Care Of Dementia Patients Research Articles

Care for dementia patients and caregivers and COVID-19 pandemic: Correspondence

• Correspondence on published article in the journal

Care for dementia patients and caregivers amid COVID-19 pandemic.

BackgroundMultiple efforts have been taken across the world to bridge gaps in evidence and provide recommendations for dementia care and caregiver support during the COVID-19 pandemic. We aimed to review the available literature on measures used to alleviate the negative impacts of the pandemic on dementia care.MethodsWe searched three databases: PubMed, CINAHL and PsycINFO to identify studies that described strategies that were recommended or taken to provide care and support to persons with dementia and their caregivers during the COVID-19 pandemic.ResultsWe included a total of 37 papers, originating from high, middle and low-income countries. We also included 6 papers exploring safety of COVID-19 vaccinations. Infection prevention recommendations predominantly involved providing consistent reminders to persons with dementia to engage in infection prevention measures and included measures to restrict wandering in long-term care settings to reduce spread of infection. Medical care included tele and video consultations to maintain and monitor clinical stability. Guidance for continuing rehabilitation activities for persons with dementia through remotely conducted cognitive stimulating activities, physical exercises and environmental modifications were further highlighted by multiple studies/articles. In addition, strategies to support caregivers were also advised and included teleconsultations and psycho-educational programs.ConclusionThe COVID-19 pandemic has exposed gaps in health and social care systems across the world, but has also revealed the enduring dedication of clinicians, expert groups and dementia support organizations to modify and adapt existing dementia care services to meet the needs of persons with dementia and their caregivers during periods of emergency.

Impact of Palliative Care for Dementia Patients in Tertiary Hospitals among Saudi Arabia: A Systemic Review

Dementia has been considered an alarming disease that is characterized by cognitive decline. There are many etiological factors of dementia including neuropsychiatric, neurodegenerative, and many other medical conditions. In the advanced phase, people with dementia are completely dependent on their carers. The prevalence rate of dementia in Saudia Arabia and Gulf countries is poorly defined. Certain medications for dementia are available. However, palliative care is considered a better process t

Development of educational system for paramedics specializing to dementia elderlies analyzed by artificial intelligence and its learning effects

AbstractBackgroundWhile the number of emergency transfer of dementia elderlies to acute care hospitals has being increasing, paramedics are facing challenges to perform their duties promptly due to difficult communication with patients.ObjectivesTo develop the standardized educational system for paramedics specializing to dementia elderlies with the use of artificial intelligence.DesignSingle arm, pre‐post study. Participants are paramedics in a metropolitan area of Japan.ExposureThe two sessions of standardized multimodal communication training program which contains lecture and workshop were provided twice, 1 month apart. The training consists three parts. 1: Mechanism and clinical manifestations of dementia, 2: Communication skills: face‐to‐face interaction; mutual gaze, geometric characteristics and duration of eye contact, verbal communication with phonetic elements, and touch interactions. 3: Interaction strategies with dementia elderlies in emergency situation. All participants performed the rescue simulation training before the training and 1 month after the completion of the training, which were video‐recorded and analyzed by artificial intelligence (AI). The video was taken by wearable camera with eye‐trackers (1st person camera) and fixed camera (3rd person camera). The satisfaction survey of effectiveness on their work and the Jefferson Scale of Empathy for healthcare professionals were also taken.Main OutcomesThe primary outcome is the change of communication skills in physical position, distance, eye contact with patients, phonetic elements and touch. The system to analyze face‐to‐face communication; mutual gaze, geometric characteristics and duration of eye contact by AI was developed by our team. Other elements of communications were evaluated manually. Secondary outcome were satisfaction and the empathy to patients.Result31 paramedics enrolled the study. Prior to the training, 88% had experienced any difficult condition taking care of dementia patients. The video analysis showed significant change of the interactive communication in the direction of approach, eye contacts and duration of mutual gaze. 96.7% considered the training was effective for their daily work and 97.5% of participants recommended this training to a colleague. The score of empathy scale showed no significant change.ConclusionThe educational system for paramedics specializing to dementia with the use of artificial intelligence is effective for their work.

Impact of settings and culture on nurses' knowledge of and attitudes and perceptions towards people with dementia: An integrative literature review.

BackgroundWell‐trained nurses are required to support dementia patients; however, the quality of the provided dementia nursing care can be impacted by nurses’ knowledge, attitudes and perceptions towards people with dementia.AimTo obtain an overview of the current nursing practice towards people with dementia around the world.DesignAn integrated literature review was conducted based on Whittemore and Knafl's method.ResultsA total of 72 articles met the inclusion criteria. Three main themes were identified: (1) nurses’ knowledge, attitudes and perceptions towards dementia; (2) nursing experience of caring for people with dementia in acute and community care settings; and (3) dementia nursing care across health regions.ConclusionNurses play the role of facilitators in the efficient delivery of quality care for dementia patients. A variety of attitudes and perceptions towards people with dementia were found to be triggered by the severity of dementia, religion, ethnicity and gender.Implications for practiceHealthcare organisations and educational settings need to coordinate and function together to improve nurses’ knowledge and encourage positive attitudes towards people with dementia.

Development and Effect of Virtual Reality Practice Program for Improving Practical Competency of Caregivers Specializing in Dementia.

The number of dementia patients in Korea is increasing with the increase in the elderly population. Accordingly, the importance of the role of the caregivers, who are the main care worker other than the family, is increasing. Therefore, in this study, a virtual reality practice program was developed to enhance the practical competency of caregivers who take care of dementia patients, and the effects were analyzed. The caregiver said that among the mental behaviors of dementia patients, aggression and delusion were the most difficult. Based on this information, a practice program was developed by realizing a case of a male dementia patient who expressed refusal to bathing help as an aggressive behavior due to delusion in virtual reality, and the effect of the virtual reality practice program was analyzed for five caregivers. As a result, ‘interest in new teaching methods’, ‘improving concentration of practical education based on real cases’, and ‘increasing confidence in caring for dementia patients’ were found. As this study is a pilot test, it is necessary to repeat the study with more subjects in the future, and to develop virtual reality implementation cases for various mental and behavioral symptoms.

Nurses' Experience of Nursing Workload-Related Issues during Caring Patients with Dementia: A Qualitative Meta-Synthesis.

The behavioral and psychological symptoms of dementia (BPSD), which appear in all dementia patients, demand sizable commitments of time and effort from nurses. This study aims to identify issues related to the workloads of nurses who provide care for dementia patients via qualitative meta-synthesis. Eleven articles were selected using a systematic review flowchart, which were then evaluated for their quality using the Critical Appraisal Skills Program checklist. Collected data were analyzed using a line-of-argument method. Theme clusters were “increased workload due to characteristics of dementia”, “increased mental stress”, “difficulty associated with playing a mediator role in addition to nursing duties”, and “lacking systematic support for dementia patient care”. To reduce the workload and mental stress of nurses in dementia care, supportive measures appropriate for their occupational characteristics should be developed, based on workload estimates that account for the attributes of dementia patients.

Caregivers’ burden and needed support for the care of dementia patients attending Ain Shams University hospitals

Background: Dementia in late stages affects patients’ life like being dependent, malnourished, having psychological and sleep problems. Caregivers face physical, financial, medical, and psychological b urdens and are in need for support to complete caregiving responsibilities. Not all caregivers have the sufficient knowledge regarding how dementia affects the patients. Aim: To determine the burden of caregiving process on caregivers of moderate to severe and severe dementia patients, the type of support and knowledge that caregivers need during this process Methods: a cross -sectional study involving 101 caregivers of moderate to severe and severe dementia patients attending outpatient clinics and inpatien ts in Ain Shams University Hospitals. Demographic data of the patients and their caregivers were collected. A questionnaire was applied on caregivers including types of burden they experienced, types of support they needed and their knowledge about dementi a & its effect on patients’ life. Results: Most caregivers had different types of caregiving burdens. Ninety -eight percent (98%) of them had fear of future burden, 89% had physical& psychological burden and 69% had financial burden. Most caregivers needed support in caregiving. Eighty percent (80%) of them needed medical support, 59.4% needed physical support, 54.5% needed psychological support, 47.5% needed financial support, while only 8.9% needed social support. None of the caregivers had accurate previous knowledge about dementia. Ninety -three percent (93%) of caregivers predicted that dementia patients might need special care. Regarding dementia effect on patients, 88.1% of caregivers knew it had an effect on patients’ behavior, 74.3 % knew it affects s leep, 54.5% knew it affects safety, 53.5% agreed with its effect on patients’ activity and 48.5% knew it affects nutrition Conclusion: Caregiving of moderate to severe and severe dementia patients is associated with huge physical, psychological and financi al burdens. Most of the caregivers are in need of more support and knowledge to help them alleviate their burden and improve patients’ care and q uality of life

549 - Psychosocial factors in the formation of non-cognitive symptoms of dementia

Background:The growing prevalence of severe cognitive impairment in populations, the involvement of a significant number of people of working age in the medical, economic, psychological and social problems associated with late dementia, the insufficiency and inconsistency of information about the mechanisms of formation of these disorders actualize a comprehensive medical and social study of dementia.The goal is to study the psychosocial mechanisms of the formation of clinical, functional disorders in dementia, to develop comprehensive medical and psychosocial programs to help patients with dementia and those involved in caring for them, based on the proposals of the psychosocial model of dementia.Methods:A selective observational comparative dynamic study of 315 people with Alzheimer’s dementia and 214 people who care for the patients was carried out. The study used clinical, clinical, psychopathological, neuropsychological, psychometric, sociometric, and statistical research methods.Results:An increase in the severity of dementia contributes to a significant (p <0.05) increase in the number of patients in a dependent position in the family. The appearance of psychotic (painful ideas [r = 0.589]), behavioral (agitation/aggression [r = 0.654]), affective (anxiety [r = 0.536], unstable mood/irritability [r = 0.581]) symptoms of dementia contribute to family role changes structure and increase interpersonal distance in the dyad “caretaker - patient.” Decreased functional activity of the patient (r = 0.758), development of behavioral disorders (aberrant behavior [r = 0.675], agitation/aggression [r = 0.713], impaired night behavior [r = 0.597]), affective symptoms (anxiety [r = 0.685]) contribute to aggravation of the distress of the caregiver. Those who provide unprofessional care for dementia patients in a statistically significant (p <0.05) majority of cases have a high level of emotional involvement in the care process. Changes in family-role and social parameters, a high level of “expressed” emotions of caregivers have an adverse effect on the development of psychotic (r = 0.618), affective (r = 0.701), behavioral (r = 0.837) dementia disorders. The degree of adherence to anti- dementia therapy by the caregiver is one of the important factors determining the amount of care received by the patient (r = 0.698). Agitation/aggression (r = 0.761), anxiety (r = 0.562), sleep disturbances (r = 0.521) contribute to increased compliance. The low satisfaction of the caregiver with premorbid (r = 0.698) and current (r = 0.653) relationships with the patient leads to a decrease in the compliance of the caregiver.Conclusion:It was revealed that the formation of cognitive impairment is caused by biological factors, their severity depends on the severity of dementia. The mechanism of psychopathological symptoms, functional disorders is heterogeneous, depending on the biological causes and psychosocial conditions of functioning of patients.

Personalized program of medical and psychological rehabilitation of dementia patients

Dementia affects a person’s adaptation in everyday life, social life and usually affects a professional quality. Caring for patients with dementia causes distress to their family members. In modern psychiatric practice, a multi-vector approach is used within the biopsychosocial model of care for dementia patients. The leading strategy for the treatment of this category of patients includes measures to prevent development of cognitive deficits and, of course, treatment as itself. The main components of treatment are pharmacotherapy, psychotherapy and psychoeducational interventions aimed at people who provide care for patients. A comprehensive program of medical and psychological rehabilitation developed for patients with dementia includes the following components: pharmacotherapy, psychotherapy, psychoeducation (for patients and their relatives), psychological training (training of communicative, cognitive, social skills). As shown by analysis of the effectiveness of proposed program of medical and psychological rehabilitation of patients with dementia, after 1.5 years of catamnestic observation, against the background of using the program, stabilization of the emotional state of patients with dementia and their relatives, a decrease in the level of neuropsychological tension, and an improvement in the cognitive status of patients were noted. The level of socio-psychological adaptation increased, it was possible to preserve social and household skills, and they were able to switch to the use of adaptive coping strategies in patients with dementia and their family members. Keywords: relatives, rehabilitation, maladaptive behavior, emotional disorders.

Caregiver’s burden and age are related determinants to quality of life in people with dementia

Dementia is a degenerative disease with poor prognosis. People with dementia will depend on their caregivers. Care for dementia patients aims to promote or preserve their quality of life. Identification of the factors that affect (determinants) the quality of life of people with dementia is required, and caregiver determinants are proven to play a role. The caregiver’s role could affect the frequency and variety of therapy. Long-term cognitive and physical disability in people with dementia further develops the caregiver’s burden. This study aimed to assess the determinants of caregivers which have a relation with the quality of life in people with dementia. This cross-sectional study involved subjects who are dementia patients at the Memory Clinic of Dr. Sardjito Hospital, Yogyakarta, Indonesia and fulfilled the inclusion criteria and did not meet the exclusion criteria. Subjects and caregivers were interviewed and helped to complete several questionnaires, including the DEMQOL, ZBI, and GDS. Analysis within variables was performed using Pearson, Mann-Whitney, and T-tests, followed by a multivariate linear regression analysis. As many as 76 people with dementia were included, with the majority having the diagnosis of vascular dementia (53.9%), and the average DEMQOL Career score was 80.58 + 17.62 and 81.82 + 20.80 for DEMQOL Proxy. Bivariate correlation analysis showed a significant correlation between the caregiver’s age, gender, family relation, burden (ZBI), and depression (GDS) with the quality of life people with dementia (p <0.05). In the multivariate analysis, caregiver’s age was related to the quality of life of people with dementia based on DEMQOL Career (B =0.270; p =0.001) and DEMQOL Proxy (B =0.271; p =0.001) and the caregiver burden was related to the quality of life of people with dementia based on DEMQOL Career (B =-0.629; p =0.000) and DEMQOL Proxy (B =-0.661; p =0.000). In conclusion, the determinants of caregiver that are significantly related to quality of life in people with dementia are caregiver’s burden and age.

Global Perspectives on Brief Cognitive Assessments for Dementia Diagnosis.

Timely diagnosis of dementia is a global healthcare priority, particularly in low to middle income countries where rapid increases in older adult populations are expected. To investigate global perspectives on the role of brief cognitive assessments (BCAs) in dementia diagnosis, strengths and limitations of existing measures, and future directions and needs. This is a qualitative study of 18 dementia experts from different areas of the world. Participants were selected using purposeful sampling based on the following criteria: 1) practicing in countries with projected growth of older adult population of over 100%by 2050; 2) expertise in dementia diagnosis and treatment; 3) involvement in clinical practice and training; and 4) recognition as a national dementia expert based on leadership positions within healthcare system, research, and/or policy work. Participants were individually interviewed in their language of choice over secure videoconference sessions. Interviews were analyzed by a multidisciplinary team using theme identification approach. Four domains with subthemes emerged illustrating participants' perspectives: 1) strengths of BCAs; 2) limitations of BCAs; 3) needs related to the use of BCAs; and 4) characteristics of an ideal BCA. While most experts agreed that BCAs were important and useful for dementia diagnosis, the themes emphasized the need for development and validation of novel measures that are sensitive, psychometrically sound, and culturally appropriate. BCAs are important for guiding diagnosis and care for dementia patients. Findings provide a roadmap for novel BCA development to assist in diagnostic decision making for clinicians serving a rapidly growing and diverse dementia population.

Smarthealth technology study protocol to improve relationships between older adults with dementia and family caregivers.

The aim of this study is to develop a Smarthealth system of monitoring, modelling, and interactive recommendation solutions (for caregivers) for in-home dementia patient care that focuses on caregiver-patient relationships. This descriptive study employs a single-group, non-randomized trial to examine functionality, effectiveness, feasibility, and acceptability of the novel Smarthealth system. Thirty persons with Alzheimer's Disease or related dementia and their family caregivers (N=30 dyads) will receive and install Smarthealth technology in their home. There will be a 1-month observation phase for collecting baseline mood states and a 2-month implementation phase when caregivers will receive stress management techniques for each detected, negative mood state. Caregivers will report technique implementation and usefulness, sent via Ecological Momentary Assessment system to the study-provided smartphone. Caregivers will provide daily, self-reported mood and health ratings. Instruments measuring caregiver assessment of disruptive behaviours and their effect on caregivers; caregiver depressive symptoms, anxiety and stress; caregiver strain; and family functioning will be completed at baseline and 3months. The study received funding in 2018 and ethics board approval in 2019. This study will develop and test novel in-home technology to improve family caregiving relationships. Results from this study will help develop and improve the Smarthealth recommendation system and determine its usefulness, feasibility, and acceptability for persons with dementia and their family caregiver. The Smarthealth technology discussed will provide in-home stress reduction resources at a time when older adults may be experiencing increasingly high rates of isolation and anxiety and caregiver dyads may be experiencing high levels of relationship strain. This study was registered with Clinical Trials.gov (Identifier NCT04536701).

Staging Stories that Heal: Boal and Freire in Engaged Composition

This article discusses the successes and vulnerabilities associated with combining the pedagogical methods of Theater, Composition, and Community Literacy in the Composition classroom. It examines how the ideas of Augusto Boal’s Theatre of the Oppressed and Paulo Freire’s Pedagogy of the Oppressed can be combined to support an innovative approach to Composition teaching, one that additionally employs engaged scholarship and service learning. The essay describes how methods and cycles of story gathering, playwriting, and rhetorical analysis have been used with various community partners, including an adult day care for dementia patients, an HIV/AIDs clinic, and Public Health outreach programs that address Health Disparities. The article explains how the ready audience of community-written plays and the inherent characteristics of theatrical production enable finite and clearly definable communication moments and products—especially in the autobiography-fantasy fused genre I have termed magical memoir—while engaging and empowering the voices of students, teachers, community partners, and audience members alike. All human beings are actors (they act!) and spectators (they observe!) They are spect-actors. … Theatre is a form of knowledge; it should and can also be a means of transforming society. Theatre can help us build our future, instead of just waiting for it. –Augusto Boal, Games for Actors and Non-Actors

Factors influencing general practitioners’ perception of and attitude towards dementia diagnostics and care—results of a survey among primary care physicians in Germany

SummaryStudies have shown that primary care is not always effective when it comes to caring for people with dementia. In addition, general practitioners do not always use diagnostic instruments consistently. The aim of the study was to identify relevant factors that influence general practitioners’ attitudes and willingness with respect to consistent diagnosis and care. For this purpose, resources, viewpoints, and behavioral patterns of general practitioners with regard to dementia diagnostics as well as common challenges in everyday practice were recorded. In the course of a survey, a total of 2266 general practitioners in Hesse and Baden-Württemberg were interviewed between January and March 2020. In addition to the descriptive analysis, a t-test was used to determine significant differences between two groups. A univariate linear regression analysis was carried out to identify possible influencing factors. 81% of the respondents do provide dementia diagnostics; 51% are involved in the treatment. Most of them see the diagnostic work-up (77%), communication and compliance problems (73%), as well as the therapeutic support (71%) as common challenges. In addition, there are interface problems regarding the interdisciplinary cooperation. Some of the respondents express doubts about the value of early detection (41%). The general practitioners’ attitude with respect to dementia diagnostics and care is determined by influencing factors that relate to geriatric competencies, expectations of self-efficacy, the integration of practice staff, as well as the knowledge of and cooperation with counseling and care services. It seems advisable to strengthen the geriatric competence of general practitioners. Moreover, it appears essential to educate general practitioners more about support structures in the field of dementia care and to integrate them accordingly. In addition, practice staff should be more systematically involved in the identification and care of dementia patients.Supplementary InformationThe online version of this article (10.1007/s10354-020-00803-9) contains supplementary material, which is available to authorized users.

The Implementation Status of the Educational Program “Care for Dementia Patients Focusing on the Viewpoint of Elderly Patients” After Its Introduction for Acute Care Hospital Nurses

The Implementation Status of the Educational Program “Care for Dementia Patients Focusing on the Viewpoint of Elderly Patients” After Its Introduction for Acute Care Hospital Nurses

Impact of the COVID-19 pandemic on use of anti-dementia medications in 34 European and North American countries.

IntroductionThe impact of the COVID‐19 pandemic on the global use of anti‐dementia medication is unknown. We aimed to determine the changes of anti‐dementia medication use in Europe (EU) and North America (NA) during the pandemic.MethodsThis is a cross‐sectional study using sales data of anti‐dementia medications in 2019 and 2020 from 34 EU and NA countries. The monthly uses of anti‐dementia medications from January through June in 2020 were compared to the corresponding months in 2019 for each country.ResultsIn the pre‐pandemic period of January to March 2020, 70 out of 102 (3 months x 34 countries) measurements (68.6%) of monthly sales volume showed an increase. In contrast, 76.5% and 85.3% countries showed reduced sales in April and May 2020, respectively.DiscussionThese findings indicate changes in use of anti‐dementia medications during the pandemic. The delivery of pharmaceutical care for dementia patients may be heavily disrupted in certain countries.

A Study on the Revitalization of Dementia Management Policy in the Community: Focusing on the Treatment and Care of Dementia Patients

본 연구는 초고령화 현상을 극복하고 이에 따른 치매노인문제에 대한 실효성 높은 대책을 강구하기 위한 목적으로 연구되었다. 본 연구는 치매관리정책의 문제점으로 치매환자가족 상담비용의 비현실성, 치매거점병원의 부족, 치매진료지침의 표준화와 같은 가이드라인의 부족, 치매 관련 종사자에 대한 전문교육과정의 부족, 치매전담형 요양시설의 부족, 치매 관련 요양 및 간호통합형 재가 서비스 부족, 치매환자에 대한 생애 말기 포괄적 지원체계의 부재 등을 제시하였다. 이러한 문제점을 해결하고 치매관리정책의 전달체계 기능 정립 및 활성화 방안은 다음과 같다. 첫째, 국가치매관리 컨트롤타워 기능을 강화해야 한다. 둘째, 교육 및 프로그램 인증시스템 구축이 요구된다. 셋째, 치매 관련 정책 조정 및 지원 기능의 강화이다. 넷째, 국가치매관리 정책 및 사업에 대한 체계적 평가기능의 강화가 필요하다. 다섯째, 교육 및 프로그램 인증시스템 구축이 요구된다. 여섯째, 치매전문교육통합관리가 마련되어야 한다. 일곱째, 치매환자 캐어플랜모델이 수립되어야 한다. 여덟째, 치매 관련 의료와 서비스의 통합적 연계 가이드라인이 개발되어야 한다.The purpose of this study was to overcome the super-aging phenomenon and to devise effective measures for the elderly with dementia. This study suggested the unrealistic cost of counseling for families with dementia, the lack of hospitals with dementia, the lack of guidance lines such as the standardization of dementia care guidelines, the lack of specialized education courses for dementia-related workers, the lack of dementia-related nursing care and integrated nursing care services, and the absence of a comprehensive support system for dementia patients. Measures to address these problems and establish and promote the delivery system of dementia management policies are as follows. First, the function of the National Dementia Management Control Tower should be strengthened. Second, it is required to establish an education and program certification system. Third, it is the adjustment of dementia-related policies and strengthening of support functions. Fourth, it is necessary to strengthen the systematic evaluation function of national dementia management policies and projects. Fifth, it is required to establish an education and program certification system. Sixth, integrated management of dementia education should be prepared. Seventh, a care plan model for dementia patients should be established. Eighth, an integrated link between dementia-related health care and services should be developed.

Advocacy Training as a Way to Increase Dementia Literacy Among College Students

In 2017, WHO passed the Global Action Plan on Dementia and declared the effort to increase dementia literacy around the world. Although dementia is mostly associated with older adults, the prevalent rate of the early on-set and the need to take care of people with dementia has mostly fallen on younger family members. Therefore, the purpose of this paper is to develop an intervention aiming to increase dementia awareness among college students. Through training and action plans, 85 university students from 9 different departments formed 12 groups to develop creatively and to conduct advocacy or public education in various communities. A questionnaire of pre- and post-test was conducted after students had completed their action plans. The response rate was 86% and the results were three-folds: (1) 31% of the students had someone in the family with dementia; (2) 35% of the students indicated that they were familiar with dementia; and (3) the pre- and post-scores on dementia awareness (p<0.001) and dementia attitudes (p<0.001) had significant improvement. This study demonstrated that there is a need to start the effort to increase dementia literacy because one-third of college-age students might be potential caregivers for their family loved ones with dementia. Preparing the students before graduating from college is a good entry because they can become health professionals to take better care of dementia patients and their family members. In conclusion, policy and practice implications will be discussed so the communities can become more dementia friendly in the future.

Building a Care Management and Guidance Security System for Assisting Patients with Cognitive Impairment

The care of dementia patients presents a large challenge for caregivers and family members. Whether it is at home or in institutional care, patients have problems with spatial and environmental cognition. It often leads to abnormal behaviors such as a route recognition problem, wandering, or even getting lost. These behaviors require caregivers to keep an eye on the movement of the cognitively impaired elderly and the safety of these movement processes, to avoid them approaching dangerous areas or leaving the care environment. This paper used qualitative research methods (i.e., participatory interviews, case studies, and contextual observation methods) in the demand exploration phase and quantitative research methods in the product’s technological verification phase. In this study, we implemented a three-stage service design process—demand exploration, demand definition, and design execution—to analyze the care status and route recognition obstacles of elders with dementia, to identify hidden needs as a turning point for new product innovations in care management and guidance security. This study summarizes six service needs for care management and guides the surveillance and safety of elders with dementia: (1) offering indoor user-centered guidance, (2) providing the instant location information of elders with dementia to caregivers, (3) landmarks setting, (4) assistance notification, (5) environmental route planning, (6) use of a wearable device as a guide for indoor route guidance. Based on the potential deficiencies and demands of observation, the care management and guidance security system (CMGSS) was designed. The experimental results show that the use of ultra-wide band positioning technology used in the indoor guiding system can accurately guide the behavior of patients to the right position, provide accurate information for caregivers, and record their daily behavior. The error range of this technology was not only within 42.42 cm in indoor static positioning but also within 55 cm in dynamic positioning, even where wall thickness was 18 cm. Although the device was designed for institutional care, it can also be applied to the management and care of general home-based patients.