Wandering (dementia)
Encyclopedia
Wandering, in persons with dementia
, is a common behavior that can cause great risk for the person, and is often the major priority (and concern) for caregivers. It is estimated to be the most common form disruption from people with dementia within institutions. Although it occurs in several types of dementia, wandering is especially common in persons with Alzheimer's disease
(AD). This can be due to forgetfulness, and also to a frequent need for stimulation.
responders. Wandering (especially if combined with sundowning
) can result in the person's being lost out of doors at night, dressed inappropriately, and unable to take many ordinarily routine steps to ensure his or her 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. A SAR
mission lasting more than a few hours is likely to expend many hundreds to thousands to tens of thousands of skilled worker hours and, per mission, those involving subjects with dementia typically expend significantly more resources than others.
, found that only 8% of the records included a wandering risk assessment. 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 home
s is the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH); this tool may be suitable for use also in assisted living facilities
.
Other 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. Tracking devices of several kinds have been evaluated.
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.
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.
Wandering can be due to a person searching for stimulation. If a wanderer does not purposefully attempt to escape the location where they are, a minimal barrier can deter wandering behaviour. However, some wanderers will look for a familiar route from their past, while others will simply 'explore.'
Some cases of wanderers operating vehicles and driving either aimlessly or along a familiar route have been reported.
In response to wandering seniors, 25 states have adopted Silver Alert
programs. Silver Alert
is a program similar to AMBER Alert
to notify the public of missing seniors with dementia and other cognitive disabilities.
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 frequency, times and severity of the incidents; and finally, integrate with other access control systems, 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.
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
, is a common behavior that can cause great risk for the person, and is often the major priority (and concern) for caregivers. It is estimated to be the most common form disruption from people with dementia within institutions. Although it occurs in several types of dementia, wandering is especially common in persons with Alzheimer's disease
Alzheimer's disease
Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death...
(AD). This can be due to forgetfulness, and also to a frequent need for stimulation.
Elopement
Unattended wandering that goes out of bounds, a behavior known as elopement, is a special concern for caregivers and search and rescueSearch and rescue
Search and rescue is the search for and provision of aid to people who are in distress or imminent danger.The general field of search and rescue includes many specialty sub-fields, mostly based upon terrain considerations...
responders. Wandering (especially if combined with sundowning
Sundowning (dementia)
In medicine, sundowning, also known as sundown syndrome, is a syndrome involving the occurrence or increase of one or more abnormal behaviors in a circadian rhythm. Sundowning typically occurs during the late afternoon, evening, and night, hence the name. It occurs in persons with certain forms of...
) can result in the person's being lost out of doors at night, dressed inappropriately, and unable to take many ordinarily routine steps to ensure his or her 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. A SAR
Search and rescue
Search and rescue is the search for and provision of aid to people who are in distress or imminent danger.The general field of search and rescue includes many specialty sub-fields, mostly based upon terrain considerations...
mission lasting more than a few hours is likely to expend many hundreds to thousands to tens of thousands of skilled worker hours and, per mission, those involving subjects with dementia typically expend significantly more resources than others.
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, CaliforniaLos Angeles, California
Los Angeles , with a population at the 2010 United States Census of 3,792,621, is the most populous city in California, USA and the second most populous in the United States, after New York City. It has an area of , and is located in Southern California...
, found that only 8% of the records included a wandering risk assessment. Assessment can be performed by a social worker. In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
the Alzheimer's Association
Alzheimer's Association
The Alzheimer's Association, incorporated on April 10, 1980 as the Alzheimer’s Disease and Related Disorders Association, Inc., is a non-profit American voluntary health organization which focuses on care, support and research for Alzheimer's disease....
has developed a program called "Safe Return", that includes assessment tools. An assessment tool designed for use in nursing home
Nursing home
A nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...
s is the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH); this tool may be suitable for use also in assisted living facilities
Assisted living
Assisted living residences or assisted living facilities provide supervision or assistance with activities of daily living ; coordination of services by outside health care providers; and monitoring of resident activities to help to ensure their health, safety, and well-being.Assistance may...
.
Wandering prevention
The most common form of wandering prevention is for a caregiver to remain in the company of the person likely to wander, so the caregiver can either accompany him or prevent him from wandering when the situation occurs.Other 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. Tracking devices of several kinds have been evaluated.
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.
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.
Wandering can be due to a person searching for stimulation. If a wanderer does not purposefully attempt to escape the location where they are, a minimal barrier can deter wandering behaviour. However, some wanderers will look for a familiar route from their past, while others will simply 'explore.'
Some cases of wanderers operating vehicles and driving either aimlessly or along a familiar route have been reported.
In response to wandering seniors, 25 states have adopted Silver Alert
Silver Alert
A Silver Alert is a public notification system in the United States to broadcast information about missing persons - especially seniors with Alzheimer's Disease, dementia or other mental disabilities - in order to aid in their return....
programs. Silver Alert
Silver Alert
A Silver Alert is a public notification system in the United States to broadcast information about missing persons - especially seniors with Alzheimer's Disease, dementia or other mental disabilities - in order to aid in their return....
is a program similar to AMBER Alert
AMBER Alert
An AMBER Alert or a Child Abduction Emergency is a child abduction alert bulletin in several countries throughout the world, issued upon the suspected abduction of a child, since 1996...
to notify the public of missing seniors with dementia and other cognitive disabilities.
Technology
In other efforts to help keep residents safe, mitigate liability, and protect reputations, Long Term Care and Assisted Living Facilities may use radio frequency (RFID) products to protect their residents. A resident wears a wrist, pendant, or ankle transmitter. This RFID tag can be read by receiving antenna units, which are placed usually at door or hallway locations that are deemed likely routes of egress and need monitoring. The system will then either sound an alarm or briefly lock a door when a door monitor reads a 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 caregiver will be able to quickly find the person at risk and keep them safely inside. Smaller scale versions of this technology are also used in private residences.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 frequency, times and severity of the incidents; and finally, integrate with other access control systems, HVAC
HVAC
HVAC refers to technology of indoor or automotive environmental comfort. HVAC system design is a major subdiscipline of mechanical engineering, based on the principles of thermodynamics, fluid mechanics, and heat transfer...
, 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.