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Practical Approaches to
Dementia Care -
Wandering
Daneill Haberfield, Behaviour Consultant / Occupational Therapist
Behaviour Assessment & Intervention Service (BASIS), NSCCAHS.
Email: [email protected]
Phone: 0421839173
NSW Falls Prevention Network Meeting
Wednesday June 23rd 2010
Dementia – Brief overview
Behavioural and
psychological
symptoms
Cognitive
Symptoms
Alzheimers‟
Lewy Body
Fronto temporal
VascularParkinson‟s
Focus today on wandering
Wandering as “pathology”
Meandering, aimless, or repetitive locomotion
that exposes a person to harm…(North American
Nursing Diagnosis Association, 2001).
More likely to experience adverse
events…(Siders et al 2004)
http://wanderingnetwork.co.uk
Wandering can be therapeutic and improve
the person‟s sense of wellbeing and agency
(Wigg, 2010).
Physiological benefits of exercise
Stimulating appetite
Relieving boredom
Improves mood / Coping with stress
Feeling of empowerment & better self-esteem
May improve sleep
Wandering can be purposeful
Dewing, J (2005) Screening for wandering among
older persons with dementia.
Risky wandering vs safe wandering
Depends on a number of factors including:
The person doing the wandering
Knowledge & skills of the caregiver
Context or setting of care
Workplace culture
In general…
Efforts to reduce wandering
should be attempted only
when… (Siders et al 2004).
(Jayasekara 2009)
Research suggests…
Assessment should include:
Identification of the reason for wandering
An examination of wandering patterns
(type, time of day, consequences etc)
Interventions:
A range of that are tailored to the
individual‟s need, the specific behaviour in
question and the underlying reasons for it (Robinson et al 2006)
Medications for wandering??
Some people who wander are
prescribed psychotropic medications to
reduce wandering, but …(Siders et al 2004).
Antipsychotic “drugs appear to have
only a limited positive effect in treating
symptoms but can cause significant
harm to people with dementia” (Banerjee,
2009)
Practical & non-
pharmacological ideas in
working with people who
wander
A person-centred approach
Risk versus Benefit
“„Risk assessments‟ should be
replaced by „risk-benefit
assessments‟. (Nuffield Bioethics, 2009)
Wandering – Non-pharmacological
interventions
1. We are not aiming to stop wandering.
2. We are aiming to reduce risks associated
including:
Fractures
Absconding
Intrusiveness
Worsening mobility
Restraint
Reducing risk of fractures
Environmental assessment
Equipment
Nutrition & Hydration
www.alzstore.com
Reducing risks associated with
absconding
Identification bracelet
Names on clothes
Safe 2 walk
www.safe2walk.com.au$9.90 plus GST per week (Alzheimer's Australia member)
or $12.90 plus GST per week (non members).
Reduce intrusiveness
Boredom is a big issue!!
Engage the person in something
that matches their skill & interest
Try to get into their reality.
Grace O'Sullivan 2010
Cupboards - Themed nooks
Sensations Dementia Care Products 2009
Sensory aprons & boxes
Maintaining mobility
Exercise programs or structured
mobility.
Give the person a reason or meaning to
wander.
Poor balance, mobility & muscle
strength are confirmed risk factors for
falls in community dwelling older people (NSW DOH, 2009).
Staff supervision issues
CCTV
Boundary fence laser
Volunteer „sitters‟ program
Summary
Assess the whole person (bio-psycho-
social / person centred model)
Match interventions to the needs that
are identified in the assessment.
Weigh up risks versus benefits & get the
family involved.
Enable “Safe walking” rather than
stopping them “wandering”
References
Brodaty, H.Draper, B, Saab, D. Low, L.Richards, V. Paton H. Lie, D. 2001. Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. International Journal of Geriatric Psychiatry. Vol 16 Issue 5, Pages 504 - 512 Published Online: 21 May 2001
Dewing, J.2005, Screening for wandering among older persons with dementia. Nursing Older People. Proquest Health and Medical Complete, pg 20.
Edgerton, E. & Richie, L. 2010. Improving Physical Environments for Dementia Care: Making Minimal Changes for Maximum Effect. In Annals of Long Term Care – Clinical Care and Aging. American Geriatric Society.
NSW Dept of Health 2009, Prevention of falls in residential aged care. Centre for health advancement population health division.
Jayasekara, R. 2009. Dementia: Wandering. Evidence Based Summaries. Joanna Briggs Institute. Adelaide.
Robinson, L. Hutchings D.Dickinson O.,Corner L., Beyer, F., Finch, T., Hughes, J., Vanoli, A. Ballard, C. Bond, J. 2006. Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review. Int J Geriatr Psychiatry 2007; 22: 9–22.
References continued
www.alzstore.com
www.alzheimers.org.uk
www.safe2walk.com.au
Siders, C. Nelson, A. Brown, L. Joseph, I. 2004, Evidence for Implementing Nonpharmacological Interventions for Wandering. Rehabilitation Nursing. Glenview:. Vol. 29, Iss. 6; pg.195.
State of Wisconsin 2009, Person-centred dementia care assessment tool. Department of health and family services, division of Disability and Elder Services.
Tilly J, Reed P, 2006. Dementia care practice recommendations for assisted living residences and nursing homes. Washington (DC): Alzheimer's Association.
Sensations in dementia care catalogue 2009.
Wigg, J. 2010, Liberating the wanderers: using technology to unlock doors for those living with dementia. Sociology of Health & Illness. Oxford: Feb 2010. Vol. 32, Iss. 2; pg. 288