Wandering and the physical environment.

BACKGROUND/RATIONALE: Guided by the need-driven dementia-compromised behavior (NDB) model, this study examined influences of the physical environment on wandering behavior. METHODS: Using a descriptive, cross-sectional design, 122 wanderers from 28 long-term care (LTC) facilities were videotaped 10 to 12 times; data on wandering, light, sound, temperature and humidity levels, location, ambiance, and crowding were obtained. Associations between environmental variables and wandering were evaluated with chi-square and t tests; the model was evaluated using logistic regression. RESULTS: In all, 80% of wandering occurred in the resident's own room, dayrooms, hallways, or dining rooms. When observed in other residents' rooms, hallways, shower/baths, or off-unit locations, wanderers were likely (60%-92% of observations) to wander. The data were a good fit to the model overall (LR [logistic regression] chi(2) (5) = 50.38, P < .0001) and by wandering type. CONCLUSIONS: Location, light, sound, proximity of others, and ambiance are associated with wandering and may serve to inform environmental designs and care practices.

Empirical derivation and validation of a wandering typology.

OBJECTIVES: To develop and validate a wandering typology. DESIGN: Cross-sectional, correlational descriptive design. SETTING: Twenty-two nursing homes and six assisted living facilities. PARTICIPANTS: One hundred forty-two residents with dementia who spoke English, met Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, criteria for dementia, scored less than 24 on the Mini-Mental State Examination (MMSE), were ambulatory (with or without assistive device), and maintained a stable regime of psychotropic medications were studied. MEASUREMENTS: Data on wandering were collected using direct observations, plotted serially according to rate and duration to yield 21 parameters, and reduced through factor analysis to four components: high rate, high duration, low to moderate rate and duration, and time of day. Other measures included the MMSE, Minimum Data Set 2.0 mobility items, Cumulative Illness Rating Scale-Geriatric, and tympanic body temperature readings. RESULTS: Three groups of wanderers were identified through cluster analysis: classic, moderate, and subclinical. MMSE, mobility, and cardiac and upper and lower gastrointestinal problems differed between groups of wanderers and in comparison with nonwanderers. CONCLUSION: Results have implications for improving identification of wanderers and treatment of possible contributing factors.

New parameters for daytime wandering.

This study aimed to describe wandering using new parameters and to evaluate parameters as a function of cognitive impairment and mobility. Forty-four wanderers in long-term care settings were videotaped 12 times. Rate and duration of wandering episodes were plotted and used to derive parameters from values above and below case medians, proportion of hours wandering, and time of day. Participants wandered during 47% of observations; on average, the hourly rate was 4.3 episodes, the peak hourly rate was 18 episodes, and the peak hourly duration was 19.9 minutes. Mini-Mental State Examination (MMSE) scores was negatively correlated with overall duration and number of observations during which duration exceeded 15 minutes per hour, was positively correlated with number of observations without wandering, and was not significantly correlated with rate-related parameters. Mobility correlated positively with rate and duration parameters. Interaction of MMSE score and mobility was the strongest predictor of wandering duration. Parameters derived from repeated measures provide a new view of daytime wandering and insight into relationships between MMSE score and mobility status with specific parameters of wandering.

Are wandering and physically nonaggressive agitation equivalent?

OBJECTIVE: The authors examined equivalence of wandering and physically nonaggressive agitation (PNA) as concepts. DESIGN: A cross-sectional correlational design was used. SETTING: Participants were recruited from 22 nursing homes and 6 assisted living facilities in two states. PARTICIPANTS: Ambulatory residents meeting DSM-IV criteria for dementia (N = 181) were studied. MEASUREMENTS: Video-tapes for up to twelve 20-minute observations per participant were coded for wandering using an empirically derived taxonomy of ambulation patterns. Separate raters coded the same tapes for six PNA behaviors on the agitation behavior mapping instrument. RESULTS: Most participants (73.5%) wandered; all showed PNA behaviors. Factor analyses yielded an one-factor solution for wandering (explained variance = 43.66%) and a two-factor solution for PNA (explained variance = 53.45%). Overall wandering correlated significantly with PNA Factor 1 (df =179, r = 0.68, p <0.001) and Factor 2, but at a lower value (df = 179, r = 0.26, p <0.01). CONCLUSION: Findings depict wandering and PNA as overlapping, but nonequivalent phenomena. Evidence supporting construct validity of wandering was more robust than that for PNA. Results have implications for accuracy in scientific and clinical detection and labeling of wandering and agitation.

Families' perceptions of services in assisted living residences.

Assisted living residences (ALRs) are increasingly used to deliver services to older adults. Proposed policies for ALRs are gradually evolving. Although families are partners in this process, little is known about their understanding of nursing services available, compared with services needed and desired. A survey was conducted to better inform the inclusion of ALRs in Michigan's regulatory process. A total of 46 respondents reported assistance with activities of daily living as the most frequently offered ALR service. Respondents found all 13 nursing services asked about in the survey highly desirable and, for each category, the current need exceeds the availability of the service.

Biomechanical activity devices to index wandering behavior in dementia.

Valid and reliable measures of wandering are needed to study this troubling behavior. Although researchers have used various perspectives, definitions, and approaches to study wandering, spontaneous ambulation is a key characteristic across all views. Biomechanical activity devices for capturing movement provide one way to index wandering. This study examined four devices with ambulatory nursing home residents with dementia (N = 178) who wore devices simultaneously during four observations. Among the Actillume, StepWatch, Step Sensor, and TriTrac-R3D, the StepWatch yielded data from the highest proportion of observations, explained the most variance (63.9 percent) among all instruments, and was acceptable to nursing staff. Although the Step Sensor was the staff's preferred device, its performance was least acceptable for research purposes. Results support use of the StepWatch in future studies of wandering.