AbstractBackgroundResearchers are increasingly utilizing real‐time sensors with ultra‐wideband radio frequency identification device (UWB RFID) technology to continuously, automatically and unobtrusively track the behavior and movement of older adults across care settings (Bowen, Kearns, Crenshaw, & Stanhope, 2019; Bowen & Rowe, 2019; Bowen & Rowe, 2016). These systems can be integrated into the health care environment and are ecologically valid measures taken concurrently as adults perform everyday activities of daily living (ADL). The purpose of this study is to examine the use of a UWB RFID system for the early recognition of behaviors associated with cognitive decline among skilled nursing residents (N=23) of two health care facilities.MethodResidents were assessed continuously for an average of 10 months (SD=32.16 weeks). Scoring algorithms from the UWB RFID system utilized 1663 data points developed from x, y coordinates to measure the number and distance (meters) of continuous walking activity in a path. A path is defined as at least 60 seconds of walking and ends with a 30‐second stop. Cognitive function was measured by the Montreal Cognitive Assessment (Nasreddine, et al., 2005) and the Physical and Cognitive Performance Test (Bowen, Rowe, Ersek, Ibrahim, & Shea, 2017).ResultOn average, residents walked 1522.8 meters/week (SD=1572.7) with an average of 23.2 paths/week (SD=25.6). In multilevel models, accounting for ADL ability, an increased average number of paths per week was associated with decreased cognitive functioning (β= ‐0.65; p≤0.01).ConclusionContinuous walking in a path may be an early indicator of cognitive decline. Using an UWB RFID system may aid in the early detection and recognition of cognitive changes in this patient population. Importantly, these changes are also associated with other health events (e.g., falls, delirium, urinary tract infection, hospitalization) that may be ameliorable to intervention.