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Griffiths AW, Cunha I, Mikhaylova-O'Connell Y, Devi R, Spilsbury K, Cherry MG. Exploring the impact of care home environments and culture on supporting residents to 'wander' safely. Aging Ment Health 2024; 28:1410-1418. [PMID: 38597455 DOI: 10.1080/13607863.2024.2338204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Up to 60% of people with dementia living in care homes will 'wander' at some point, which has typically been seen by staff as a problematic behaviour. A range of non-pharmacological interventions have been tested to either support or prevent wandering. However, even recent innovative practice continues to maintain a focus on reducing or preventing wandering. This study aimed to identify, for the first time, care home staff perspectives on home level factors that facilitate or hinder them supporting residents to wander safely. METHOD Semi-structured qualitative interviews were conducted with 19 care home staff, working in the North of England. Framework analysis was used to analyse the data. RESULTS A range of environmental considerations were identified by staff. Care home design influenced how residents were able to move safely around, and inclusion of points of interest encouraged walking to different locations, such as a garden. Staff worried about managing access to other residents' rooms by people who wander. Within the care home culture, prioritising safe staffing levels, training and awareness, involving external healthcare professionals where required and mentorship from experienced staff members, all contributed towards safe wandering. Staff support for positive risk-taking within the care home was key to promote person-centred care, alongside careful oversight and management of relationships between residents. CONCLUSION We identified a range of cultural and environmental factors that contribute towards safe wandering. A positive approach to risk-taking by staff is required to support residents to engage in wandering as an enjoyable activity, whilst acknowledging that there are inherent risks associated with this.
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Affiliation(s)
- Alys Wyn Griffiths
- Division of Neuroscience, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Iria Cunha
- Springfield Healthcare Limited, Leeds, West Yorkshire
| | | | - Reena Devi
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - Mary Gemma Cherry
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
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Perez H, Miguel Cruz A, Neubauer N, Daum C, Comeau AK, Marshall SD, Letts E, Liu L. Risk Factors Associated with Missing Incidents among Persons Living with Dementia: A Scoping Review. Can J Aging 2024:1-15. [PMID: 38297497 DOI: 10.1017/s0714980823000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Worldwide, over 55-million people have dementia, and the number will triple by 2050. Persons living with dementia are exposed to risks secondary to cognitive challenges including getting lost. The adverse outcomes of going missing include injuries, death, and premature institutionalization. In this scoping review, we investigate risk factors associated with going missing among persons living with dementia. We searched and screened studies from four electronic databases (Medline, CINAHL, Embase, and Scopus), and extracted relevant data. We identified 3,376 articles, of which 73 met the inclusion criteria. Most studies used quantitative research methods. We identified 27 variables grouped into three risk factor domains: (a) demographics and personal characteristics, (b) health conditions and symptoms, and (c) environmental and contextual antecedents. Identification of risk factors associated with getting lost helps to anticipate missing incidents. Risk factors can be paired with proactive strategies to prevent incidents and inform policies to create safer communities.
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Affiliation(s)
- Hector Perez
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Antonio Miguel Cruz
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Glenrose Rehabilitation Research, Innovation & Technology (GRRIT) Hub, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | | | - Christine Daum
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Aidan K Comeau
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Elyse Letts
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lili Liu
- Faculty of Health, University of Waterloo, Waterloo, ON, Canada
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Wylie G, Kroll T, Witham MD, Morris J. Increasing physical activity levels in care homes for older people: a quantitative scoping review of intervention studies to guide future research. Disabil Rehabil 2023; 45:3160-3176. [PMID: 36093619 PMCID: PMC10503503 DOI: 10.1080/09638288.2022.2118869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/26/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Physical activity (PA) levels in older care home residents are low. This has detrimental effects on health. Little is known about the nature of interventions to increase physical activity in this population. METHODS A scoping review to: (1) identify and describe interventions to increase PA in older care home residents, and (2) describe the extent to which interventions address care home context, systemised by social-ecological models. We systematically searched databases for peer-reviewed intervention studies to increase PA in older people resident in care homes. Data were extracted using the template for intervention description and replication (TIDieR) and mapped against a social-ecological framework to locate the intervention focus. RESULTS The 19 included studies consisted of interventions tested in randomised or quasi-experimental trial designs. Interventions consisted of single or multiple components and predominantly addressed individual resident level factors (such as muscle strength) rather than broader social and environmental aspects of context. Interventions were not all fully described. For most interventions a distinct theoretical foundation was not identified. Interventions were mostly delivered by health professionals and research staff external to care homes. CONCLUSIONS Future interventions should address contextual care home factors and should be clearly described according to intervention description guidance.Implications for rehabilitationPhysical activity holds promise as an effective means of improving health and function in older care home residents, but physical activity levels in this population are low.Several reasons beyond the individual resident but related to care home contextual factors may explain low PA in care homesTo date, contextual factors influencing PA in care homes have been poorly addressed in interventions.Wider care home context (social, cultural, and environmental factors) must be considered in future interventions.
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Affiliation(s)
- Gavin Wylie
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Thilo Kroll
- Health Sciences Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, UK
| | - Miles D. Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Jacqui Morris
- School of Health Sciences, University of Dundee, Dundee, UK
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4
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Recognizing a missing senior citizen in relation to experience with the elderly, demographic characteristics, and personality variables. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-019-00499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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5
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Saito T, Murata C, Jeong S, Inoue Y, Suzuki T. Prevention of accidental deaths among people with dementia missing in the community in Japan. Geriatr Gerontol Int 2018; 18:1301-1302. [DOI: 10.1111/ggi.13443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/12/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Tami Saito
- Department of Social Science; National Center for Geriatrics and Gerontology; Obu Japan
| | - Chiyoe Murata
- Department of Social Science; National Center for Geriatrics and Gerontology; Obu Japan
| | - Seungwon Jeong
- Department of Social Science; National Center for Geriatrics and Gerontology; Obu Japan
| | - Yusuke Inoue
- Department of Health and Welfare Science; Okayama Prefectural University; Okayama Japan
| | - Takao Suzuki
- Institute of Gerontology; J.F. Oberlin University; Tokyo Japan
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Abstract
The increase of dementia makes cognitive disorder a global challenge. Even if wandering is not a symptom of dementia in general, professionals and scientists dominate the definition of wandering as an aimless movement of people with cognitive impairment, mainly dementia. In consequence, professional types of wandering management were elaborated trying to avoid or replace it. However, this can cause negative effects. The article analyses an apparently common informal type of wandering management. It consists of slipping an address paper in the wallet of the ill person. The analysis reveals that this practice is normatively structured by a gift of trust.
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Affiliation(s)
- Sebastian J Moser
- a Ethics Department , Faculty of Medicine, University Paris-Sud/ Paris Sacley , Labex Distalz , France
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Brittain K, Degnen C, Gibson G, Dickinson C, Robinson L. When walking becomes wandering: representing the fear of the fourth age. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:270-284. [PMID: 28177148 DOI: 10.1111/1467-9566.12505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Dementia is linked to behavioural changes that are perceived as challenging to care practices. One such behavioural change is 'wandering', something that is often deeply feared by carers and by people with dementia themselves. Understanding how behavioural changes like wandering are experienced as problematic is critically important in current discussions about the behavioural and psychological symptoms of dementia. In this article we draw on our secondary analysis of qualitative interviews and focus groups with carers of people with dementia to critically question 'when does walking become wandering'? Drawing on theoretical perspectives from anthropology, sociology and human geography to explore experiences of carers and of people with dementia, we argue that a conceptual shift occurs in how pedestrian activity, usually represented as something purposeful, meaningful and healthy (walking) is seen as something threatening that needs managing (wandering). We demonstrate how this shift is connected to cultural assumptions about the mind-body relationship in both walking and in dementia. We further argue that the narratives of carers about wandering challenge the notion of 'aimless' walking in the fourth age. This is because, as these narratives show, there are often pronounced links to specific areas and meaningful places where people with dementia walk to.
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Affiliation(s)
| | - Cathrine Degnen
- School of Geography, Politics and Sociology, Newcastle University, UK
| | - Grant Gibson
- School of Applied Social Science, Stirling University, UK
| | - Claire Dickinson
- Department of Nursing, Midwifery and Health, Northumbria University, UK
| | - Louise Robinson
- Department of Nursing, Midwifery and Health, Northumbria University, UK
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Bond KS, Jorm AF, Kitchener BA, Kelly CM, Chalmers KJ. Development of guidelines for family and non-professional helpers on assisting an older person who is developing cognitive impairment or has dementia: a Delphi expert consensus study. BMC Geriatr 2016; 16:129. [PMID: 27387756 PMCID: PMC4936264 DOI: 10.1186/s12877-016-0305-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/21/2016] [Indexed: 01/08/2023] Open
Abstract
Background Assisting a person with dementia can lead to significant carer burden and possible negative outcomes for the person. Using the Delphi method, this study developed expert consensus guidelines for how family and non-professional carers should assist a person who is developing cognitive impairment, or has dementia or delirium. Methods A systematic search of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions needed for assisting a person who is developing cognitive impairment, or has dementia or delirium. These items were rated over three rounds by two international expert panels comprising professionals specialising in research or treatment of dementia, and dementia carer advocates. Results A total of 65 participants (43 in the professional panel and 22 in the carer advocate panel) completed all three survey rounds. Of the 656 survey items that were rated, a total of 389 items were endorsed by at least 80 % of each panel. The endorsed items formed the basis of a guidelines document that explains what family and non-professional carers need to know and do when assisting a person who is developing cognitive impairment, or has dementia or delirium. Conclusions The two groups of experts were able to reach substantial consensus on how to assist a person who is developing cognitive impairment, or has dementia or delirium. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0305-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K S Bond
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, VIC, 3052, Australia.
| | - A F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Parkville, VIC, 3010, Australia
| | - B A Kitchener
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, VIC, 3052, Australia.,School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - C M Kelly
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, VIC, 3052, Australia.,School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - K J Chalmers
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, VIC, 3052, Australia
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Pai MC, Lee CC. The Incidence and Recurrence of Getting Lost in Community-Dwelling People with Alzheimer's Disease: A Two and a Half-Year Follow-Up. PLoS One 2016; 11:e0155480. [PMID: 27183297 PMCID: PMC4868297 DOI: 10.1371/journal.pone.0155480] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/29/2016] [Indexed: 11/18/2022] Open
Abstract
Getting lost (GL) is a serious problem for people living with Alzheimer's disease (PwAD), causing psychological distress in both PwAD and caregivers, and increasing the odds of being institutionalized. It is thus important to identify risk factors for the GL events in PwAD. Between April 2009 and March 2012, we invited 185 community-dwelling PwAD and their caregivers to participate in this study. At the baseline, 95 had experienced GL (Group B); the remaining 90 (Group A) had not. We focused on the incidence of GL events and the associated factors by way of demographic data, cognitive function assessed by the Cognitive Ability Screening Instrument (CASI), and spatial navigation abilities as assessed by the Questionnaire of Everyday Navigational Ability (QuENA). After a 2.5-year period, the incidence of GL in Group A was 33.3% and the recurrence of GL in Group B was 40%. Multiple logistic regression analysis revealed that the inattention item on the QuENA and orientation item on the CASI had independent effects on the GL incidence, while the absence of a safety range was associated with the risk of GL recurrence. During the 2.5 years, the PwAD with GL incidence deteriorated more in the mental manipulation item on the CASI than those without. We suggest that before the occurrence of GL, the caregivers of PwAD should refer to the results of cognitive assessment and navigation ability evaluation to enhance the orientation and attention of the PwAD. Once GL occurs, the caregivers must set a safety range to prevent GL recurrence, especially for younger people.
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Affiliation(s)
- Ming-Chyi Pai
- Division of Behavioral Neurology, Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Alzheimer’s Disease Research Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chih-Chien Lee
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Martin E, Biessy-Dalbe N, Albaret JM, Algase DL. French Validation of the Revised Algase Wandering Scale for Long-Term Care. Am J Alzheimers Dis Other Demen 2015; 30:762-7. [PMID: 23823141 PMCID: PMC10852820 DOI: 10.1177/1533317513494454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVES The aim of this study was to create a French equivalent of the revised Algase wandering scale for long-term care (RAWS-LTC). METHODS The RAWS-LTC French version (F-RAWS-LTC), Mini-Mental State Examination, and Neuropsychiatric Inventory were administered to a sample of 100 institutionalized patients from 12 specialized homes. RESULTS The mean of the overall F-RAWS-LTC was 2.32 (standard deviation [SD]=0.74, range 1-4), and the mean of each subscale was 2.48 for persistent walking, 1.62 for eloping behavior, and 2.30 for spatial disorientation. The correlation between the overall F-RAWS-LTC and each subscale was between 0.73 (for Spatial Disorientation) and 0.87 (for Persistent Walking). The correlation between the degree of behavioral disturbances and the overall F-RAWS-LTC is 0.42, and the correlation with the cognitive impairment is 0.50. Differences between the wanderers and nonwanderers are significant for the overall F-RAWS-LTC and for all the subscales. DISCUSSION Data demonstrate the statistical validity of the F-RAWS-LTC.
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Affiliation(s)
- Elodie Martin
- Psychomotricity Training Institute, University of Toulouse, UPS, Toulouse, France
| | | | - Jean-Michel Albaret
- Psychomotricity Training Institute, University of Toulouse, UPS, Toulouse, France PRISSMH EA 4561, University of Toulouse, UPS, France
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Halek M, Bartholomeyczik S. Description of the behaviour of wandering in people with dementia living in nursing homes - a review of the literature. Scand J Caring Sci 2011; 26:404-13. [PMID: 22035204 DOI: 10.1111/j.1471-6712.2011.00932.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Affiliation(s)
- Jan Dewing
- Person-centred Research and Practice Development, East Sussex Healthcare NHS Trust/Canterbury Christchurch University Kent; Visiting Professor at University of Ulster and at the Midwifery and Indigenous Health Studies University of Wollongong, Australia
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Douglas A, Letts L, Richardson J. A systematic review of accidental injury from fire, wandering and medication self-administration errors for older adults with and without dementia. Arch Gerontol Geriatr 2010; 52:e1-10. [PMID: 20334937 DOI: 10.1016/j.archger.2010.02.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 02/18/2010] [Accepted: 02/23/2010] [Indexed: 11/28/2022]
Abstract
The assessment of risk of injury in the home is important for older adults when considering whether they are able to live independently. The purpose of this systematic review is to determine the frequency of injury for persons with dementia and the general older adult population, from three sources: fires/burns, medication self-administration errors and wandering. Relevant articles (n=74) were screened and 16 studies were retained for independent review. The studies, although subject to selection and information bias, showed low proportions of morbidity and mortality from the three sources of injury. Data did not allow direct comparison of morbidity and mortality for persons with dementia and the general older adult population; however, data trends suggested greater event frequencies with medication self-administration and wandering for persons with dementia. Assessment targeting these sources of injury should have less emphasis in the general older adult population compared to persons with dementia.
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Affiliation(s)
- Alison Douglas
- McMaster University, School of Rehabilitation Science, Faculty of Health Sciences, 1400 Main St W.- IAHS Bldg. Rm 402, Hamilton, ON, Canada L8S 1C7.
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Managing the wandering behaviour of people living in a residential aged care facility. INT J EVID-BASED HEA 2007. [DOI: 10.1097/01258363-200712000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hodgkinson B, Koch S, Nay R, Lewis M. Managing the wandering behaviour of people living in a residential aged care facility. INT J EVID-BASED HEA 2007; 5:406-36. [PMID: 21631803 DOI: 10.1111/j.1479-6988.2007.00078.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Wandering behaviour is frequently seen in older people with cognitive impairment. The prevalence of patients exhibiting wandering behaviour has been estimated to be 11.6% on traditional units and 52.7% on Alzheimer's units. Wandering is one of the core behavioural characteristics that impact on familial carers and is likely to influence the decision to place a family member in an aged care environment. Considering the possible risks associated with wandering behaviour, the successful identification and management of wandering is essential. Wandering is also a problem for caregivers in the institutionalised setting, in terms of containment, usually being addressed by securing the environment. There has been some research conducted to assist in the understanding and management of wandering behaviour; however, the findings have been diverse resulting in a level of confusion about the best approaches to take. Objectives This review aims to present the best available evidence on the management of wandering in older adults who reside in an aged care facility (both high and low care). Search strategy An extensive search of keywords contained in the title and abstract, and relevant MeSH headings and descriptor terms was performed on the following databases: MEDLINE, CINAHL, PsychINFO, AGELINE, Cochrane Library, Embase, APAIS Health, Current Contents, Dare, Dissertation Abstracts, Personal Communication, Social Science Index. Selection criteria Papers were selected if they focused on the treatment of wandering in an institutional setting. Some studies were not specifically examining wanderers over the age of 65 years as per the protocol requirements, but were included as it was felt that their findings could be applied to this age group. Data collection and analysis Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calculated from individual comparative studies containing count data where possible. All other data were presented in a narrative summary. Results Searches identified one care protocol, two systematic reviews and 24 other studies that satisfied the inclusion criteria. The following recommendations are divided into four categories of interventions (environmental, technology and safety, physical/psychosocial, and caregiving support and education) with only Level 1, 2 or 3 evidence presented. Environmental modifications Gridlines placed in front of doors or covering exit door doorknobs or panic bars may be effective at reducing exit-seeking behaviour (Level 3b). Technology and safety Mobile locator devices may be effective at enabling quick location of wandering residents (Level 3c). Physical/psychosocial interventions Implementation of a walking group or an exercise program may reduce the incidence of disruptive wandering behaviour (Level 3b). Use of air mat therapy may reduce wandering behaviour for at least 15 min post therapy (Level 2). Providing music sessions (and reading sessions) may keep residents from wandering during the period of the session (Level 3b). Caregiving support and education There is no evidence to support any interventions. Conclusions The majority of the available research for which the guidelines are based upon was derived from observational studies or expert opinion (Level of evidence 3 or 4). More rigorous research is required to demonstrate the efficacy of these recommendations.
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Affiliation(s)
- Brent Hodgkinson
- University of Queensland and Blue Care Research and Practice Development Centre, Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Victoria, Australia
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Hodgkinson B, Koch S, Nay R, Lewis M. Managing the wandering behaviour of people living in a residential aged care facility. ACTA ACUST UNITED AC 2007; 5:454-496. [PMID: 27820020 DOI: 10.11124/01938924-200705080-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Wandering behaviour is frequently seen in older people with cognitive impairment. The prevalence of patients exhibiting wandering behaviour has been estimated to be 11.6% on traditional units and 52.7% on Alzheimer's units. Wandering is one of the core behavioural characteristics that impact on familial carers and is likely to influence the decision to place a family member in an aged care environment. Considering the possible risks associated with wandering behaviour, the successful identification and management of wandering is essential. Wandering is also a problem for caregivers in the institutionalised setting, in terms of containment, usually being addressed by securing the environment. There has been some research conducted to assist in the understanding and management of wandering behaviour; however, the findings have been diverse resulting in a level of confusion about the best approaches to take. OBJECTIVES This review aims to present the best available evidence on the management of wandering in older adults who reside in an aged care facility (both high and low care). SEARCH STRATEGY An extensive search of keywords contained in the title and abstract, and relevant MeSH headings and descriptor terms was performed on the following databases: MEDLINE, CINAHL, PsychINFO, AGELINE, Cochrane Library, Embase, APAIS Health, Current Contents, Dare, Dissertation Abstracts, Personal Communication, Social Science Index. SELECTION CRITERIA Papers were selected if they focused on the treatment of wandering in an institutional setting. Some studies were not specifically examining wanderers over the age of 65 years as per the protocol requirements, but were included as it was felt that their findings could be applied to this age group. DATA COLLECTION AND ANALYSIS Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calculated from individual comparative studies containing count data where possible. All other data were presented in a narrative summary. RESULTS Searches identified one care protocol, two systematic reviews and 24 other studies that satisfied the inclusion criteria. The following recommendations are divided into four categories of interventions (environmental, technology and safety, physical/psychosocial, and caregiving support and education) with only Level 1, 2 or 3 evidence presented. ENVIRONMENTAL MODIFICATIONS Gridlines placed in front of doors or covering exit door doorknobs or panic bars may be effective at reducing exit-seeking behaviour (Level 3b). TECHNOLOGY AND SAFETY Mobile locator devices may be effective at enabling quick location of wandering residents (Level 3c). PHYSICAL/PSYCHOSOCIAL INTERVENTIONS Implementation of a walking group or an exercise program may reduce the incidence of disruptive wandering behaviour (Level 3b). Use of air mat therapy may reduce wandering behaviour for at least 15 min post therapy (Level 2). Providing music sessions (and reading sessions) may keep residents from wandering during the period of the session (Level 3b). CAREGIVING SUPPORT AND EDUCATION There is no evidence to support any interventions. CONCLUSIONS The majority of the available research for which the guidelines are based upon was derived from observational studies or expert opinion (Level of evidence 3 or 4). More rigorous research is required to demonstrate the efficacy of these recommendations.
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Affiliation(s)
- Brent Hodgkinson
- 1 University of Queensland and Blue Care Research and Practice Development Centre, 2 Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Victoria, Australia
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Neville CC, McMinn B, Cave P. Implementing the wandering evidence for older people with dementia: key issues for nurses and carers. Int J Older People Nurs 2006; 1:235-8. [DOI: 10.1111/j.1748-3743.2006.00044.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dewing J. Wandering into the future: reconceptualizing wandering 'A natural and good thing'. Int J Older People Nurs 2006; 1:239-49. [DOI: 10.1111/j.1748-3743.2006.00045.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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