Dementia-related Dementia-related Wandering: Wandering: Management Management InterventionsInterventions

D. Helen Moore, PhDD. Helen Moore, PhDBarbara McKenzie, MABarbara McKenzie, MA

USF Geriatric Education CenterUSF Geriatric Education CenterSummer InstituteSummer Institute

June 13, 2007June 13, 2007

Part I. Introduction Part I. Introduction

• definitiondefinition

• significancesignificance

• quality of wanderingquality of wandering

• high-risk/low-risk wanderinghigh-risk/low-risk wandering

• what, where, when and course of wanderingwhat, where, when and course of wandering

What is Wandering? What is Wandering?

““a syndrome of dementia-related locomotion a syndrome of dementia-related locomotion having a frequent, repetitive, temporally-having a frequent, repetitive, temporally-disordered and/or spatially-disoriented disordered and/or spatially-disoriented nature that is manifested in lapping, nature that is manifested in lapping, random, and/or pacing patterns, some of random, and/or pacing patterns, some of which are associated with eloping, eloping which are associated with eloping, eloping attempts, or getting lost unless attempts, or getting lost unless accompanied.”accompanied.”

Source: Algase, DL, Moore, DH, Vandeweerd, C & Gavin-Dreschnack, D (2007). Source: Algase, DL, Moore, DH, Vandeweerd, C & Gavin-Dreschnack, D (2007). Mapping the Maze of Terms and Definitions in Dementia-related WanderingMapping the Maze of Terms and Definitions in Dementia-related Wandering, , Aging & Mental HealthAging & Mental Health, in press., in press.

Why Care About Why Care About Wandering?Wandering?

““Most common unsafe Most common unsafe behavior in persons with behavior in persons with

dementia”dementia”

High-risk/low-risk wanderingHigh-risk/low-risk wandering

•activity of the wanderer activity of the wanderer

•care setting care setting

•caregiver knowledge and caregiver knowledge and awarenessawareness

Qualities of WanderingQualities of Wandering

•haphazard haphazard

•may lack apparent destinationmay lack apparent destination

•fretful, pacingfretful, pacing

•cannot be easily redirectedcannot be easily redirected

•may result in unintended leavingmay result in unintended leaving

The “When” of WanderingThe “When” of Wandering

• begins in the morning hours begins in the morning hours

• increases throughout the dayincreases throughout the day

• peaks at 5 pm to 7 pm.peaks at 5 pm to 7 pm.

The “Where” of WanderingThe “Where” of Wandering

• nursing home settingsnursing home settings

• community-based settingscommunity-based settings

• home-based settingshome-based settings

The Course of WanderingThe Course of Wandering

• 60% of all dementia cases60% of all dementia cases

• mild, moderate and severe dementia mild, moderate and severe dementia

• Persistent - lasts for yearsPersistent - lasts for years • subsides in late-stage, profound subsides in late-stage, profound

dementiadementia

Part II. Causes of WanderingPart II. Causes of Wandering

WandererWanderer•Medical Medical

•Personality Personality

EnvironmentEnvironmentalal

•SocialSocial

•PhysicalPhysical

Medical CausesMedical Causes

•visual/perceptual deficitsvisual/perceptual deficits

•attentional problemsattentional problems

•medication side effectsmedication side effects

Personality CausesPersonality Causes

•extroversionextroversion

•hx. of exercise to manage hx. of exercise to manage stressstress

•pre-morbid occupationpre-morbid occupation

Social Environment CausesSocial Environment Causes

•staff mix and stabilitystaff mix and stability

•overall ambianceoverall ambiance

•extent of social engagementextent of social engagement

Physical EnvironmentPhysical Environment CausesCauses

•lightlight

•noisenoise

•temperaturetemperature

•complexity of architecturecomplexity of architecture

•crowdingcrowding

Part III.Part III.Problematic wandering:Problematic wandering:management goals and management goals and

recommended interventionsrecommended interventions

Excessive walkingExcessive walking

GOAL - Support patient’s physical needs:GOAL - Support patient’s physical needs:

•adjust medicationsadjust medications

•hydratehydrate

•provide nutrientsprovide nutrients

•provide safe environmentprovide safe environment

Elopement, day or nightElopement, day or night

GOAL - Alert caregivers:GOAL - Alert caregivers:

•door alarm systemsdoor alarm systems

•pressure-activated systemspressure-activated systems

•combined systemscombined systems

TrespassingTrespassing

GOAL - Keep patient out of off-limits areas:GOAL - Keep patient out of off-limits areas:

•visual exit barriersvisual exit barriers

•tape barrierstape barriers

•mirrorsmirrors

Losing way Losing way

GOAL - Guide patient:GOAL - Guide patient:

•signs, landmarks, cueingsigns, landmarks, cueing

•enhanced lightingenhanced lighting

•establish toileting scheduleestablish toileting schedule

Exiting-seekingExiting-seeking

GOAL - Reduce exit seeking behaviors:GOAL - Reduce exit seeking behaviors:

•architectural barriersarchitectural barriers

• lockslocks

•visual exit barriersvisual exit barriers

ShadowingShadowing

• ““Shadowing” in dementia-related Shadowing” in dementia-related wandering is defined in the literature wandering is defined in the literature as the patient’s close following or as the patient’s close following or trailing a caregiver’s locomotion.trailing a caregiver’s locomotion.

Patient may go missingPatient may go missing

GOAL - Track patient’s location:GOAL - Track patient’s location:

• RFIDRFID

• GPSGPS

• personal guidance systemspersonal guidance systems

Patient missing in the Patient missing in the facilityfacility

Goal: Staff response to quickly locate Goal: Staff response to quickly locate patient and prevent injury or exitpatient and prevent injury or exit

•policiespolicies

•proceduresprocedures

Patient missing in Patient missing in communitycommunity

GOAL: GOAL: Community quickly locates and Community quickly locates and returns the patientreturns the patient

• Alzheimer’s Assoc. Safe ReturnAlzheimer’s Assoc. Safe Return®® ProgramProgram

• Community-based search and rescueCommunity-based search and rescue

VA Patient Safety CenterVA Patient Safety CenterSafe Wandering ResourcesSafe Wandering Resources

http://www.visn8.va.gov/

patientsafetycenter/patientsafetycenter/

ContactContact

D. Helen Moore, PhDD. Helen Moore, PhD

Health Science SpecialistHealth Science Specialist

VISN 8 Patient Safety Center of Inquiry (118M)VISN 8 Patient Safety Center of Inquiry (118M)

11605 N. Nebraska Avenue, 11605 N. Nebraska Avenue,

Tampa, FL 33612-5738Tampa, FL 33612-5738

813-558-3931 ph; 813-558-3990 fax813-558-3931 ph; 813-558-3990 fax

Dorothy.Moore4@va.govDorothy.Moore4@va.gov