Impact of road network structure on dementia-related missing incidents: a spatial buffer approach.

Dementia-related missing incidents are a highly prevalent issue worldwide. Despite being associated with potentially life-threatening consequences, very little is still known about what environmental risk factors may potentially contribute to these missing incidents. The aim of this study was to conduct a retrospective, observational analysis using a large sample of police case records of missing individuals with dementia (n = 210). Due to the influence that road network structure has on our real world navigation, we aimed to explore the relationship between road intersection density, intersection complexity, and orientation entropy to the dementia-related missing incidents. For each missing incident location, the above three variables were computed at a 1 km radius buffer zone around these locations; these values were then compared to that of a set of random locations. The results showed that higher road intersection density, intersection complexity, and orientation entropy were all significantly associated with dementia-related missing incidents. Our results suggest that these properties of road network structure emerge as significant environmental risk factors for dementia-related missing incidents, informing future prospective studies as well as safeguarding guidelines.

Wandering Among Preschool Children with and Without Autism Spectrum Disorder.

OBJECTIVES: (1) Report the occurrence of wandering, or leaving a supervised space, among children with confirmed autism spectrum disorder (ASD), other developmental delay (DD) with a previous but unconfirmed ASD diagnosis (DDprevASD), DD without a previous ASD diagnosis, and a population comparison group (POP) at an age when wandering is no longer expected and (2) explore whether ASD status is associated with wandering independent of behavioral, developmental, and maternal factors. METHOD: Parents and children aged 4 to 5 years enrolled in the Study to Explore Early Development Phase-1+2. All children were screened for ASD symptoms upon enrollment. Those with ASD symptoms and/or a previous ASD diagnosis received the Mullen Scales of Early Learning (MSEL) to determine their developmental level and 2 ASD diagnostic tests to determine their ASD status. All other children were evaluated with the MSEL alone. Mothers completed the Child Behavior Checklist/1½-5, which includes an item on whether the child wanders away (categorized as at least sometimes true vs not true) and items assessing behavior problems. RESULTS: Children with ASD (N = 1195) were significantly more likely to wander than children classified as DDprevASD (N = 230), DD (N = 1199), or POP (N = 1272) (60.4%, 41.3%, 22.3%, and 12.4%, respectively, p < 0.01). ASD status, very low developmental level, and affective, anxiety, attention, and oppositional problems were each independently associated with wandering behavior. CONCLUSION: Wandering is significantly more common among children with ASD and those with behavioral and developmental problems compared with other children. These findings can be used to increase the awareness of wandering among children with atypical development.

Exploratory research on outcomes for individuals missing through dementia wandering in Japan.

AIM: To clarify the factors related to outcomes of individuals missing through dementia wandering. METHODS: We carried out binary logistic regression analysis with 160 family members of missing persons (88 survivors, 72 decedents). RESULTS: Living alone at the point of going missing (OR 13.45, 95% CI 1.12-161.56), being found within the local area (OR 6.36, 95% CI 2.26-17.88), and a long period between going missing and being found (OR 6.14, 95% CI 3.14-12.00) were significantly related with death. CONCLUSIONS: Early detection of missing persons is essential in preventing dementia wandering-related deaths. The time taken to locate missing dementia patients who lived alone was longer, relative to that of those who lived with others, and this increased the risk of death. Furthermore, the locations where the deceased were located tended to be local, rather than distant areas. Geriatr Gerontol Int 2019; 19: 902-906.

Recommendations for the prevention of deaths among nursing home residents with unexplained absences.

OBJECTIVES: Unexplained absences (UAs) contribute to the mortality and morbidity rates in the nursing home (NH) population. Valuing expert professional knowledge and skills is central to the achievement of improved care in NHs. This study developed and prioritised recommendations to prevent deaths of NH residents (NHRs) with UAs. METHODS: Two expert consultation forums using the modified nominal group technique to develop recommendations were conducted, followed by an online survey to prioritise the most important recommendations for implementation. A framework applying the temporal dimension ("pre-event," "event" and "post-event") of an internationally accepted injury prevention framework, Haddon's Matrix, was applied to the recommendations. Participants were purposively sampled and identified via aged care organisations; and were selected based on their experience in aged care practice, policy, research, elder rights, seniors' law, or missing persons search and rescue (SAR). RESULTS: Forum one comprised six, and forum two comprised nine experts from mixed disciplines. Seven participants completed the online survey. Twenty recommendations to prevent future injury and death were developed, five of which were prioritised for implementation in the aged care sector. In order of priority, these include: universal UA definition; mandated SAR plan, early assessment of NHRs; unmet needs behavioural assessments; and participation in decision-making. CONCLUSIONS: The recommendations cover the broad spectrum of complex issues raised in managing unexplained absences, and are a vital first step towards informing care providers, governments and SAR teams about how to prevent injury and death of NHRs in residents with UAs. Future research should explore how to translate and evaluate the recommendations into practice.

Wandering Behaviors and Activities of Daily Living Among Older Adults With Cognitive Impairment.

PURPOSE: The aim of the study was to examine the characteristics of wandering associated with preserved versus worsened activities of daily living (ADL) function. DESIGN: Longitudinal prospective design. Twenty-two cognitively impaired residents of an assisted living facility with over 450 observations were followed up to 8 months. METHODS: Hierarchical linear modeling techniques examine how wandering activity (episodes, distance traveled, gait speed), measured by a real-time locating system, may affect ADL (the Barthel index, the Functional Independence Measure [FIM]). FINDINGS: Wandering episodes were associated with increased ADL (B = 0.11, p ≤ .05, FIM); wandering distance (B = -4.52, p ≤ .05, the Barthel index; B = -2.14, p ≤ .05, FIM) was associated with decreased ADL. CONCLUSION: Walking an average of 0.81 miles per week with 18 or fewer wandering episodes is associated with decreased ability to perform ADL. CLINICAL RELEVANCE: Tailored protocols that allow productive wandering with ongoing assessment for fatigue/other physiological needs to appropriately limit distance walked within wandering episodes are needed for this population.

Wandering by Children with Autism Spectrum Disorder: Key Clinical Factors and the Role of Schools and Pediatricians.

OBJECTIVE: To examine the clinical characteristics associated with wandering in children with autism spectrum disorder (ASD), the impact on families, and how medical and educational professionals address wandering. METHODS: An anonymous, online questionnaire was distributed through autism-related organizations to parents of children with ASD. The questionnaire asked about demographics, developmental diagnoses, past wandering behavior, and impact of wandering on parents. It also asked about the use of electronic tracking devices, requested Individualized Education Program (IEP) modifications, use of restraints and/or seclusion to prevent wandering at school, and receipt of guidance about wandering. Parents were included if they lived in the United States and had a child aged 4 to 18 years with ASD who had previously wandered. RESULTS: A total of 1454 parents who completed the questionnaire met the inclusion criteria. It was found that 22.4% of the children wandered from their home or yard and 24.6% from a public place more than monthly. Wandering concerns affected 73.3% of parents' decisions to let their child spend time with friends or family in their absence. Furthermore, 48.6% and 58.7% of parents were moderately/very worried about their child wandering from home or yard or a public place, respectively. Over half of the parents (54.9%) parents requested IEP changes to address wandering. Only 33.3% of parents had previously received any counseling about wandering. CONCLUSION: Children with ASD and a history of elopement wandered at a fairly high frequency. Wandering concerns increased worry and anxiety for parents and negatively impacted household routines. The medical community is not adequately educating families about these risks. Pediatricians must become more aware of available prevention and mitigation strategies.

Unexplained absence resulting in deaths of nursing home residents in Australia-A 13-year retrospective study.

OBJECTIVES: To examine deaths of Australian nursing home (NH) residents following an unexplained absence. METHODS: Population based cross-sectional study was conducted using coronial data from the National Coronial Information System. Participants are residents of accredited NHs if death followed an unexplained absence and was reported to the Coroner between July 1, 2000 and June 30, 2013. Individual, organisational, environmental, and unexplained absence event factors were extracted from coronial records. Data were analysed using descriptive statistics. RESULTS: Of 21 672 NH deaths, 24 (0.1%) followed an unexplained absence. This comprised 17 unintentional external (injury-related) causes and 7 natural cause deaths. Drowning was the most frequent external cause of death (59%, n = 10). Deaths occurred more frequently in males (83.3%, n = 20), and in the age group 85-94 years (37.5%, n = 9). The majority of NH residents, for whom data were available (n = 15), had a diagnosis of dementia (86.7%, n = 13). Most residents were found in waterways (41.7%, n = 10). Median distance travelled was 0.5 km (IQR: 0.25-2.4 km), with almost 70% of residents found within 1.0 km of their NH. Most residents left the NH by foot (88.2%, n = 15). Half of the residents were found within 6 hours of time last seen (median: 6 hours, 40 minutes; IQR: 6.0-11.45 hours). CONCLUSION: Unexplained absences in elderly NH residents are a relatively common event. This study provides valuable information for aged care providers, governments, and search and rescue teams, and should contribute to debates about balancing issues of safety with independence.

Prevalence and Correlates of Elopement in a Nationally Representative Sample of Children with Developmental Disabilities in the United States.

Despite increased awareness and concern about children with developmental disabilities wandering away from adult supervision, there is a paucity of research about elopement. This is the first study to examine and report the prevalence and correlates of elopement in a nationally representative sample of school-age children in the United States with an autism spectrum disorder (ASD) and/or cognitive impairment. Data were obtained from the CDC's "Pathways" Survey, a follow-up telephone survey of the parents of 4,032 children with a developmental condition. 3,518 children that had ASD, intellectual disability (ID), and/or developmental delay (DD) at the time of survey administration were included for analysis. Children were divided into three condition groups: ASD-only; ID/DD-only; ASD+ID/DD. Logistic regression analyses were used to compare the prevalence of elopement and rates of preventive measure use (barriers and/or electronic devices) across condition groups, and to examine the clinical and demographic correlates of elopement. T-tests were also performed to compare scores on the Children's Social Behavior Questionnaire (CSBQ) between wanderers and non-wanderers. Overall, 26.7% of children had reportedly eloped within the previous year, most commonly from public places. Children with ASD-only and ASD+ID/DD were more likely to have eloped than those with ID/DD-only. Across all groups, wanderers scored higher than non-wanderers on five out of six CSBQ subscales; they were more likely not to realize when there is danger, to have difficulty distinguishing between strangers and familiar people, to show sudden mood changes, to over-react to everything/everyone, to get angry quickly, to get lost easily, and to panic in new situations or if change occurs. Even after controlling for elopement history, parents of children in the ASD+ID/DD group were more likely than those in the other condition groups to report using physical or electronic measures to prevent wandering.

Risk assessment of wandering behavior in mild dementia.

OBJECTIVE: This prospective longitudinal study aims to determine the risk factors of wandering-related adverse consequences in community-dwelling persons with mild dementia. These adverse consequences include negative outcomes of wandering (falls, fractures, and injuries) and eloping behavior. METHODS: We recruited 143 dyads of persons with mild dementia and their caregivers from a veteran's hospital and memory clinic in Florida. Wandering-related adverse consequences were measured using the Revised Algase Wandering Scale - Community Version. Variables such as personality (Big Five Inventory), behavioral response to stress, gait, and balance (Tinetti Gait and Balance), wayfinding ability (Wayfinding Effectiveness Scale), and neurocognitive abilities (attention, cognition, memory, language/verbal skills, and executive functioning) were also measured. Bivariate and logistic regression analyses were performed to assess the predictors of these wandering-related adverse consequences. RESULTS: A total of 49% of the study participants had falls, fractures, and injuries due to wandering behavior, and 43.7% demonstrated eloping behaviors. Persistent walking (OR = 2.6) and poor gait (OR = 0.9) were significant predictors of negative outcomes of wandering, while persistent walking (OR = 13.2) and passivity (OR = 2.55) predicted eloping behavior. However, there were no correlations between wandering-related adverse consequences and participants' characteristics (age, gender, race, ethnicity, and education), health status (Charlson comorbidity index), or neurocognitive abilities. CONCLUSION: Our results highlight the importance of identifying at-risk individuals so that effective interventions can be developed to reduce or prevent the adverse consequences of wandering.

A new tool to asses risk of wandering in hospitalized patients.

This article describes the development and implementation of a wandering screening and intervention program based on identifying hospitalized patients with impaired cognition and mobility. A wandering screening tool developed by a multidisciplinary team was linked to appropriate levels of interventions available in the electronic health record. Advanced practice nurses (APNs) confirmed the accuracy of screening and interventions by bedside nurses for all patients who screened positive. Of 1,528 patients hospitalized during a 3-week period, 48 (3.1%) screened positive for wandering. At-risk patients were older (age ≥ 65) (66.7%), those admitted to surgical units (41.7%), Caucasian (89.6%), and men (58.3%). Thirteen (27.1%) had dementia and 45 (93.8%) had impaired cognition. Of those patients who screened positive for wandering, the APNs agreed with the bedside nurses' assessment in 79.2% of cases (38/48) about wandering risk and 89.5% (34/38 true positives) for the interventions. A two-item wandering screening tool and intervention was feasible for use by bedside nurses. Further studies are needed to determine whether this tool is effective in preventing wandering.

Reliability and validity of the Algase Wandering Scale - version 2 for Japanese people with dementia.

In Japan, where older people already make up more than 23% of the population and the proportion is still growing, the burden on those caring for people with dementia is an increasing problem. This burden is magnified by wandering behavior, a peripheral symptom. Thus, there is a need for an objective measure of wandering behavior to determine what constitutes effective care. In this study, we translated the Algase Wandering Scale - Version 2 into Japanese, and examined its reliability and validity. Ambulatory residents with dementia were selected from two nursing homes and two wards specializing in dementia care in hospitals in Japan. Nurses and care workers taking care of these residents answered questionnaires regarding the residents. From the results, the Algase Wandering Scale - Version 2, Japanese version, was examined for inter-rater reliability, stability, internal consistency, and concurrent validity. The results of the analysis in the present study demonstrated that the Algase Wandering Scale - Version 2, Japanese version, has reliability and validity, and that it can measure the presence or absence of wandering and its severity. Surveys of residents with various wandering patterns in many facilities and verification of construct validity are warranted in the future.

Occurrence and family impact of elopement in children with autism spectrum disorders.

OBJECTIVES: Anecdotal reports suggest that elopement behavior in children with autism spectrum disorders (ASDs) increases risk of injury or death and places a major burden on families. This study assessed parent-reported elopement occurrence and associated factors among children with ASDs. METHODS: Information on elopement frequency, associated characteristics, and consequences was collected via an online questionnaire. The study sample included 1218 children with ASD and 1076 of their siblings without ASD. The association among family sociodemographic and child clinical characteristics and time to first elopement was estimated by using a Cox proportional hazards model. RESULTS: Forty-nine percent (n = 598) of survey respondents reported their child with an ASD had attempted to elope at least once after age 4 years; 26% (n = 316) were missing long enough to cause concern. Of those who went missing, 24% were in danger of drowning and 65% were in danger of traffic injury. Elopement risk was associated with autism severity, increasing, on average, 9% for every 10-point increase in Social Responsiveness Scale T score (relative risk 1.09, 95% confidence interval: 1.02, 1.16). Unaffected siblings had significantly lower rates of elopement across all ages compared with children with ASD. CONCLUSIONS: Nearly half of children with ASD were reported to engage in elopement behavior, with a substantial number at risk for bodily harm. These results highlight the urgent need to develop interventions to reduce the risk of elopement, to support families coping with this issue, and to train child care professionals, educators, and first responders who are often involved when elopements occur.

Comparing dementia patients' nighttime objective movement indicators with staff observations.

BACKGROUND: Pharmacological and non-pharmacological approaches are commonly used to treat patients' institutionalised for nighttime wandering. Actigraphy and other scales have been used to evaluate the efficacy of these treatments. However, in clinical settings, nursing records are often the sole source of daily observation of nighttime wandering. Thus, physicians rely on nursing records to evaluate pharmacological and non-pharmacological treatments. This study examined nighttime movements of patients with dementia, comparing the results of integrated circuit tag monitoring with hourly nighttime nursing records. We tested which factors were associated with agreement rates between the two data sources. METHODS: The study hospital was a general hospital in Osaka, Japan. Monitoring was conducted in a closed 60-bed dementia care unit. An integrated circuit tag monitoring system was used to monitor the movement of institutionalised dementia patients for over half a year. The distance moved per hour by subjects was measured using the monitoring system, and the data were compared with hourly nighttime nursing records. Agreement rates were calculated between the two data sources. RESULTS: Thirty-five patients were monitored. Between 10-30% of subjects moved at any given hour during the night. The overall agreement rate between sources of movement data was 39%. Agreement rates were significantly correlated with the interquartile of the distance moved, changes in medication, physical conditions, and behavioural and psychological symptoms of dementia measured during the day. CONCLUSIONS: Although the agreement rate was low, staff appeared to pay more attention to patients associated with notable events during the day and patients exhibiting variability in distance moved.

Elopement among community-dwelling older adults with dementia.

BACKGROUND: Adverse consequences following elopement among older people with dementia have been widely reported but the phenomenon of elopement has been under-researched. This study aimed to examine patterns of elopement incidents, search processes and subsequent prevention strategies and to explore factors that predict elopement among community-dwellers with dementia. METHODS: Twenty subjects with a recent history of elopement and 25 subjects without any history of elopement completed the study. Their cognitive status, dementia severity and behavioral manifestations were evaluated. Family informants were interviewed to gather data on demographic characteristics, clinical conditions, caring patterns, lifestyle, history of elopement, and information about any elopement incidents. RESULTS: Two-thirds of subjects had moderate severity of dementia (Clinical Dementia Rating ≥ 2). The elopers did not differ from the non-elopers in demographics, caring arrangements, clinical conditions or lifestyle patterns. Eighty percent of eloped subjects had a prior history of elopement. Logistic regression analyses suggested that manifestation of behavioral symptoms predicted elopement (OR = 1.410). Analysis of the 68 elopement incidents revealed that the vast majority of family caregivers failed to recognize any emotional/behavioral clues prior to elopement. Immediate and multiple search strategies were adopted, with eloped subjects mostly found near the point last seen. Yet, subsequent preventive strategies adopted were largely conventional. CONCLUSION: Although elopement is difficult to predict, there is a need to enhance and sensitize caregivers' understanding of elopement as related to dementia and more effective preventive strategies. Public education on dementia could also serve to engage lay people more effectively in the search process of eloped persons with dementia.

A systematic review of accidental injury from fire, wandering and medication self-administration errors for older adults with and without dementia.

The assessment of risk of injury in the home is important for older adults when considering whether they are able to live independently. The purpose of this systematic review is to determine the frequency of injury for persons with dementia and the general older adult population, from three sources: fires/burns, medication self-administration errors and wandering. Relevant articles (n=74) were screened and 16 studies were retained for independent review. The studies, although subject to selection and information bias, showed low proportions of morbidity and mortality from the three sources of injury. Data did not allow direct comparison of morbidity and mortality for persons with dementia and the general older adult population; however, data trends suggested greater event frequencies with medication self-administration and wandering for persons with dementia. Assessment targeting these sources of injury should have less emphasis in the general older adult population compared to persons with dementia.

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.

Longitudinal investigation of wandering behavior in Department of Veterans Affairs nursing home care units.

OBJECTIVES: To explore the extent of and factors associated with male residents who change wandering status post nursing home admission. DESIGN: Longitudinal design with secondary data analyses. Admissions over a 4-year period were examined using repeat assessments with the Minimum Data Set (MDS) to formulate a model understanding the development of wandering behavior. SETTING: One hundred thirty-four Veterans Administration (VA) nursing homes throughout the United States. PARTICIPANTS: Included 6673 residents admitted to VA nursing homes between October 2000 and October 2004. MEASUREMENTS: MDS variables (cognitive impairment, mood, behavior problems, activities of daily living and wandering) included ratings recorded at residents' admission to the nursing home and a minimum of two other time points at quarterly intervals. RESULTS: The majority (86%) of the sample were classified as non-wanderers at admission and most of these (94%) remained non-wanderers until discharge or the end of the study. Fifty-one per cent of the wanderers changed status to non-wanderers with 6% of these residents fluctuating in status more than two times. Admission variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behavior, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status. CONCLUSION: A resident's change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but spares mobility.

Prevalence and correlates of problem behaviors among adolescents in Hong Kong.

The aims of this study were to examine the frequency and correlates of problem behaviors among Hong Kong adolescents. It is a cross-sectional survey targeting secondary forms 1 to 3 (equivalent to grades 7-9 in the United States) students (N = 1029). A self-administered questionnaire was used as the measurement tool. The study found that there are intercorrelations of problem behaviors in adolescence, such as tobacco use, alcohol use, drug abuse, and having connections with triad society. Given the intercorrelations among problem behaviors, identification of a single type of problem behavior in adolescents can help discover the likelihood of the occurrence of other problem behaviors. It can facilitate identification and intervention at an early stage. The results provide some insights for the concerned authorities to develop a syndrome approach addressing problem behaviors.

Scheduled medications and falls in dementia patients utilizing a wander garden.

Little has been reported about the relationship of a dementia wander garden with scheduled psychiatric medications in addition to changes in fall number and severity. The 28 participating residents of a dementia unit were divided into high (HUG) and low (LUG) wander garden user groups and assessed for the number and severity of falls. The type and dose of scheduled psychiatric medications were monitored for 12 months before and 12 months after the wander garden was opened. Results indicated that the residents experienced about a 30% decrease for the raw number of falls and fall severity scores. The HUG had a significant reduction in high-dose antipsychotics, whereas there was relatively no change in antidepressant, hypnotic, and anxiolytic use. High wander garden user group required fewer scheduled medications and experienced reduced falls and lower fall morbidity than the LUG. The most significant changes in scheduled psychiatric medications were reductions in scheduled antipsychotics and an increase in residents requiring no antipsychotics.

Wandering behavior in veterans with psychiatric diagnoses residing in nursing homes.

OBJECTIVE: To investigate nursing home residents with psychiatric diagnoses who wander and who are not diagnosed with dementia. METHOD: A national cross-sectional study was conducted in a male Veterans Administration Nursing Home Care Unit population using a retrospective review of the MDS. RESULTS: Eleven thousand six hundred and nineteen residents were identified as having a psychiatric diagnosis without significant cognitive impairment; just under 1% (n = 113) wandered. Using rare events logit regression, we determined that a diagnosis of schizophrenia/bipolar disorder or comorbid psychiatric conditions were associated with increased risk of wandering compared to residents diagnosed with anxiety/depression. Psychiatric wanderers were also more likely to, have symptoms of delirium, exhibit socially inappropriate behavior, manifest problems in decision-making, take anti-psychotic medications, and to be more independent in locomotion. CONCLUSIONS: Psychiatric wanderers may be conceptualized better as exhibiting ambulatory concomitants of unremitted neurological/psychiatric symptoms or medication side effects of their treatment. Findings have implications for addressing treatable causes of wandering.