Using Wearable Devices to Monitor Activity and Sleep in Inpatients With Parkinson Disease With and Without Delirium: Feasibility and Acceptability Study.

Abstract

Delirium is a serious condition characterized by an acute change in attention, arousal, and sleep disturbance. It is common in inpatients with Parkinson disease (PD) but is frequently missed or misidentified due to overlapping symptoms, such as cognitive impairment, hallucinations, and sleep disturbances. While clinical tools often measure only a snapshot of delirium, wearable devices could facilitate the identification and ongoing monitoring of delirium, including continuous assessment of activity and sleep patterns, which are frequently disrupted. Establishing feasibility is essential before wearable technologies can be implemented in routine clinical care. This study aimed to determine the feasibility and acceptability of using wearable devices in inpatients with PD, with and without delirium. Participants were recruited from an ongoing prospective cohort study comprising inpatients with PD. Delirium was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria and assessed daily. Participants were invited to wear Axivity AX6 devices attached to their lumbar region (lower back) and/or wrist for up to 7 days. Feasibility was assessed in terms of recruitment, device placement, nonsecurement, wear time, and compliance. Acceptability, practicality, and clinical constraints were recorded and compared between groups. Participants were predominantly older adults with advanced PD and high levels of frailty and cognitive impairment. The wearable device recruitment rate was 75.4% (46/61), comprising 68 admissions. Delirium was identified in 64.7% (44/68) of admissions. The wrist-worn device showed greater participant acceptability, with 98.5% (67/68) of participants wearing a device on the wrist compared to 38.2% (26/68) of participants wearing a lumbar device (25/68, 36.8%, wore both). Wrist placement was more practical, rated as "somewhat" or "very easy" to secure in 95.5% (64/67) of cases compared to 69.2% (18/26) for lumbar placement (P<.001). Clinical constraints such as injury or pain and low level of arousal were associated with lumbar nonsecurement. These findings indicate that wrist-worn devices are more practical and acceptable in acutely unwell patients. Wear time compliance for both placements tended to be lower in delirium cases but comparable overall (>83% for each location, P>.05). This is the first study to evaluate the feasibility of using wearable devices in inpatients with PD with and without delirium. Wearable devices were feasible, and the wrist-worn devices demonstrated greater participant acceptability and practicality, with fewer clinical constraints. These findings provide important guidance for the design and implementation of future digital health studies in this population and may ultimately support earlier recognition and management of delirium while enabling continuous, objective monitoring of delirium-related changes not captured by standard clinical assessments.