Wandering (dementia)

Common behavior in people with dementia

Wandering occurs when a person with dementia roams around and becomes lost or confused about their location. It 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 of disruption from people with dementia within institutions.[1] Although it occurs in several types of dementia, wandering is especially common in people with Alzheimer's disease (AD). People with dementia often wander because they are stressed, looking for someone or something, attending to basic needs, engaging in past routines, or with visual-spatial problems.[2] Other times, they may wander without aim at all.[3]

## Elopement

[edit]

Elopement, or unattended wandering that goes out of bounds, is a special concern for caregivers and search and rescue responders. Wandering (especially if combined with sundowning) can result in the person being lost outdoors at night, dressed inappropriately, and unable to take many ordinarily routine steps to ensure their 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.[4] A search and rescue 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.[4]

## Assessment

[edit]

Assessment of a person's risk of wandering is often neglected. A review of medical records of 83 people with dementia living in Los Angeles found that only 8% of the records included a wandering risk assessment.[5] 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 homes is the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH); this tool may be suitable for use in assisted living facilities.[6]

## Prevention

[edit]

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 them or prevent them from wandering when the situation occurs.

Other methods used to prevent wandering, or simply to reduce the risk of wandering, may include sedative drugs, physical restraints, physical barriers, 24-hour real-time surveillance, or tracking devices. The ethics of these methods have been frequently called into question; the use of physical restraints, for example is widely considered to be inhumane.[7] Tracking devices of several kinds have been evaluated.[8][9]

Much of the literature on wandering concerns institutional residents. Studies on wandering from private residences are insufficient for comparison of prevention via drugs versus other methods.[10]

The risk of wandering can be reduced by several low-tech and minimally intrusive techniques. For example, placing a visual barrier such as a curtain or a black area rug across a doorway may mimic a hole, thus discouraging elopement behaviors.[11]

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, place, or area from their past, while others will simply "explore."

Some cases of wanderers operating vehicles and driving either aimlessly or along a familiar route, road, or highway have been reported.

In response to wandering seniors, 25 states in the US have adopted Silver Alert programs. Silver Alert is similar to AMBER Alert to notify the public of missing seniors with dementia and other cognitive disabilities.

## Technology

[edit]

In other efforts to help keep residents safe, mitigate liability, 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[12] 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.[13]

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.

This type of system seems to be preferable because it helps monitor those at risk for wandering and elopement while not infringing on the freedom of other residents or visitors to a facility.

## See also

[edit]

* Fugue state

## References

[edit]

1. ^ U.S. Congress, Office of Technology Assessment (1992). Special care units for people with Alzheimer's and other dementias: Consumer education, research, regulatory, and reimbursement issues. Washington DC: Government Printing Office. ISBN 978-1-4289-2817-6.
2. ^ Mayo Clinic Staff. (2020, August 07). Alzheimer's: Understand wandering and how to address it. Retrieved February 3, 2021, from https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/alzheimers/art-20046222
3. ^ Strubel, D., & Corti, M. (n.d.). Wandering in dementia. Retrieved February 3, 2021, from https://www.alz.org/help-support/caregiving/stages-behaviors/wandering
4. ^ a b "Wandering and Alzheimer's overview". dbs-sar.com. Retrieved 2008-08-26.
5. ^ Cherry DL, Vickrey BG, Schwankovsky L, Heck E, Plauchm M, Yep R (August 2004). "Interventions to improve quality of care: the Kaiser Permanente-Alzheimer's Association Dementia Care Project" (PDF). Am J Manag Care. 10 (8): 553–60\. PMID 15352531.
6. ^ Beattie ER, Song J, LaGore S (2005). "A comparison of wandering behavior in nursing homes and assisted living facilities". Res Theory Nurs Pract. 19 (2): 181–96\. doi:10.1891/088971805780957323. PMID 16025697.
7. ^ Robinson L, Hutchings D, Corner L, Beyer F, Dickinson H, Vanoli A, Finch T, Hughes J, Ballard C, May C, Bond J (August 2006). "A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use". Health Technology Assessment. 10 (26): iii, ix–108. doi:10.3310/hta10260. hdl:10822/971100. PMID 16849002.
8. ^ Miskelly F (September 2005). "Electronic tracking of patients with dementia and wandering using mobile phone technology". Age Ageing. 34 (5): 497–9\. doi:10.1093/ageing/afi145. PMID 16107453.
9. ^ Miskelly F (May 2004). "A novel system of electronic tagging in patients with dementia and wandering". Age Ageing. 33 (3): 304–6\. doi:10.1093/ageing/afh084. PMID 15082438.
10. ^ Hermans DG, Htay UH, McShane R (2007). Htay, U Hla (ed.). "Non-pharmacological interventions for wandering of people with dementia in the domestic setting" (PDF). Cochrane Database Syst Rev. 2010 (1): CD005994. doi:10.1002/14651858.CD005994.pub2. PMC 6669244. PMID 17253573.`{{cite journal}}`: CS1 maint: multiple names: authors list (link)
11. ^ Feliciano L, Vore J, LeBlanc LA, Baker JC (2004). "Decreasing entry into a restricted area using a visual barrier". J Appl Behav Anal. 37 (1): 107–10\. doi:10.1901/jaba.2004.37-107. PMC 1284486. PMID 15154224.
12. ^ "Why residents wander and what you can do about it — Feature Article — Interview". Nursing Homes. 2003.
13. ^ "Security Alarm System supports Independent Living of Demented Persons".

* Desai AK, Grossberg GT (June 2001). "Recognition and Management of Behavioral Disturbances in Dementia". Prim Care Companion J Clin Psychiatry. 3 (3): 93–109\. doi:10.4088/pcc.v03n0301. PMC 181170. PMID 15014607.
* Wagenaar DB, Mickus M, Luz C, Kreft M, Sawade J (December 2003). "An administrator's perspective on mental health in assisted living". Psychiatr Serv. 54 (12): 1644–6\. doi:10.1176/appi.ps.54.12.1644. PMID 14645806.
* Heard K, Watson TS (1999). "Reducing wandering by persons with dementia using differential reinforcement". J Appl Behav Anal. 32 (3): 381–4\. doi:10.1901/jaba.1999.32-381. PMC 1284199. PMID 10513031.

* v
* t
* e

Mental disorders (Classification)

Adult personality and behavior

| Sexual|

* Ego-dystonic sexual orientation
* Paraphilia
* Fetishism
* Voyeurism
* Sexual anhedonia
* Sexual anorexia
* Sexual maturation disorder
* Sexual relationship disorder

|

Other|

* Factitious disorder
* Munchausen syndrome
* Fear of intimacy
* Gender dysphoria
* Intermittent explosive disorder
* Dermatillomania
* Kleptomania
* Pyromania
* Trichotillomania
* Personality disorder

Childhood and learning

| Emotional and behavioral|

* ADHD
* Conduct disorder
* ODD
* Emotional and behavioral disorders
* Separation anxiety disorder
* Movement disorders
* Stereotypic
* Social functioning
* DAD
* RAD
* Selective mutism
* Speech
* Cluttering
* Stuttering
* Tic disorder
* Tourette syndrome

|

Intellectual disability|

* X-linked intellectual disability
* Lujan–Fryns syndrome

Psychological development
(developmental disabilities)|

* Pervasive
* Specific

Mood (affective)

* Bipolar
* Bipolar I
* Bipolar II
* Bipolar NOS
* Cyclothymia
* Depression
* Atypical depression
* Dysthymia
* Major depressive disorder
* Melancholic depression
* Seasonal affective disorder
* Mania

Neurological and symptomatic

| Autism spectrum|

* Autism
* Asperger syndrome
* High-functioning autism
* PDD-NOS
* Savant syndrome

|

Dementia|

* AIDS dementia complex
* Alzheimer's disease
* Creutzfeldt–Jakob disease
* Frontotemporal dementia
* Huntington's disease
* Mild cognitive impairment
* Parkinson's disease
* Pick's disease
* Sundowning
* Vascular dementia
* Wandering

Other|

* Delirium
* Organic brain syndrome
* Post-concussion syndrome

Neurotic, stress-related and somatoform

| Adjustment|

* Adjustment disorder with depressed mood

|

Anxiety|

| Phobia|

* Agoraphobia
* Childhood phobia
* Social anxiety
* Social phobia
* Anthropophobia
* Specific social phobia
* Specific phobia
* Claustrophobia

|

Other|

* Generalized anxiety disorder
* OCD
* Panic attack
* Panic disorder
* Paranoia
* Stress
* Acute stress reaction
* PTSD

Dissociative|

* Depersonalization-derealization disorder
* Dissociative identity disorder
* Dissociative amnesia
* Dissociative fugue
* Dissociative disorder not otherwise specified
* Other specified dissociative disorder

Somatic symptom|

* Body dysmorphic disorder
* Conversion disorder
* Ganser syndrome
* Globus pharyngeus
* Psychogenic non-epileptic seizures
* False pregnancy
* Hypochondriasis
* Mass psychogenic illness
* Nosophobia
* Psychogenic pain
* Somatization disorder

Physiological and physical behavior

| Eating|

* Anorexia nervosa
* Bulimia nervosa
* Rumination syndrome
* Other specified feeding or eating disorder

|

Nonorganic sleep|

* Hypersomnia
* Insomnia
* Parasomnia
* Night terror
* Nightmare
* REM sleep behavior disorder

Postnatal|

* Postpartum depression
* Postpartum psychosis

Sexual desire|

* Hypersexuality
* Hypoactive sexual desire disorder

Psychoactive substances, substance abuse and substance-related

* Drug overdose
* Hallucinogen persisting perception disorder
* Intoxication
* Physical dependence
* Rebound effect
* Stimulant psychosis
* Substance dependence
* Substance-induced psychosis
* Withdrawal

Schizophrenia, schizotypal and delusional

| Delusional|

* Delusional disorder
* Folie à deux

|

Psychosis and
schizophrenia-like|

* Brief reactive psychosis
* Schizoaffective disorder
* Schizophreniform disorder

Schizophrenia|

* Childhood schizophrenia
* Disorganized (hebephrenic) schizophrenia
* Pseudoneurotic schizophrenia
* Simple-type schizophrenia

Other|

* Catatonia

Symptoms and uncategorized

* Impulse-control disorder
* Klüver–Bucy syndrome
* Psychomotor agitation
* Stereotypy
* Caregiver burden

Category
*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template