Wandering in dementia

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Wandering, in persons with dementia, is a common behavior that causes great risk for the person and concern for caregivers. It is estimated to be the most common type of disruptive behavior in institutionalized persons with dementia.^[1] Although it occurs in several types of dementia, wandering is especially problematic in persons with Alzheimer's disease (AD). This is because AD frequently produces impaired memory: persons with impaired memory are likely to become disoriented and lost simply because they do not recognize where they are nor remember how they came to be there.

Elopement[]

Unattended wandering that goes out of bounds, a behavior known as elopement, is a special concern for caregivers and search and rescue responders. Because elopement often follows from a combination of wandering and sundowning, it typically results in the person being lost out of doors at night, dressed inappropriately, and unable to take many ordinarily routine steps to ensure their personal safety and security. This is a situation of great urgency, and the necessity of searching at night imposes added risks on the searchers.

In some countries the social costs of elopement, already significant, are increasing rapidly.^[2] A SAR mission lasting more than a few hours is likely to expend many hundreds to thousands to tens of thousands of skilled man hours and, per mission, those involving subjects with dementia typically expend significantly more resources than others.^[2]

Assessment[]

Assessment of a person's risk of wandering often is neglected. A review of medical records of 83 persons with dementia resident in Los Angeles, California found that only 8% of the records included a wandering risk assessment.^[3] Assessment can be performed by a social worker. In the United States the Alzheimer's Association has developed a program called "Safe Return", that includes assessment tools. An assessment tool designed for use in nursing homes is the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH); this tool may be suitable for use also in assisted living facilities.^[4]

Prevention[]

Methods used to prevent wandering, or simply to reduce the risk of wandering out of bounds, include: drugs, physical restraints, physical barriers, 24-hour real time surveillance, and tracking devices. All of these methods have ethical issues and one, use of physical restraints, is widely considered to be inhumane.^[5] Tracking devices of several kinds have been evaluated.^[6]^[7]

Much of the literature on wandering concerns persons resident in institutions. Studies on wandering from private residences are insufficient for comparison of prevention via drugs versus other methods.^[8]

The risk of wandering can be reduced by several low-tech and minimally intrusive techniques, including: placing a visual barrier such as a curtain across a doorway.^[9]

Technology[]

In other efforts to help mitigate liability, Long Term Care and Assisted Living Facilities may use radio frequency (RFID) products to protect their residents. A resident wears a wrist or ankle transmitter. This RFID tag can be read by receiving antennas, which are placed usually at door or hallway locations that are deemed likely routes of escape and will need monitoring. The system will then either sound an alarm or lock a door when a door system reads a resident transmitter worn by a resident that is at risk for wandering. This helps prevent an elopement as staff can be notified by alarms at the door, pocket pagers, and email. A well trained staff will be able to quickly find the person at risk and keep them safely inside.

Newer versions of this equipment have become more advanced. The newest types of systems may have the ability to: identify a RFID tag by a specific resident and forward that name to the staff; give staff a last known location of the resident; show a photo of the resident at the staff station with a mapped out door location; report the the frequency, times and severity of the incidents; and finally, integrate with other access control sytems, HVAC, fire alarm equipment and phone equipment.

The reason this type of system seems to be preferable is that it helps monitor those at risk for wandering and elopements while not infringing on the freedom of other residents or visitors to a facility.

While many companies compete in this market, the two oldest and most well known companies that provide this equipment are generally considered to be RF Technologies^[10] and their Code Alert^[11] brand and Stanley Senior Technologies ^[12] with their Wanderguard^[13] brand.^{[How to reference and link to summary or text]} The companies have been around so long and are in so many facilities that regionally their brands have become synonymous with the generic term for this type of equipment.^{[How to reference and link to summary or text]}

References[]

↑ U.S. Congress, Office of Technology Assessment (1992). Special care units for people with Alzheimer's and other dementias: Consumer education, research, regulatory, and reimbursement issues., Government Printing Office.
↑ ^2.0 ^2.1 Wandering and Alzheimer's overview. dbs-sar.com. URL accessed on 2008-08-26.
↑ Cherry DL, Vickrey BG, Schwankovsky L, Heck E, Plauchm M, Yep R (August 2004). Interventions to improve quality of care: the Kaiser Permanente-Alzheimer's Association Dementia Care Project. Am J Manag Care 10 (8): 553–60.
↑ Beattie ER, Song J, LaGore S (2005). A comparison of wandering behavior in nursing homes and assisted living facilities. Res Theory Nurs Pract 19 (2): 181–96.
↑ Robinson L, Hutchings D, Corner L, Beyer F, Dickinson H, Vanoli A, Finch T, Hughes J, Ballard C, May C, Bond J (August 2006). A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use. Health Technol Assess 10 (26): iii, ix–108.
↑ Miskelly F (September 2005). Electronic tracking of patients with dementia and wandering using mobile phone technology. Age Ageing 34 (5): 497–9.
↑ Miskelly F (May 2004). A novel system of electronic tagging in patients with dementia and wandering. Age Ageing 33 (3): 304–6.
↑ Hermans DG, Htay UH, McShane R (2007). Non-pharmacological interventions for wandering of people with dementia in the domestic setting. Cochrane Database Syst Rev (1): CD005994.
↑ Feliciano L, Vore J, LeBlanc LA, Baker JC (2004). Decreasing entry into a restricted area using a visual barrier. J Appl Behav Anal 37 (1): 107–10.
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PMID 15014607
PMID 14645806
PMID 10513031

Template:Mental and behavioral disorders

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[1] U.S. Congress, Office of Technology Assessment (1992). Special care units for people with Alzheimer's and other dementias: Consumer education, research, regulatory, and reimbursement issues., Government Printing Office.

[dbs-sar-2] 2.0 ^2.1 Wandering and Alzheimer's overview. dbs-sar.com. URL accessed on 2008-08-26.

[pmid15352531-3] Cherry DL, Vickrey BG, Schwankovsky L, Heck E, Plauchm M, Yep R (August 2004). Interventions to improve quality of care: the Kaiser Permanente-Alzheimer's Association Dementia Care Project. Am J Manag Care 10 (8): 553–60.

[pmid16025697-4] Beattie ER, Song J, LaGore S (2005). A comparison of wandering behavior in nursing homes and assisted living facilities. Res Theory Nurs Pract 19 (2): 181–96.

[5] Robinson L, Hutchings D, Corner L, Beyer F, Dickinson H, Vanoli A, Finch T, Hughes J, Ballard C, May C, Bond J (August 2006). A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use. Health Technol Assess 10 (26): iii, ix–108.

[6] Miskelly F (September 2005). Electronic tracking of patients with dementia and wandering using mobile phone technology. Age Ageing 34 (5): 497–9.

[7] Miskelly F (May 2004). A novel system of electronic tagging in patients with dementia and wandering. Age Ageing 33 (3): 304–6.

[8] Hermans DG, Htay UH, McShane R (2007). Non-pharmacological interventions for wandering of people with dementia in the domestic setting. Cochrane Database Syst Rev (1): CD005994.

[pmid15154224-9] Feliciano L, Vore J, LeBlanc LA, Baker JC (2004). Decreasing entry into a restricted area using a visual barrier. J Appl Behav Anal 37 (1): 107–10.

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