Wandering Issues at a Nursing Home

Dementia forces many adult children to place aging parents in settings providing long-term care. A number of brain diseases cause dementia, which affects the ability to think and remember and may result in dementia-related behaviors like wandering. Because it can lead to negative consequences like falls or elopement (leaving designated boundaries without returning), wandering becomes a serious concern for caregivers. Proper risk assessment and management techniques help determine the best ways to prevent harmful outcomes for wandering patients.

Wandering Risk Factors

When making risk assessments, caregivers need to treat patients individually. Because each person experiences different symptoms, a one-size-fits-all approach does not work for people with dementia. While cognitive impairment makes the most obvious risk factor for wandering, a number of other risk factors include:

• Male gender
• Older age
• Interrupted sleep patterns
• Agitation
• Aggression
• Premorbid extroverted social behavior

Internal and External Stressors

Patients who wander often experience internal and external discomfort. Most have a lower tolerance for stress, which gets worse as the disease progresses. External factors like noise or activity often make internal stress worse. A need for toileting assistance causes people to wander as does the need for feelings of safety or familiarity.

Screening Tools

Experts use a number of tools to assess a person’s inclination to wander. These include the Cohen-Mansfield Agitation Inventory (CMAI), the Rating Scale for Aggressive Behavior in the Elderly (RAGE), the Neuropsychiatric Inventory (NPI), and the Revised Algase Wandering Scale (RAWS). All make useful tools for assessing cognitive impairment and frequency of certain behaviors that coincide with wandering.

Differences Regarding Wandering Management

While experts all want to protect wanderers from undesirable outcomes, opinions differ when it comes to wandering management. Because of the benefits of exercise, many believe wandering should be allowed in safe and secure environments. Others worry how wandering affects daily routines like eating and personal care, and whether it may jeopardize the privacy of other patients.

Wandering Prevention

Physical restraints and unnecessary medication like antipsychotic drugs have proven ineffective and inappropriate for wandering residents. These treatments boost risks for infection, falls, and pressure ulcers. In addition, they raise levels of anxiety, agitation, and violent behaviors.

Extroverted residents often benefit from social contact with friends, relatives, staff, or other residents. Physical exercise also reduces an inclination to wander, and engaging in interactive activities has been shown to reduce boredom and wandering behaviors in at-risk residents.

Facility Interventions

Housing residents in locked units helps control elopement but does not always prevent it, and locked units limit feelings of freedom. Alternatives include secure indoor and outdoor areas that permit residents to wander freely. Limiting the number of people in each living area also reduces stress and wandering in residents.  Other useful facility-wide tools include:

• Group mealtime
• A video monitoring system
• Silent door alarms
• Electromagnetic wrist trackers

Friends and family have enough to worry about in dealing with a loved one’s dementia without adding wandering into the equation. A facility that provides a thorough risk assessment for wandering and one that takes steps to manage and prevent wandering behaviors helps to reduce some of the worry.