The Assessment of Long-Term Care Environments for Wayfinding Design.

OBJECTIVES: The purpose of this article is to compare three different methods to assess the complexity of a long-term care (LTC) environment for wayfinding before and after an environmental design intervention. The methods include space syntax (SS), the Wayfinding Checklist (WC), and the Tool to Assess Wayfinding Complexity (TAWC). BACKGROUND: Wayfinding is important to maintain older adults' independent functioning. The design of environments can impact wayfinding ability by providing support; this can be via building structure or by environmental design features such as signage and landmarks. Few methods or tools have been scientifically validated to assess environments for wayfinding complexity. In order to compare environments in terms of complexity and to measure the impact of interventions, valid and reliable tools are necessary. METHODS: This article discusses the results of the use of three wayfinding design assessment tools using three routes in one LTC environment. The results of the three tools are discussed. RESULTS: SS analysis could quantitatively measure the complexity of routes using integration values, which indicates connectedness. The TAWC and the WC were able to measure differences in visual field scores pre- and postenvironmental intervention. There were limitations to each tool: the lack of psychometric properties for the TAWC and the WC, and the lack of ability to measure changes in design features within visual fields with SS. CONCLUSIONS: Multiple tools to assess environments for wayfinding design may be needed in studies that test environmental interventions. Future research is needed to provide psychometric testing for the tools.

Sentimentos e percepções do luto de sobreviventes ao suicídio de jovens / Feelings and perceptions of grief among survivors of youth suicide / Sentimientos y percepciones de duelo entre sobrevivientes de suicidio de jóvenes

Sobreviventes ao suicídio são pessoas que têm suas vidas profundamente afetadas e apresentam sofrimento psicológico, físico ou social após serem expostas a esse fato. O objetivo deste estudo foi analisar a experiência de sobreviventes ao suicídio de jovens, a partir do luto. Participaram sete sobreviventes entre familiares, amigos e parceiros amorosos de jovens que cometeram suicídio. A análise de conteúdo de entrevistas narrativas apontou que os participantes utilizam explicações racionalizadas ou dissociadas, criando uma distância entre o evento e eles mesmos. Como formas de lidar com o sofrimento podem buscar o isolamento, apoio entre amigos, prática religiosa e/ou a dedicação ao trabalho. Reafirma-se a dimensão do luto diante dessa experiência, além da importância da prevenção ao suicídio e da posvenção aos sobreviventes.(AU)

Suicide survivors are people who have their lives deeply affected; they experience psychological, physical, and social suffering following the occurrence. The aim of this study is to analyze the experience of survivors of youth suicide attempts, based on grief. Seven survivors participated among family, friends, and romantic partners of young people who committed suicide. The content analysis of narrative interviews showed that the participants use rationalized or dissociated explanations, creating a distance between the event and themselves. As ways to deal with suffering, they seek isolation, support among friends, religious practice, and/or dedication to work. The dimension of grief in the face of this experience is reaffirmed, as well as the importance of suicide prevention and postvention for survivors.(AU)

Este artículo tiene como objetivo presentar la construcción metodológica desarrollada en una investigación de maestría, en la que sostenemos la escritura de escenas como método de investigación de la escucha clínica. Las escenas del trabajo en cuestión se recogieron a lo largo del tiempo desde la experiencia en un proyecto de extensión universitario de atención a la niñez y adolescencia en situación de vulnerabilidad social aplicado en una comunidad periférica. En este texto, presentamos los interrogantes que se elaboraron en torno a la elección por el trabajo con escenas y compartimos el rescate histórico de las mismas como un método de escribir la clínica y la reanudación del análisis a partir de la tradición psicoanalítica. Amparadas en el psicoanálisis y en lecturas y contribuciones del filósofo francés Jacques Derrida, nos basaremos en la noción de que la escena se constituye como un lugar de producción, engendrando la configuración particular de elementos significantes en los procesos de subjetivación y de construcción social. La escena no es aquí una representación de lo que pasa en la clínica, sino un modo de producir escucha y sus procesos de investigación.(AU)

Joint effect of cognitive decline and walking ability on incidence of wandering behavior in older adults with dementia: A cohort study.

OBJECTIVES: Wandering behavior is one of the most troublesome behavioral disturbances in dementia. Inconsistent associations between physical function and wandering behavior were reported, and the effect of cognitive decline may be different according to walking ability. The purposes of this study are to investigate whether high walking ability is a risk factor for wandering behavior and to investigate the interaction of walking ability and cognitive function with wandering behavior in older adults with dementia. METHODS: This retrospective cohort study included 3979 elderly adults with dementia. The association of cognitive function and walking ability with incidence of wandering behavior during a 5-year follow-up period were examined using a generalized linear model, and relative excess risk due to interaction (RERI) was calculated. RESULTS: Severe cognitive decline and high walking ability were associated with a higher risk for wandering behavior. Additionally, some joint effects of cognitive decline and walking ability decline were higher than the sum of its individual effects (RERI [95% confidence interval], severe cognitive decline × 'walk with help': 1.58 [0.35, 2.81]; severe cognitive decline × 'independent': 3.09 [1.05, 5.14]). CONCLUSIONS: Effects of cognitive decline and walking ability on incidence of wandering behavior were observed, and the effects varied depending on their combination.

Exploring a Novel Tool to Measure Wandering Behavior in the Early Childhood Classroom.

Wandering, or random movement, affects cognitive and social skills. However, we lack methods to objectively measure wandering behavior. The purpose of this pilot study was to explore the use of the Ubisense real-time location system (RTLS) in an early childhood setting to explore wandering in typically developing (TD) children (n = 2) and children with or at risk for developmental disabilities (WA-DD; n = 3). We used the Ubisense RTLS, a tool for capturing locations of individuals in indoor environments, and Fractal Dimension (FD) to measure the degree of wandering or the straightness of a path. Results of this descriptive, observational study indicated the Ubisense RTLS collected 46,229 1-s location estimates across the five children, and TD children had lower FD (M = 1.36) than children WA-DD (M = 1.42). Children WA-DD have more nonlinear paths than TD children. Implications for measuring wandering are discussed.

Wandering behavior in children with autism spectrum disorder and other developmental disabilities.

PURPOSE OF REVIEW: Approximately one in four children with autism spectrum disorder (ASD) 'elope' or wander away from supervision each year; however, many caregivers do not receive adequate information on how to address wandering behavior. The purpose of this review is to summarize the available research on elopement frequency, wandering patterns, and interventions to provide pediatricians and other childcare professionals with appropriate strategies to address wandering behavior. RECENT FINDINGS: Despite the high prevalence of wandering by children with ASD or other developmental disabilities, there is relatively limited research in this area. Recent research has identified common patterns and factors associated with risk of elopement and elopement frequency. SUMMARY: Pediatricians should counsel families on the common issues and intervention strategies related to elopement. By increasing awareness of wandering in children with ASD, caregivers can feel better prepared to make informed decisions regarding their child's wellbeing and safety.

Night-Time Monitoring System (eNightLog) for Elderly Wandering Behavior.

Wandering is a common behavioral disorder in the community-dwelling elderly. More than two-thirds of caregivers believe that wandering would cause falls. While physical restraint is a common measure to address wandering, it could trigger challenging behavior in approximately 80% of the elderly with dementia. This study aims to develop a virtual restraint using a night monitoring system (eNightLog) to provide a safe environment for the elderly and mitigate the caregiver burden. The eNightLog system consisted of remote sensors, including a near infra-red 3D time-of-flight sensor and ultrawideband sensors. An alarm system was controlled by customized software and algorithm based on the respiration rate and body posture of the elderly. The performance of the eNightLog system was evaluated in both single and double bed settings by comparing to that of a pressure mat and an infrared fence system, under simulated bed-exiting scenarios. The accuracy and precision for the three systems were 99.0%, 98.8%, 85.9% and 99.2%, 97.8%, 78.6%, respectively. With higher accuracy, precision, and a lower false alarm rate, eNightLog demonstrated its potential as an alternative to physical restraint to remedy the workload of the caregivers and the psychological impact of the elderly.

Incidence and Mortality of Dementia-Related Missing and Their Associated Factors: An Ecological Study in Japan.

BACKGROUND: Dementia-related missing and subsequent deaths are becoming serious problems with increases in people with dementia. However, there are no sufficient studies investigating the incidence rate, the mortality rate, and their risk factors. METHODS: An ecological study aggregated at the Japanese prefectural level was conducted. Dementia-related missing persons cases and deaths in 2018 were extracted from the statistics of the National Police Agency in Japan. We extracted variables about older adults' characteristics, care, and safety as candidate variables considered to be relevant to dementia-related missing persons cases and deaths. Associations of the candidate variables with the incidence and mortality rates were analyzed using the generalized linear model (family: quasi-poisson, link: log) adjusted for confounding factors (proportion of older adults and gross prefectural product). RESULTS: The incidence rate and mortality rate per 100,000 person-year was 21.72 and 0.652 in Japan, respectively. One facility increase in the number of nursing care facilities for older adults per 100,000 persons aged 65-years-old or more was associated with a 7.9% (95% confidence interval [CI], 3.3-12.4%) decrease in the incidence rate. One increase in the number of public health nurses per 100,000 persons was associated with a 3.2% (95% CI, 1.6-4.9%) decrease in the incidence rate. A ten percent increase in the proportion of people who live in an urban area was associated with a 20.3% (95% CI, 8.7-33.2%) increase in the incidence rate and a 12.9% (95% CI, 5.6-19.8%) decrease in the mortality rate. CONCLUSIONS: Identified associated factors may be useful for managing or predicting dementia-related missing persons cases and associated deaths.

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 by Children with Autism Spectrum Disorders: Impact of Electronic Tracking Devices on Elopement Behavior and Quality of Life.

OBJECTIVE: Half of US children with autism spectrum disorder (ASD) have attempted to elope from adult supervision at least once, elevating their risk for serious injury/death. This study aimed to assess, in a sample of children with ASD aged 4 to 18 years who had previously wandered, whether electronic tracking device (ETD) use is associated with changes in the elopement behavior and household quality of life (QOL). METHODS: An anonymous, online questionnaire assessing elopement interventions, elopement behavior, household QOL, attitudes toward ETDs, and sociodemographics was distributed via US autism-related organizations to caregivers of children with ASD. Differences in retrospective estimates of elopement behavior and household QOL before ETD use and during ETD use were evaluated using Wilcoxon signed-rank tests. RESULTS: A total of 2563 participants completed the questionnaire; 1459 participants met the inclusion criteria. For the current (n = 361) and past (n = 96) ETD users, ETD use was associated with decreased frequency and duration of elopement and decreased risk for serious injury because of elopement (all p < 0.001). ETD use was similarly associated with improvements across all 5 measures of QOL. Among the past ETD users, reasons for discontinuation included device discomfort/fit (33.3%), burden of use (27.1%), and financial cost (14.6%). Among the non-ETD users (n = 1002), common barriers to ETD use were cost (47.5%) and lack of awareness of ETD technology (18.8%). CONCLUSION: Electronic tracking devices represent a promising technology to help safeguard the well-being of children with ASD while reducing the emotional toll that elopement imposes on families. Cost concerns, burden of use, and lack of awareness seem to limit the widespread adoption of ETDs.

Evaluation of antecedent behaviors of dementia-related wandering in community and facility settings.

Aim: To understand antecedent behaviors to critical wandering among persons living with dementia in or outside of a facility. Materials & methods: Caregivers were asked to write down the type and number of antecedent behaviors they observed in persons with dementia that were about to critically wander for 2-4 weeks. Observations were made through a developed questionnaire. Results: Six antecedent behaviors were observed: stating intent to leave, door lingering/tampering, preparing to go outside, packing up belongings, calling to be picked up and draw to outside stimuli. Conclusion: Information from this study can be used in the education of wander-management strategy adoption among caregivers of persons with dementia at risk of getting lost.

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.

The validity of the online thought-probing procedure of mind wandering is not threatened by variations of probe rate and probe framing.

Recently, there has been a surge of interest in the measurement of mind wandering during ongoing tasks. The frequently used online thought-probing procedure (OTPP), in which individuals are probed on whether their thoughts are on-task or not while performing an ongoing task, has repeatedly been criticized, because variations in the frequency of thought probes and the order in which on-task and off-task thoughts are referred to have been shown to affect mind-wandering rates. Hitherto, it is unclear whether this susceptibility to measurement variation only affects mean response rates in probe-caught mind wandering or poses an actual threat to the validity of the OTPP, endangering the replicability and generalizability of study results. Here, we show in a sample of 177 students that variations of the frequency or framing of thought probes do not affect the validity of the OTPP. While we found that more frequent thought probing reduced the rate of probe-caught mind wandering, we did not replicate the effect that mind wandering is more likely to be reported when off-task thoughts are referred to first rather than second. Crucially, associations between probe-caught mind wandering and task performance, as well as associations between probe-caught mind wandering and covariates (trait mind wandering, reaction-time variability in the metronome-response task, and working-memory capacity) did not change with variations of the probing procedure. Therefore, it seems unlikely that the great heterogeneity in the way the OTPP is implemented across different studies endangers the replicability and generalizability of study results. Data and analysis code are available at https://osf.io/7w8bm/ .

Effects of walking on sundown syndrome in community-dwelling people with Alzheimer's disease.

BACKGROUND: Sundown syndrome is an important care issue for people with dementia (PwD) and for family caregivers. Walking is a safe and simple physical activity for most PwD, yet no research has explored the effects of different long-term walking periods on sundown syndrome. OBJECTIVES: This study aimed to determine the effects of walking on sundown syndrome, and to identify whether different walking time periods would show different effects on sundown syndrome in community-dwelling people with Alzheimer's disease. METHODS: A quasi-experimental designed study with repeated measurements was conducted. Sixty PwD were recruited and assigned to either the control group or the morning or afternoon walking group according to their caregiver's preference. The participants in the two walking groups completed an average of 120-min walking per week, accompanied by their caregivers. Forty-six achieved the 6-month intervention. Four measurements were taken, one at the pretest and one at weeks 8, 16 and 24. The Chinese version of the Cohen-Mansfield Agitation Inventory, community form (C-CMAI) was used to assess the severity of the sundown syndrome. The generalised estimating equation (GEE) was applied for the longitudinal data analysis. RESULTS: There was a significant change across the study period (p = .048) in the morning walking group, indicating that the score for sundown syndrome decreased when PwD walked in the morning. Considering group effects, compared to the control group, the C-CMAI scores significantly decreased after 16 weeks of walking in the afternoon walking group (p = .001) and after 24 weeks in both the morning and afternoon walking groups (p = .001), indicating that after PwD had walked for 16 weeks, sundown syndrome ameliorated in the afternoon group and continually decreased after 24 weeks in both the morning and afternoon groups. However, there was no significant group difference between the morning and afternoon walking groups during the 24-week walking intervention. CONCLUSIONS: The results indicated that both morning walking and afternoon walking are beneficial for ameliorating the symptoms of sundown syndrome; however, walking in the afternoon may have a faster effect on the symptoms than walking in the morning. Walking is a safe, simple, feasible and effective intervention to benefit individuals with sundown syndrome. IMPLICATIONS FOR PRACTICE: Regularly walking for 30 min a day, four times a week, is beneficial to alleviate sundown syndrome among PwD living in the community. Either morning or afternoon walking is effective for decreasing sundown syndrome, and the longer the walking time, the greater the impact on sundown syndrome.

Errância e nomadismo feminino: o caso de duas mulheres trecheiras / Errancia y nomadismo femenino: el caso de dos mujeres trecheiras / Wandering and female nomadism: the case of two female wanderers

Resumo Para investigar o papel da mobilidade na constituição dos gêneros, realizamos uma pesquisa com mulheres trecheiras - mulheres sem residência fixa, transitando de cidade em cidade e que utilizam os serviços de assistência social. Participaram do estudo duas mulheres usuárias dos serviços da casa de acolhimento aos migrantes de uma cidade do Estado do Mato Grosso do Sul, situada na divisa dos Estados de São Paulo e Paraná. Mediante a perspectiva cartográfica e utilizando entrevistas abertas, observamos trajetórias marcantes de ruptura com a vida sedentária e a passagem para uma vida em trânsito, desprendida de vínculos com a família, o trabalho e os papéis tradicionais atribuídos à mulher. Elas buscaram na errância uma alternativa de vida melhor, uma tentativa de fuga dos problemas e das violências de gênero vividas no ambiente doméstico e no relacionamento familiar e foram aprendendo, dia a dia, no trecho, a viverem como trecheiras.

Resumen Para investigar el papel de la movilidad en la constitución de los géneros, realizamos una encuesta a mujeres que trabajaban con mujeres trecheiras - mujeres sin residencia fija, transitando de una ciudad a otra, y que usan los servicios de asistencia social. Participaron del estudio dos mujeres usuarias de los servicios de refugio para migrantes de una ciudad en el estado de Mato Grosso do Sul, ubicado en la frontera de los estados de São Paulo y Paraná. A través de la perspectiva cartográfica y el uso de entrevistas abiertas, observamos trayectorias notables de ruptura con la vida sedentaria y el paso a una vida en tránsito, separada de los lazos con la familia, el trabajo y los roles tradicionales atribuidos a las mujeres. Buscaron en la errancia una mejor alternativa de vida, un intento de escapar de los problemas y la violencia de género experimentada en el entorno doméstico y las relaciones familiares, y aprendieron, día a día, a vivir como trecheiras.

Abstract In order to investigate the role of mobility in the constitution of genders, we conducted a survey of women wanderers - women without fixed residence, moving from city to city and using social assistance services. The study included two women who use migrant shelter services from a city in the state of Mato Grosso do Sul, located on the border of the states of São Paulo and Paraná, Brazil. Through the cartographic perspective and using open interviews, we observed remarkable trajectories of rupture with sedentary life and the passage to a life in transit, detached from ties with family, work and the traditional roles attributed to women. They sought, in their wanderings, a better life alternative, an attempt to escape the problems and gender-based violence experienced in the domestic environment and family relationships, and they learned, day by day, to live as wanderers.

What do we know about best police practices for lost persons with dementia? A scoping review.

Aim: To examine the efficacy of strategies used by the police for missing persons with dementia. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we searched peer-reviewed and gray literature of existing police practices used for missing persons with dementia. Data from the studies were analyzed descriptively. Results: The literature described 16 articles and 18 websites. Strategies ranged from identification tools, successful field techniques, locating technologies and community engagement/education. Overall scientific evidence was low, with only three studies evaluating the usability and effectiveness of the suggested strategies. Conclusion: More rigorous research is required to demonstrate the efficacy of best police practices for missing persons with dementia, which in turn could assist in the development of a best practice guideline.

Heroic music stimulates empowering thoughts during mind-wandering.

It is generally well-known, and scientifically well established, that music affects emotions and moods. However, only little is known about the influence of music on thoughts. This scarcity is particularly surprising given the importance of the valence of thoughts for psychological health and well-being. We presented excerpts of heroic- and sad-sounding music to n = 62 individuals, and collected thought probes after each excerpt, assessing the valence and the nature of thoughts stimulated by the music. Our results show that mind-wandering emerged during listening to either type of music (heroic, sad), and that the type of music strongly influenced the thought contents during mind-wandering. Heroic-sounding music evoked more positive, exciting, constructive, and motivating thoughts, while sad-sounding music evoked more calm or demotivating thoughts. The results thus indicate that music has a strong effect on the valence of thought contents during mind-wandering, with heroic music evoking more empowering and motivating thoughts, and sad music more relaxing or depressive thoughts. These findings have important implications for the use of music in everyday life to promote health and well-being in both clinical populations and healthy individuals.

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.

Wandering Behavior From the Perspectives of Older Adults With Mild to Moderate Dementia in Long-Term Care.

Wandering is often described as aimless and disruptive in long-term care (LTC) facilities. Kitwood's Enriched Model of Dementia challenges one to focus on the person, not the behavior. The current exploratory study addressed a gap in knowledge of wandering behavior by gaining the perspectives of older adults with mild to moderate dementia residing in LTC. Walking interviews were conducted with eight older adults. Six themes emerged from their perspectives: Walking as Enjoyable, Walking for Health Benefits, Walking as Purposeful, Walking as a Lifelong Habit, Walking as a Form of Socialization, and Walking to Be With Animals. These results suggest a reconceptualization of wandering behavior from aimless walking and disruption to a purposeful and beneficial activity. [Res Gerontol Nurs. 2019; 12(5):239-247.].

"Would you like to join me for a walk?" The feasibility of a supervised walking programme for people with dementia who wander.

AIMS AND OBJECTIVES: Five of the eight focus areas of Bowen's Feasibility Framework were utilised to assess the feasibility of implementing the Safe Walking Program (SWP) with people with severe dementia who wander in long-term care (LTC). BACKGROUND: Dementia-related wandering in LTC is associated with adverse outcomes related to intensity (malnutrition, exhaustion and pain, injury) and type of walking (sleep deprivation, resident violence and elopement, death). There is little evidence guiding best practice for managing wandering in LTC. DESIGN: The SWP involved a three-week trial of taking residents (n = 7) for a 30-min supervised walk, 30 min before individual peak walking activity periods (PWAP), outside the care facility. Quantitative (real-time observation and 24/7 Actigraph™ data: not reported here) and qualitative data were collected pre-, during and postintervention. METHODS: Feasibility to implement the SWP protocol was evaluated using a protocol fidelity checklist completed at the end of each scheduled intervention. Acceptability and sustainability of the programme were evaluated through staff interviews. RESULTS: Eighty per cent of scheduled walks commenced and were completed, with 91% of walks lasting the full 30 min. Care staff reported benefits for participants and care staff. The perceived sustainability of the SWP in the LTC setting was impacted by the strict timing of the walk to coincide with participant's individual PWAP. The use of care staff to lead some scheduled walks was seen as interfering with care routines. CONCLUSIONS: To enhance the acceptability/sustainability of the SWP in LTC, further testing of the importance of dose and timing is required. Consideration needs to be given to suggested modifications to the protocol. IMPLICATIONS FOR PRACTICE: The SWP is an acceptable and enjoyable activity for people with severe dementia who wander. Utilising walking tracks around the neighbourhood was perceived as being an important element of the programme.