Approximately 50% of all nursing home residents suffer some form of dementia, most frequently Alzheimer’s disease. Since wandering is most often associated with Alzheimer’s dementia, it is no wonder that wandering is a problem in nursing homes.
It is estimated that up to 31% of nursing home residents wander at least once, including one in five people with dementia, and that 11-24% of institutionalized dementia patients wander.
Wandering occurs when a nursing home resident strays into the unsafe territory and may be harmed.
The North American Nursing Diagnosis Association (NANDA) defines wandering as “meandering, aimless, or repetitive locomotion that exposes the individual to harm; frequently incongruent with boundaries, limits, or obstacles.” There are numerous classifications of wandering, including elopement, environmentally cued wandering, reminiscent/fantasy wandering, tactile wandering, recreational wandering, and agitated purposeful wandering.
Wandering is associated with disorientation and difficulty relating to the environment, low social interaction, excessive pacing, and/or increased motor activity and results from cognitive impairment, including difficulty with abstract thinking, language, judgment, and spatial skills.
Dementia patients with unmet physical or psychosocial needs, such as the need for toileting assistance or the need to find a place of safety or someone familiar, may be more prone to wandering.
Goal-directed wanderers appear to be searching for someone or something, and non-goal directed wanderers have a short attention span and may wander aimlessly.
The most dangerous type of wandering is elopement, in which a nursing home resident leaves the residence and does not return. Those who engage in elopement are distinguished by purposeful, overt, and often repeated attempts.
The risk of wandering increases with older age, male sex, poor sleep patterns, agitation, aggression, and a more socially active and outgoing premorbid lifestyle.
Wandering creates additional risks, including:
- Entering an area that contains safety hazards including chemicals, fire hazards, tools and equipment that pose safety threats
- Entering an area that is physically unsafe, especially stairwells, poorly lit areas, construction areas, etc.
- Entering an area that has a person who poses a threat to the person’s safety, including an irate or fearful fellow-nursing home resident, or another person who may exploit or otherwise harm the person who wanders
- Getting lost and not being able to find the way back, and suffering from heat or cold exposure, drowning, or being struck by a car or other vehicle
- Suffering dehydration or other medical complications resulting from not having needs met.
There are many tools used by nursing homes to assess wandering risk.
Nursing homes that participate in Medicare or Medicaid are required to conduct a comprehensive, accurate assessment of each resident’s needs within 14 days after admission, and every three months thereafter, unless a significant change in the resident’s physical or medical condition prompts immediate reassessment.
Since elopement most often occurs within 48 hours of initial admission, it is important to conduct the initial assessment immediately upon admission.
Recommended preventative measures against wandering include the following:
- Providing staff with proper training and support
- Close monitoring of residents with dementia
- Encouraging at-risk residents to sit at the table with other residents during mealtime
- Facilitating social contact between at-risk and staff or low-risk residents
- Establishing controlled indoor and outdoor areas
- Posting signs to remind visitors not to assist residents in leaving the home
- Providing walking companions
- Use of transmitting devices to notify staff when alarms are activated
- Establishing a formal search procedure for staff
- Keeping photographs of residents on file, and installing a surveillance system
If a loved one has suffered harm or injury as a result of wandering or elopement at a nursing home, adult foster care or assisted living facility, contact us immediately for a free consultation.