Dementia, Wandering, Interventions, Aging in place, Review. Peer-reviewed articles were examined for the following attributes: features of wander-management strategies (i.e., strategy type, specifications, cost, product readiness level) and characteristics of research (i.e., clinical implications, sample size, participant characteristics, level of clinical evidence of outcomes). There are concerns over control and restraint (i.e., tagging like a criminal). Saunders comprehensive review for the NCLEX-RN examination. Patients with ASD can be aggressive, wandering or bolting from a safe environment to get to something of interest, such as water, the park, or railroad tracksor to get away from an unpleasant or terrifying situation, such as one with loud noises, bustle, or flashing lights. A Toolkit: Patients At Risk for Wandering - VHA National Center for Primary reasons were due to the high number of review articles included in this study, in addition to many strategies that were proposed but not evaluated. Examine the patient for sundown syndrome. Strategies, however, were only proposed, but its effectiveness was never evaluated. Assess for the existence of potential adverse effects of wandering, such as weight change, poor social skills, falls or injuries, and elopement. Federal government websites often end in .gov or .mil. This information provides evidence for caregivers and clinicians when they select strategies to manage wandering in persons living with dementia. This gadget might be as simple as a doorbell or as complex as an electric house alarm. As much as possible, minimize the patients exposure to unexpected settings and individuals, maintain caregiver consistency, and maintain care routines such as feeding times, bathing, and sleeping regimens. Thank you! Evaluating an electronic monitoring system for people who wander. This intervention intends to prevent injury or accident from occurring if the patient becomes disoriented and begins to wander. The nurse should make lounge rooms available for patients to pause and rest while walking. Successful interventions involve tailoring exercise programs, medication reviews, and environmental modifications to the needs of individual residents. Do not abandon him or her alone in a car. In terms of living arrangements, there are a growing number of persons with dementia who are living at home alone in the community, changing the scope of how one might care for these individuals [50]. Therefore, establish a quiet environment for the patient to avoid confusion and limit the chances of wandering. To avoid the danger of wandering, determine the times of day when risky roaming is likely to occur, plan relevant activities to keep the patient engaged, and avoid scolding the person if he or she is looking for a partner or wants to go home. Thus it is critical to identify and treat any physical problems or medical conditions. This can be a good way to . Interpretation: We identified six categories of high-tech and 14 subcategories of low-tech strategies that can be used by caregivers and persons with dementia. Evidence-Based Protocols for Managing Wandering Behaviors. A total of 19 high-tech articles, 34 low-tech articles, and 11 articles containing both high- and low-tech strategies could not be classified using the PRL scale. Vital signs should be checked every 4 hours. The rates of cognitive impairment are on the rise worldwide as our world population ages. Medical-surgical nursing: Concepts for interprofessional collaborative care. Arksey H., O'Malley L. Scoping studies: towards a methodological framework. The activities may help to alleviate confusion and agitation and release energy. We examined peer-reviewed and gray literature published between January 1990 and November 2017. Close and lock any doors that lead outdoors. 2015 IEEEE International Conference on Industrial Engineering and Engineering Management. A framework for managing wandering and preventing elopement. Because this could result in an injury or fatality, consider evaluating existing organizational protocols and strategies to prevent elopement or wandering. Boredom expression. From this review, we can conclude that many high- and low-tech strategies exist to manage the negative outcomes associated with wandering in persons with dementia. Determine the medications that the patient is currently taking. interventions help maintain the interest of the resident and redirect . For the peer-reviewed articles, two were in the analytical and experimental critical functions phase (PRL3), and 21 were either in development and testing phases in laboratory, or validated in relevant environments (PRL 4 and 5), or the technologies were in demonstration or pilot phase (PRL6). Over three days, assess and describe the amount (frequency and duration), pattern (random, lapping, or pacing), and 24-hour distribution of wandering behavior. A scoping review. Two articles used qualitative methods, which cannot be assessed using Sackett's criteria [36]. This review, however, only included high-tech solutions, excluding several key strategies, such as door murals and distractions, which may also help with managing this behavior. Instead, reassure them and emphasize that you will be with them and that they are safe. Large, colorful signs with the patient's name that are It is suggested that locator devices do not increase autonomy but just assists in finding the person with dementia sooner. Responding to agitation in people with dementia. This is a scoping literature review based on Daudt, van Mossel, and Scott's (2013) [26] modification of Arksey and O'Malley's (2005) [27] methodology. The goal of this intervention is to constantly and closely monitor the patient. Wandering residents and elopement prevention - McKnight's Long-Term Even fewer (2%; 2/118) compared their effectiveness. [25] was followed to address bias. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. Wandering is also linked to several illnesses, including autism spectrum disorder, Down syndrome, and dementia caused by Alzheimers disease, stroke, head trauma, or Parkinsons disease. Interactive wall was experienced positively by wandering elders, and installation was an improvement in attracting persons with dementia than old empty environments. Initiate a systematic search of resident care units and other immediate areas: rooms, closets and stairwells, even those areas that are normally locked, along with the roof if there is roof access. Establish supervision. The group also identified four key areas essential to successfully managing wandering behavior: Leadership, Assessment/Care Planning, Policy/Procedures, and Environment. Perceived as effective; however, it is not used by a majority of facilities (only used by 28% of facilities). As people become increasingly perplexed, they may search for someone or something from their past. Searching. . Patients suffering from prolonged confusion may have psychological distress. This might be a deceased lover, a lost acquaintance, or a childhood home. The use of two pairs of raters during the selection for relevant articles, and a third and fourth rater when there was disagreement, minimized rater-bias that may have arisen from the subjective nature of applying the inclusion and exclusion criteria. and transmitted securely. Changes in the brain might result in feelings of uneasiness and anxiety. Wandering Assisted Living Residents Some persons with dementia, for example, wander inside and outside of their homes [49], whereas some may only wander in one of these settings. Other causes of wandering include the following: What are the positive and negative effects of wandering behavior? This brief looks at the strategies some states and counties are using to boost the equity and quality of their home visiting services for these at-risk families, from rethinking how they assess the needs of resident . Studies containing high-techonly strategies were characterized by low journal impact factor (i.e., Source Normalized Impact per Paper mean 0.94, SD 0.59; 95% confidence interval [0.79, 1.08]) and were published in journals located in Q1 (13 studies), Q2 (16 studies), Q3 (5 studies), and Q4 (6 studies) journal quartile per SCImago Journal Rank classification [39]. Tilly, J. Ethical issues, such as coercing persons with dementia to use locating devices (2), concerns over the device conveying the user as frail as sick (2), removing the person with dementia of their dignity, and worries over privacy and security were conveyed. The nurse should determine who is at risk of wandering. The repercussions of wandering can range from minor to severe bodily injury and death. Aside from a lack of usability testing and user-centered approaches of wander-management strategies, available solutions were difficult to find and were vastly scattered across the gray literature. Non-pharmacological interventions for wandering of people with dementia in the domestic setting (review). This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Consider installing door sensors to notify caregivers whenever a door opens. The patient returns home later than expected from a usual walk or drive. Evidence-based review of moderate to severe acquired brain injury. The nurse is responsible for determining what time of day the patients frequently wander. Enhancing the scoping study methodology: a large, inter-professional team's experience with Arksey and O'Malley's framework. 1). Nursing Diagnosis: Wandering related to a diminished sense of danger and impulsive behavior secondary to Autism Spectrum Disorder (ASD), evidenced by attempting to run away from an uneasy situation and escape unpleasant sensory stimuli such as loud and irritating noise. This RCT [40] achieved a PEDro score of 5, with a level of evidence 2, where adapted exercise games (i.e., active activities with a softball) significantly decreased agitated behaviors, such as searching or wandering behaviors (54%, P<.05), whereas escaping restraints had no significant change (40%, P=.07). Present one simple direction at a time, just repeat it as needed. The device may be a bracelet or may be a small lightweight device that is placed on a buckle, watch, or sewn into a piece of clothing. Copyright 2023 Haymarket Media, Inc. All Rights Reserved This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. It is important to have a missing resident protocol in place so that staff is aware of procedures to follow should such an event occur. Although people who wander may gain social contact, exercise, and stimulation, they can also become lost or exhausted. Disturbed Sleep Pattern Nursing Diagnosis, Hopelessness Nursing Diagnosis and Nursing Care Plan. It often includes also wanting to leave the . Memory lapse. Plan the activities of the patient during that time. We conclude that although effectiveness of 49 interventions and usability of 13 interventions were clinically tested, most were evaluated in institutional or laboratory settings, few addressed ethical issues, and the overall level of scientific evidence from these outcomes was low. Add a note about your Privacy Policy and how you intend to use your users information. No effects of temperature on wandering prevalence were found. If the patient is experiencing difficulty falling or staying asleep, consult a doctor for additional evaluation and therapy. Articles containing both high- and low-tech solutions were found to have the highest technology readiness level (PRL9), in comparison with high-techonly articles with an average PRL7 and low-techonly strategies with an average PRL7. Strategy was suggested in the literature, but its effectiveness was not evaluated. This treatment is favorable to pediatric patients. In 2016, 46.6 million people globally were living with dementia, and this number is projected to increase to 75 million by 2030 [1]. Algase D.L., Beattie E.R.A., Song J.A., Milke D., Duffield C., Cowan B. Validation of the Algase Wandering Scale (Version 2) in a cross cultural sample. Use a simulated presence videotape or DVD. Two authors (N.A.N. Many ASD patients may have sleep issues. Assure that the patients family members understand how critical it is to keep the patient occupied and busy to decrease the patients desire or possibility to wander. Reimagining Strategies for Immigrant Justice. People with cognitive impairments may experience. Hamers P.H., Gulpers M.J.M., Strik W. Use of physical restraints with cognitively impaired nursing home residents. Please follow your facilities guidelines, policies, and procedures. sharing sensitive information, make sure youre on a federal GPS was found to be more time effective in finding a missing person with dementia than RF. Betty Norman, BSN, MBA, CPHRM, is Risk Control Director at Glatfelter Healthcare Practice, part of Glatfelter Program Managers, a strategic business unit dedicated to Glatfelter Insurance Groups program business. Wandering could be the result of a loss of short-term memory. PDF Responding to the Wandering and Exit-seeking Behaviors of People with Watch for the following warning indicators in family and friends: Nursing Diagnosis: Wandering related to disorientation, disease advancement, dementia, chronic sickness, disease progression that exhausts the health care provider or his family, and growing patient reliance on others secondary to Alzheimers disease as evidenced by tiredness, anxiety, tension, and social isolation. This intervention assists in detecting drug abuse and adverse effects that may result in a disturbed thought process and an increased risk of wandering. Perseveration may suggest that the wanderer is unable to voluntarily discontinue his or her behavior, necessitating nursing judgment as to when wandering should be stopped to improve the patients security, comfort, or well-being. Executive summary. Learn how your comment data is processed. The risk factors for elopement include: Restlessness and agitation in the room or facility. Managing Wandering in Dementia Patients This document discusses each key component area. This strategy will also give them the impression that they are not being disregarded. Algase D.L., Moore H.D., Vandeweerd C., Gavin-Dreschnack D.J. For example, engaging in fun activities during these times will keep your residents active and less likely to become agitated or disoriented and wander. Never lock the patient in the house. Looking for necessities. Walking may alleviate discomfort. PDF Falls, Wandering, and Physical Restraints: Interventions for Residents The authors have no conflicts of interest to declare. Dewing J. More than 60% of persons with dementia will wander. Portney L., Watkins M. third, ed. Sundown syndrome can be caused by sleep problems, starvation, thirst, or unfulfilled toileting demands. To fulfill each patients particular needs, the nurse should provide sensory stimulation through a range of meaningful interactions. The nursing home must provide an appropriate plan of care to prevent wandering, or manage it in a safe environment. Arch Psychiatr . The most commonly used approaches were interviews (2/16) and observations (2/16). Wandering is common in patients with dementia and leads to early institutionalization and caregivers' burden. Taking care of people at risk of wandering might be challenging at times. Fatal accidental hypothermia, orthopedic injuries, soft tissue injuries, hunger, weight loss, and accidents are the most prevalent causes of death in patients who wander or elope from a care home. their energies from wandering or pacing. Neubauer N.A., Lapierre N., Rios-Rincon A., Miguel-Cruz A., Rousseau J., Liu L. What do we know about technologies for wandering? Introduction to Nursing Diagnosis Wandering. When did the wandering behavior begin and how frequently does it occur? Dickersin K., Min Y., Meinert C. Factors influencing publication of research results. Peer-reviewed literature studies were searched in six databases: EMBASE, CINAHL, Ovid Medline, PsycINFO, Web of Science, and Scopus. (1998). Be proactive with your residents about wandering prevention, not reactive should an incident occur.. Door testing behaviors were reduced by 42%. Notify local police to request their assistance. Situational anxiety caused by environmental, interpersonal, or structural change can lead to prolonged confusion, dysfunctional conduct, and wandering. Confusion, wandering, uncertainty, suspiciousness, impaired thinking, and an absence of social inhibitions can lead to socially inappropriate or harmful behavior toward oneself or others. ), Proposed but effectiveness was not evaluated. Practice communication and behavioral strategies. The patient will discover elements that trigger depressive reactions and employ ways to minimize the volume and recurrence of these episodes effectively. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Rubbing lotion with lavender, geranium, rosemary, and mandarin oils into skin of the person with dementia decreased anxiety and wandering. The most commonly used high-tech subcategories from the scholarly literature were locating strategies (i.e., GPS, radio frequency, Bluetooth, and Wi-Fi; 71.6%, 78/109) and alarm and sensors (i.e., motion and occupancy sensors, monitors, and optical systems; 19.3%, 21/109). Managing the wandering behaviour of people living in a residential aged Venkatesh V., Moris M.G., Davis G.B., Davis F.D. Most high-tech solutions were available through an array of commercial websites selling the technology. Acquire a history of personality traits and stress-related behavioral responses. Make sure that the patient always carries an identification card. Newsletter Having protocols in place and providing adequate staff training are key to planning for this type of event. Notify management, family members and physician(s). While the research literature on wandering and exit-seeking is limited, it does address methods of responding to these behaviors. The initial search identified 4096 peer-reviewed studies; 118 studies were included in the data-abstraction phase and final analysis (2.9%, 118/4096) (Fig. The nurse must assess and meet the patients basic needs, including pain management, personal care, and appropriate food and fluids. Rowe M.A., Bennett V. Look at deaths occurring in persons with dementia lost in the community. The patient will engage in activities of daily living to the extent of his or her ability. Encourage and help the patient complete the chores required to satisfy their daily needs and remain independent. Wandering or becoming lost is typical in patients with cognitive problems. Previous systematic reviews of nonpharmacological interventions to manage wandering have excluded studies on the basis of study design or quality criteria, or only included studies with samples of residents with dementia in long-term care (Price, Hermans, & Grimley Evans, 2000; Robinson et al., 2006; Robinson, Hutchings, Dickinson, et al., 2007). Many assisted living residents live restless lives, and may wander to help cope with their anxiety and restlessness. Alprazolam and Fasudil also indicated decreases in wandering behavior. Loneliness - wandering may be a substitute for social interaction. Over 50% of those in nursing homes suffer from some form of dementia, and about half of these individuals wander. Geriatric Nursing 7, 94-95. This should take place upon admission, with periodic reevaluation performed as . Conduct an investigation to determine how the elopement occurred in order to correct any underlying contributing factors. It can be either an aimless or purposeful behavior [5], and its severity can be affected by rhythm disturbances [6], spatial disorientation and visual-perceptual deficits [7], physical [8] and social [9] environments, or changes in personality and behavior patterns [10]. Pearson Prentice Hall; Toronto, Canada: 2009. Discuss the strategy with the patient and other family members before going out in public, including the following schedule and regulations. Gray literature was reviewed for features of wander-management strategies (i.e., strategy type, specifications, cost, device features). Product is not available in this quantity. Results demonstrated the effectiveness of integrating a wall mural painted on the entrance of doorways, through the reduction of door testing behaviors exhibited by the participants. Background: Aberrant motor behaviour or wandering refers to aimless movement without a specific purpose. If it's reasonable and your loved one doesn't mind, consider dressing them in clothing that's easy to see from a distance. Wang X.H., Li Y.X., Fan W.H., Xuan J.Q., Wang L.Z., Mu M.M. A person may wander for a variety of reasons, including: Fear or stress. Periodic missing resident drills may prove very helpful. Depression is prevalent in Parkinsons disease patients; there are no recent studies that explain if depression is a reaction to the disorder or a biochemical defect. As a library, NLM provides access to scientific literature. Medical ID jewelry is a good idea, such as a bracelet or pendant. Keep the walking paths of the patients clear and well-lit. Nelson A.L., Algase D.L. Thus, collaborating with other staff members may be beneficial. Teaching the patient how to self-calm when overwhelmed and respond appropriately to no can make a significant difference. Address the triggers in a person-centered care plan. Desired Outcome: The patient will have improved coping abilities with his or her cognitive condition, risk of wandering, and care demands. Although proven effective in supporting young children and their caretakers, home visiting programs are less likely to see the enrollment of immigrant and refugee families. The main goal of managing wandering behavior is to protect the resident from serious injury or death. Use of air mat therapy may reduce wandering behaviour for at least 15 min post therapy (Level 2). Clinically oriented studies that included only persons with dementia over age 50years. Electronic tagging is a system used to track residents who wander. The patient who has wandering tendencies will be placed in a secure environment. Overall, 183 high- and 143 low-tech strategies were included, with the majority (59.5%) of the strategies being derived from the scholarly literature. We also include a video interview of a senior care home facility administrator on how to secure a facility or home propertly to prevent wandering, and a usability . Provide nutritious finger foods and drinks that the resident can carry while safely wandering. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams. Conflicting evidence, however, was found across all strategies, and scientific rigor was repeatedly mentioned as being poor quality [52]. Petonito G., Muschert G.W., Carr D.C., Kinney J.M., Robbins E.J., Brown J.S. The Alzheimer's Association. Foundations of Clinical Research Applications to Practice. 6. Based on this review, we provide guidelines and recommendations for future research in this field. For the overall outcomes, 48.3% (57/118) of the included peer-reviewed literature showed advantages of wander-management strategies in terms of managing wandering in persons with dementia. Understand that a patient's condition and behaviors can . Mapping the maze of terms and definitions in dementia-related wandering. Thirteen studies did not include results that evaluated wander-management strategies; therefore, they were not included in calculations. Eichler T., Hoffmann W., Hertel J., Richter S., Wucherer D., Michalowsky B. If loud noise is a trigger, consider noise-canceling headphones, and employ the tag-team strategy to ensure a trustworthy caregiver constantly watches the patient. Regarding design [34], [35], seven high-tech studies were of qualitative design [phenomenology (4) and grounded theory (3)], 21 were of quantitative design [cross-sectional design (10), single-case design (4), case study (3), before-after design (1), randomized controlled trial (1), randomized pre-post (1), and descriptive (1)], and 9 were reviews [systematic review (4) and other review (5)]. Locating devices increased confidence and peace of mind of caregivers (3) and provided perceptions of reassurance and enhanced independence for the person with dementia. We offer free consultation. Ensure all basic needs are met, including toileting, nutrition and hydration. Looking for ways to make connections with your non verbal dementia patients? 11. Consider taking these steps: Being prepared to respond to a missing resident emergency is as important as preparing for other emergencies. Wander-management strategies comprise a range of interventions for different environments. Display signage. Data analysis was conducted by one person (N.A.N.). The patient may be looking for the past. Place signs and drawings around the outside of the patients room to help him discover it. Publication year of the included peer-reviewed literature varied, with wander-management strategy publications appearing in the early 1990s, and the total number of publications increasing over the last 27years. This technique seeks to refocus the patients attention so that he can prevent wandering.