. Toronto Callbasedonpriorityresponsewhichisinfluencedbyweatherandmissingperson’smedicalconditions.Oncepersonis confirmed missing, then corporate communications is informed, and the police will report back to their station. Media relations will send photo, and gain authorisation. Social media alert will include information on dementia with permission of the family, so it gains sympathy from the public Note. PWD refers to persons with dementia. Other services, however, still resort to using media person. Police are obligated to gain consent from the family outletsastheirmainstrategy.)isisbecauseeachindividual ofthemissingpersonastowhatinformationcanbereleased detachment does not have access to social media, as they to the public, in order to respect people’s privacy. With the have only one larger regional twitter account. Due to the stigma still evident around dementia, police services get varying responses, dictating whether they can disclose in- time sensitivity of these releases, for these services, local media is the fastest way they can get the information to the formation that the missing person has dementia in their public. media releases. “So,forusthough,unlikesomeotherpoliceservices,each “So, if the family says, no, I do not want that going out, individual station or detachment does not have social there’s nothing we can do, yeah, supposedly. We always media, we have one larger regional twitter account. So encourage it [including ‘dementia’ in media releases] yeah, for us, I mean without having the ability to post it (media police officer 1).” ourselves, then a call or a post, you know. If it’s super “In circumstances where a family is against releasing that urgent, yeah, we have the local say radio station that we the missing person has dementia, police will phrase the can call and say, can you post this on your Facebook page releasetothefollowinginhopesofgainingattentionfrom or can you Tweet this out and they’ll do that on our ask the public.” (media police officer 4).” “Police are very concerned for their wellbeing and any- body that has seen whomever, please contact police im- 3.6. Disclosure of Dementia. Identification of a missing mediately (SAR police officer 5).” person as having a cognitive impairment in these media releases was also brought up by media officers. In general, Media and SAR officers thought that the use of media to police thought if there was concern for the missing person’s alert the public was critical for rapid search of a missing safety, including the term ‘dementia’ in media releases can person with dementia and its overall potential should not be assist in generating sympathy from the public which may ignored.Socialmediahasthepotentialandrecruitmoreeyes result in more eyes on the ground looking for the missing on the ground. It can inspire communities to dedicate Journal of Aging Research 5 “)e reluctance to call immediately, the feeling that with resources, such as volunteers, to offer help in the search process. some people because especially with the older generation thattheyfeellikethey’rewastingourtime.I’mworkingin moreofaruraldivisionnowupinourservicewegetthata 3.7. Tipping Point for the Implementation of SAR and Media lot. Like I literally was just dealing with a case this ReleaseStrategies. )eincreasednumber of casesof missing morningandallIgoteverysecondsentencefromhimwas persons with dementia was the tipping point for SAR to use really sorry to waste your time. And you just reassure social media strategies. One of the interviewees from the them that you know, this is where we want to be, we want South-Central region commented: tobeinvolvedearlyandoftenifwehavetoinordertostop the tragedy from happening (SAR police officer 5).” “For us it was actually physically getting the increase of calls specifically towards whether they’re elderly or they In some situations, multiple missing occurrences took are diagnosed with dementia. Not all of them result in a place before families contact police after they have not been full out search but the divisions they are dealing with, I’d able to locate the missing person after their own extensive almost say on a weekly basis where they have elderly searches. Care facilities were also known to delay contacting people gone missing and whether it’s just they’ve over the police about a missing person with dementia. extended themselves on a walk that they normally do or Perhaps reporting, in the first instance, from care pro- whether this is just the onset of some sort dementia that viderswhodonotnecessarilyseethegravityofthesituation, they have not been diagnosed with, and we’re seeing it callinatimelyfashion.Butthere’snothingwe’regoingtobe (SAR police officer 1).” able to do about that. You get the odd instance where somebody has waited–it’s almost like they’re–they’ve been )ese findings were further supported by interviewees caught with their hand in the cookie jar, and they’re hoping when asked questions regarding the collection of missing to solve it themselves before calling (SAR police officer 12). persons with dementia data. For example, across all Ontario regions, between 10 and 50% of missing persons calls in the “In some circumstances, care facilities were unable to last 5 years have involved a person with dementia, with provide the information necessary for police to carry increases in the incidents of these missing persons calls through withtheir investigationsuchas pointof lastseen, reported ranging from a 1% increase per year to the inci- and what the missing person was wearing, which may dence doubling over the last 5 years (Table 5). contribute to the delay in reporting. Police suggested that care facilities need to keep records that contain the de- mentia resident’s most recent photo, and clothing de- 3.8. Gaps in Practice. Two general categories arose in terms scriptions.Oneparticipantdescribedasimplestrategy for of gaps in practice for the rapid search of missing persons facilities to keep a binder on residents that is kept up to with dementia among police services: (1) community edu- date.” cation and awareness and (2) proactive strategies and “So, what we find is the facilities are not–it’s hard to say available resources. likeit’snotliketheycankeeptrackofalltheofthepatients 24/7 but at the same time you know we should be able to 3.9. Community Education and Awareness. All participants narrow it down within an hour or so. What we also see withthefacilityisthattheyarenotabletoprovideuswith highlighted that there was a misconception that care part- ners must wait 24 hours to call the police after a person with clothing descriptions on a regular basis which means that they are not even sure what is in the person’s closet–like dementia goes missing. When an incident is reported later, the search radius is typically greater, further reducing their anyofthosedetailsareimportantforus.Severalyearsago, we tried to get an initiative going where all the facilities ability to locate missing persons in a timely manner. had a binder for each of their residences, especially those “We also heard that, you know, “We are not allowed to identified with dementia which was helpful (SAR police call the police, unless it’s been 24 hours with a missing officer 3).” person.”Idonotknowifthat’sjustsomemisinformation, Othereducationandawarenessgapsincludealackofbasic you know, that they hear, whether it’s through the TV or not. )ey have this feeling there is a waiting period for SAR training and education on dementia signs and symptoms forallofficers,andthewidereducationtothepubliconhowto missing persons where we try to say “Absolutely not, call us as soon as possible” because that just gives us a better determine whether an older adult with potential signs of dementia is missing. Interviewees emphasized that many in- time for us to get out there (SAR police officer 10).” dividuals in the community, including some members of police services, are not aware that an older adult is lost. )is is Another reason for this delay is a fear that care partners are wasting the police’s time, resulting in families conducting understandable because a person with dementia could look their own ground search prior to initiating the call to police. like any person. Education is significant to help with this and OneintervieweefromtheCentralRegionstatedthefollowing. help people be aware of what signs to look for. 6 Journal of Aging Research Table 5: Trend of calls about missing persons with dementia, by region. Region in Range (% of missing persons calls that involved Frequency Trend over the last 5 years Ontario persons with dementia) North 30–50 N/A Drastic increase East 30–50 N/A Steadily increasing South Central 27–33 N/A >1% increase per year South West 10 N/A Steadily increasing 2–3 calls/12-hour Increased.Onedepartmenthasdoubledwithin Central 30–50 shift the last 5 years Toronto N/A 5–7 calls/24 hours Increased slightly “In the end, people are more likely to pay attention to a and vice versa. Within one of the other jurisdictions however, there was only one central twitter account from lost dog. )ey’re driving down the road and they see a lost dog and report it versus a random person that may where media releases were sent. As stated by the police, be elderly. )e assumption is that person wants to be this takes extra time, causing many detachments to resort there. )ere’s not necessarily anything wrong. When I to traditional modes of media rather than social media. spoke with that woman [that was lost], my assumption )is may have an influence on the level of effectiveness was, “Okay, she just does not speak English and that’s media releases can have for finding missing persons with why she’s confused.” When you’re dealing with dementia as soon as possible. )is can also be seen with someone with dementia there are key things that set SAR where in some regions the closest SAR teams are them aside from just someone who does not speak your more than an hour away. language.Ithinkthateducationcomponentneedstoget out there more so that people are more aware. A person “Our closest search and rescue is in London. So, our team is a 13-man team and they can hit the ground really quick could look dishevelled, dirty, elderly and confused and, “You know what, maybe they’re just homeless. I do not and they can be effective, but obviously we’re limited by really care.” )ey move on not realizing that person has numbers, right? So, to have a trained qualified large beenmissingforfourorfivedays,suffersfromdementia number search and rescue team here there would pro- and they’re dirty because they’ve just been wandering bably...by the time we decide that we want to activate the streets for the past five days. If I had known more them, get them to Sarnia, get coordinated, we’re probably thenIprobablywouldhavecontactedourpoliceservice. three to four hours before they’re on route. . .so, yeah, At least I could’ve got some attention there sooner, but that’sprobablyourbiggestgap,isgettingthemtogooutin itcamedowntosimplynotknowingandanassumption a timely way, but I do not know how to deal with that becausewejustdonothavethatvolunteerbasehere(SAR that she just does not speak English (SAR police officer 9).” police officer 2).” Whileproactivestrategiesmayreducethetimeittakesto 3.10. Proactive Strategies and Available Resources. find missing persons with dementia and prevent future Proactive strategies and available resources were another incidences, participants stated that everything comes down common gap noted by the interviewees. For most regions, to costs. Strategies such as Project Lifesaver® are expensive there was a need to promote more proactive strategies such for police services to integrate, and locator devices may be as vulnerable persons registries to assist police services in associated with purchase and subscription costs to families, operating within existing department budgets. inhibiting some individuals from having access to these strategies. “Intermsofyouknowhowwearegoingtogoforwardasa government how are we going to sustain long-term “It’s a subscription amount [locator devices and Medi- searches and you know and still operate within budgets ® cAlert ],youknow,andit’ssignificant.So,it’sdifficultfor that we have for policing services in our you know, re- usto,youknow,wecannotpushthatonanybody.Wecan spective jurisdictions. So, anything we can do to try and suggest it and obviously, it helps us significantly but the mitigatesomeofthoseexpensesandalsoaregoingtobea families maybe, you know, constrained for cost. Cell- benefit for each municipality and region in the province phones for us is a big thing, you know, if we can find out and so forth going forward (SAR police officer 6).” that person is carrying a cellphone and we’ll reached out to local cellphone companies and do what’s called a ping Other gaps in available resources include the number in order to try to triangulate a position where that person of media and SAR officers that are available within certain was or is. But again, not all people especially in that jurisdictions. In one of the regions in northern Ontario, demographic are carrying cellphones. So, [Project] Life- for example, there was only one media officer for the saver is something that is always at the back our minds, entire area. )erefore, when the officer was off duty, their it’s just something that is not feasible right now due to area must be covered by a neighbouring police service, costs (SAR police officer 1).” Journal of Aging Research 7 According to the participants, a means to subsidize time delay between when the person with dementia was last proactivestrategiesisessentialtoensureeveryonehasaccess seen and when the police are notified. Suggested reasons to these resources and services. were care partner’s fear of wasting the police’s time. In the case of a facility, staff would not report a missing person to “Ithinksubsidywouldbeamazingbecausetherearesome the police immediately for fear of litigation and judgement. families that cannot afford it or are not even aware of Some care partners may not appreciate the gravity of the sometheseresources.Andthenthepoliceservicesthatwe situationuntilitistoolate.)esefindingswerealsoreported have,Seniorsupportofficersemployedhereattheservice, by Shalev Greene et al. [23], who described that the most that is a resource that at the front end that can push that common andimportant factors influencing the delay calling information out. So that, you know, those tools can be the police were caregiver’s sense of embarrassment, guilt, utilized prior to somebody going missing. As much as we and fear of disapproval or judgement by the police because like, you know, we definitely would hand out these re- they were unable to keep the person with dementia safe. sources afterwards but let’s try to stop it right from the Participants in this study also suggested that a fear of negative reactions by a person with dementia after finding front end and give out these resources so that, you know, wedonotevencomeintothesituationwhereoneofthese out their care partner called the police, a caregiver’s distrust people have gone missing (SAR police officer 8).” of thepolice, and a desireto protect their relative wereother reasons for not notifying the police immediately. Older adults who are lost are not always recognizable by 4. Discussion the public, nor by the police themselves. )is was confirmed )e purpose of this study was to determine what existing by the participants of this study. It is not uncommon for the strategies were being used by first responders in Ontario, public and police to mistake a lost person with dementia as Canada, that focused on missing persons with dementia. To someone who is either homeless or simply out engaging in ourknowledge,thisisthefirststudytoexamineanddescribe regular activities, not requiring assistance. While topics of strategies used by police services within Canada to find this nature underlying education and awareness have been broughtforward withintheliterature[24–26],fewresources missing persons with dementia. In terms of existing practices among police, currently are available within the grey literature, where police and communities can seek information of this nature [15]. )e used strategies involved the use of search tactics, notifica- tions to the public through media channels, vulnerable inclusion of awareness campaigns and publicly available personsregistries,andseveralstrategiesnotedby(Neubauer education resources could be used to describe how missing et al.) [15], such as locator devices and identification incidents occur among persons with dementia. In turn, it methods. )ese strategies were used in part due to tipping could assist in informing the public why wandering be- points that were incurred by each police service, such as haviour is not always related to these occurrences [27], nor individualcasestudies,theinfluxinthenumberofcasesand are they a result of poor caregiving [25]. )is highlights the callsofmissingpersonswithdementia,andtheawarenessof importance of alerting a community or reporting missing the urgency necessary to find this population due to their older adults and demonstrates the need for a greater em- phasis and implementation of strategies and subsequent inability to survive for long on their own. While several strategies were already incorporated within police depart- guidelinesthatcanfurtheraddresstheseeducationgaps[15]. ments throughout Ontario, there werestill gaps experienced )e description of a missing person as having dementia by police when responding to and dealing with missing or cognitive impairment was also inconsistently used in persons with dementia. One needed improvement would be media releases. While the use of the term “dementia” in to promote that one size does not fit all in terms of the media releases resulted in more members of the public adoption of police practices among varying police becoming engaged in keeping a lookout for the missing departments. person, police were required to obtain consent from the )e types of strategies were also associated with the missing person’s family. According to the participants, it is availability of resources. While Project Lifesaver was used common for family members to be against releasing this within several police jurisdictions, others were unable to information, primarily due to the stigma associated with dementia and the potential of making the missing person adopt it despite the high cost. We also do not know the effectiveness of these strategies [22]. )is was beyond the evenmorevulnerable,suchaspeopletakingadvantageofthe missing persons who are described as vulnerable and cog- scope of this project but would warrant a separate study; nevertheless, cost spending on strategies should be sup- nitively impaired [28]. ported by evidence that the strategy or program is effective or makes a difference. )e availability of police officers that 5. Conclusion and Recommendations can take on the role of media or SAR officer varied across jurisdictions, and chosen strategies depended on human In conclusion, there is a variation of certain practices and resource capacity. strategies and there are also some consistent approaches in An issue identified by the interviewees was the common searching for missing persons with dementia. )ese strat- belief among the general public that care partners must not egies can be related to available resources. Evidence on the call the police immediately when a vulnerable older adult is effectiveness of these strategies however remains limited. missing. Participants explained that there was a significant )e development of a practice guideline of search strategies 8 Journal of Aging Research tofindmissingpersonswithdementiacouldreducethetime MitacsAccelerate,inpartnershipwiththeAlzheimerSociety to locate these individuals and reduce the cost on police of Ontario. resources. 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Journal

Journal of Aging ResearchHindawi Publishing Corporation

Published: May 15, 2021

References