# Presentation: 742112

## Dementia-related Wandering: Management Interventions

- D. Helen Moore, PhD
- Barbara McKenzie, MA
- USF Geriatric Education Center
- Summer Institute
- June 13, 2007

**Notes:**
Dementia-related wandering: Management Interventions. By D. Helen Moore, PhD and Barbara McKenzie, MA as presented at the USF Geriatric Education Center Summer Institute, June 13, 2007.

## Part I.  Introduction 

- definition
- significance
- quality of wandering
- high-risk/low-risk wandering
- what, where, when and course of wandering

**Notes:**
Introduction

In this presentation we will define wandering, discuss its significance, the quality of wandering, high-risk and low-risk wandering, and the what, where, when and course of wandering.

## What is Wandering? 

- “a syndrome of dementia-related locomotion having a frequent, repetitive, temporally-disordered and/or spatially-disoriented nature that is manifested in lapping, random, and/or pacing patterns, some of which are associated with eloping, eloping attempts, or getting lost unless accompanied.”
**Source: Algase, DL, Moore, DH, Vandeweerd, C & Gavin-Dreschnack, D (2007). Mapping the Maze of Terms and Definitions in Dementia-related Wandering*****, Aging & Mental Health*****, in press.**

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

The source of this definition is a 2007 in-press article by D. L. Algase, D. H. Moore, C. VandeWeerd & D. Gavin-Dreschnack entitled “Mapping the Maze of Terms and Definitions in Dementia-Related Wandering to be published in the Journal of Aging and Mental Health.

## Why Care About Wandering?

- “Most common  unsafe behavior in persons with dementia”

**Notes:**
It is important to care about wandering because it is the most common unsafe behavior in persons with dementia.

## High-risk/low-risk wandering

- activity of the wanderer
- care setting
- caregiver knowledge and awareness

**Notes:**
The three variables that  interact to form a “wandering danger quotient” are:

The nature of wanderer’s locomotive activity, e.g. from “pottering” to “exit-seeking.”

The security systems in place in the home, community or LTC care setting

The family or professional caregiver’s understanding of the potential safety hazards and ways to prevent them.

## Qualities of Wandering

- haphazard
- may lack apparent destination
- fretful, pacing
- cannot be easily redirected
- may result in unintended leaving

**Notes:**
The qualities of wandering are:
Haphazard
May lack apparent destination
Fretful, pacing
Cannot be easily redirected
May result in unintended leaving.

## The “When” of Wandering

- begins in the morning hours
- increases throughout the day
- peaks at 5 pm to 7 pm.

**Notes:**
Wandering generally begin in the morning hours, increases throughout the day and peaks at 5pm to 7pm.

## The “Where” of Wandering

- nursing home settings
- community-based settings
- home-based settings

**Notes:**
Wandering is found in nursing home, community-based and home-based settings.

## The Course of Wandering

- 60% of all dementia cases
- mild, moderate and severe dementia
- Persistent - lasts for years
- subsides in late-stage, profound dementia

**Notes:**
The course of wandering:
60% of all dementia cases.
Mild, moderate and severe dementia.
Is persistent and lasts for years.
Subside in late-stage, profound dementia.

## Part II. Causes of Wandering

- Wanderer
- Medical
- Personality

- Environmental
- Social
- Physical

**Notes:**
The causes of wandering include:

The wanderer’s medical history and personality.
The wanderer’s environment including social and physical.

## Medical Causes 

- visual/perceptual deficits
- attentional problems
- medication side effects

**Notes:**
Medical causes of wandering include:
Visual/perceptual deficits.
Attentional problems.
Medication side effects.

## Personality Causes

- extroversion
- hx. of exercise to manage stress
- pre-morbid occupation

**Notes:**
Personality causes include:
Extroversion.
History of exercise to manage stress.
Pre-morbid occupation.

## Social Environment Causes

- staff mix and stability
- overall ambiance
- extent of social engagement

**Notes:**
Social environment causes include:
Staff mix and stability.
Overall ambiance.
Extent of social engagement.

## Physical Environment Causes

- light
- noise
- temperature
- complexity of architecture
- crowding

**Notes:**
Physical environment causes include:
Light
Noise
Temperature
Complexity of architecture
Crowding

## Part III.Problematic wandering:management goals and recommended interventions

**Notes:**
Problematic wandering: management goals and recommended interventions.

## Excessive walking 

- _GOAL - Support patient’s physical needs:_
- adjust medications
- hydrate
- provide nutrients
- provide safe environment

**Notes:**
If the person is doing excessive walking, the goal is the support the patient’s physical needs. Some options are:
Adjust medications
Hydrate
Provide nutrients
Provide safe environment

## Elopement, day or night

- _GOAL - Alert caregivers:_
- door alarm systems
- pressure-activated systems
- combined systems

**Notes:**
If the person is eloping, day or night, the goal is to alert caregivers. This can be accomplished through:
Door alarm systems
Pressure-activated systems
Combined systems

## Trespassing

- _GOAL - Keep patient out of off-limits areas:_
- visual exit barriers
- tape barriers
- mirrors

**Notes:**
If the person is trespassing, the goal is to keep the patient out of off-limit areas by using visual exit barriers, tape barriers and/or mirrors.

## Losing way 

- _GOAL - Guide patient:_
- signs, landmarks, cueing
- enhanced lighting
- establish toileting schedule

**Notes:**
If the person is losing their way, the goal is to guide the patient through:
1. Signs, landmarks, cueing
2. Enhanced lighting
3. Establishing a toileting schedule

## Exiting-seeking

- _GOAL - Reduce exit seeking behaviors:_
- architectural barriers
- locks
- visual exit barriers

**Notes:**
If the person is exit-seeking, the goal is to reduce the behavior by using architectural barriers, locks and/or visual exit barriers.

## Shadowing

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

**Notes:**
The literature defines “shadowing” in dementia-related wandering as the patient’s close following or trailing a caregiver’s locomotion.

## Patient may go missing

- _GOAL - Track patient’s location:_
- RFID
- GPS
- personal guidance systems

**Notes:**
If the patient goes missing, the goal is to track the patient’s location. This can be accomplished by using RFID, GPS or personal guidance systems.

## Patient missing in the facility

- _Goal: Staff response to quickly locate patient and prevent injury or exit_
- policies
- procedures

**Notes:**
If the patient is missing in the facility, the goal is for the staff to respond quickly to locate the patient and prevent injury or exit by developing effective policies and procedures.

## Patient missing in community

- GOAL: _Community quickly locates and returns the patient_
- Alzheimer’s Assoc. Safe Return® Program
- Community-based search and rescue

**Notes:**
If the patient is missing in the community, the goal is to quickly locate and return the patient by utilizing the Alzheimer’s Association’s Safe Return Program as well as community-based search and rescue.

## VA Patient Safety CenterSafe Wandering Resources                 

- _[http://www.visn8.med.va.gov/](http://www.visn8.med.va.gov/)_
- _patientsafetycenter/_

## Contact

- D. Helen Moore, PhD
- Health Science Specialist
- VISN 8 Patient Safety Center of Inquiry (118M)
- 11605 N. Nebraska Avenue,
- Tampa, FL 33612-5738
- 813-558-3931 ph; 813-558-3990 fax
- Dorothy.Moore4@va.gov

**Notes:**
For more information contact D. Helen Moore, PhD at 813-558-3931 or Dorothy.Moore4@va.gov