Dr. Futrell is Professor Emerita, Dr. Melillo is Professor and Chair, and Dr. Remington is Associate Professor, Department of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts. Dr. Schoenfelder is Associate Clinical Professor and Editor, John A. Hartford Center for Geriatric Excellence, The University Iowa College of Nursing, Iowa City, Iowa.
Guidelines in this series were produced with support provided by grant P30 NR03979 (PI: Toni Tripp-Reimer, The University of Iowa College of Nursing), National Institute of Nursing Research, National Institutes of Health. Copyright © 2008 The University of Iowa Gerontological Nursing Interventions Research Center, Research Translation and Dissemination Core.
Address correspondence to Deborah Perry Schoenfelder, PhD, RN, Associate Clinical Professor, The University of Iowa College of Nursing, 430 Nursing Building, 50 Newton Road, Iowa City, IA 52242; e-mail: email@example.com.
Wandering can be problematic for caregivers, as well as for the person with dementia. Wandering behavior may disrupt the individual’s sleep, eating, safety, or the caregiver’s ability to provide care. To individualize interventions for wandering, it is important to assess premorbid factors, the disease process, behaviors typical of the disease, and medications and their side effects. Other factors, including the environment and the knowledge and skill of the caregiver, should be considered when planning care for older adults with dementia who are at risk for wandering behaviors (Remington & Futrell, 2005). This article summarizes the evidence-based practice guideline Wandering (Futrell & Melillo, 2002), which was developed by the Gerontological Nursing Intervention Research Center at The University of Iowa College of Nursing, and is available online at http://www.nursing.uiowa.edu/products_services/evidence_based.htm.
The purpose of this evidence-based guideline is to assist caregivers in dealing with wandering behavior in community-dwelling or institutionalized older adults with dementia.
Individuals at risk for wandering behavior include community-residing or institutionalized older adults with dementia (Holtzer et al., 2003; Schonfeld et al., 2007). Wandering behavior is similar in long-term care facilities and assisted living facilities despite differences in staffing and regulations (Beattie, Song, & LaGore, 2005).
NANDA (2009) has identified defining characteristics that describe wandering, as well as related factors that put individuals at risk for wandering (p. 162). Defining characteristics include:
Related factors are as follows:
The following assessment criteria indicate patients who are likely to benefit the most from use of this evidence-based practice guideline. Caregivers should assess:
Triggers for wandering can be environmental conditions such as ambient temperature and sensory stimulation, or internal conditions such as physiological needs (Nelson & Algase, 2007). Interventions may be applied when patients are not wandering, thus reducing their impetus to wander (Heard & Watson, 1999). Travel patterns of patients who wander should also be identified. These include (Algase, Beattie, Bogue, & Yao, 2001; Martino-Saltzman, Blasch, Morris, & McNeal, 1991):
Whereas direct travel is most efficient, the other methods are inefficient. Travel inefficiency is inversely related to cognitive status. That is, severely demented patients travel inefficiently throughout the day. Less cognitively impaired patients travel more inefficiently near end of day, perhaps due to fatigue effects.
Assessment should also incorporate notation of the types of wandering behaviors (Lai & Arthur, 2003). These may include restless pacing, exit seeking, self-stimulating, and modeling or shadowing.
Premorbid lifestyles that help identify those likely to wander include an active interest—physically and mentally—in music. Examples include singing, playing an instrument, and having a recognized love of music (Thomas, 1999). Those who demonstrate extroverted personality characteristics of warmth, gregariousness, activity, positive emotion, and altruism may also be more likely to wander. Examples include being more continually active in daily activities, demonstrating social-seeking behavior, and demonstrating a greater positive regard toward oneself and others (Thomas, 1997).
Additional premorbid lifestyles to assess include…