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Dementiarelated Wandering: Management Interventions
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Dementia-related Wandering: Management Interventions. D. Helen Moore, PhD. Barbara McKenzie, MA ... 'a syndrome of dementia-related locomotion having a frequent, ... – PowerPoint PPT presentation
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Title: Dementiarelated Wandering: Management Interventions
1
Dementia-related Wandering Management
Interventions
- D. Helen Moore, PhD
- Barbara McKenzie, MA
- USF Geriatric Education Center
- Summer Institute
- June 13, 2007
2
Part I. Introduction
- definition
- significance
- quality of wandering
- high-risk/low-risk wandering
- what, where, when and course of wandering
3
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.
4
Why Care About Wandering?
- Most common unsafe behavior in persons with
dementia
5
High-risk/low-risk wandering
- activity of the wanderer
- care setting
- caregiver knowledge and awareness
6
Qualities of Wandering
- haphazard
- may lack apparent destination
- fretful, pacing
- cannot be easily redirected
- may result in unintended leaving
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The When of Wandering
- begins in the morning hours
- increases throughout the day
- peaks at 5 pm to 7 pm.
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The Where of Wandering
- nursing home settings
- community-based settings
- home-based settings
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The Course of Wandering
- 60 of all dementia cases
- mild, moderate and severe dementia
- Persistent - lasts for years
- subsides in late-stage, profound dementia
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Part II. Causes of Wandering
- Wanderer
- Medical
- Personality
- Environmental
- Social
- Physical
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Medical Causes
- visual/perceptual deficits
- attentional problems
- medication side effects
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Personality Causes
- extroversion
- hx. of exercise to manage stress
- pre-morbid occupation
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Social Environment Causes
- staff mix and stability
- overall ambiance
- extent of social engagement
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Physical Environment Causes
- light
- noise
- temperature
- complexity of architecture
- crowding
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Part III.Problematic wanderingmanagement goals
and recommended interventions
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Excessive walking
- GOAL - Support patients physical needs
- adjust medications
- hydrate
- provide nutrients
- provide safe environment
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Elopement, day or night
- GOAL - Alert caregivers
- door alarm systems
- pressure-activated systems
- combined systems
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Trespassing
- GOAL - Keep patient out of off-limits areas
- visual exit barriers
- tape barriers
- mirrors
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Losing way
- GOAL - Guide patient
- signs, landmarks, cueing
- enhanced lighting
- establish toileting schedule
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Exiting-seeking
- GOAL - Reduce exit seeking behaviors
- architectural barriers
- locks
- visual exit barriers
21
Shadowing
- Shadowing in dementia-related wandering is
defined in the literature as the patients close
following or trailing a caregivers locomotion.
22
Patient may go missing
- GOAL - Track patients location
- RFID
- GPS
- personal guidance systems
23
Patient missing in the facility
- Goal Staff response to quickly locate patient
and prevent injury or exit - policies
- procedures
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Patient missing in community
- GOAL Community quickly locates and returns the
patient - Alzheimers Assoc. Safe Return Program
- Community-based search and rescue
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VA Patient Safety CenterSafe Wandering
Resources
- http//www.visn8.med.va.gov/
- patientsafetycenter/
26
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_at_va.gov
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