Wandering In nursing homes is a major cause of injury for dementia and Alzheimer’s patients. 
According to a 2006 study, at least twenty percent of all dementia patients will have an incident of wandering at least once during the course of the condition. Wandering is what it is called when patients that are suffering from a loss of cognitive functions leave safe areas, either in a nursing home or community setting. When a patient completely leaves the facility or home, it is known as elopement. This is the most dangerous kind of wandering, and many patients have become injured or died during periods of elopement.
Reasons that Patients Wander in Nursing Homes
New dementia or Alzheimer’s patients in nursing homes are particularly prone to wandering. This is because the environment is new and unfamiliar. The patient may be overwhelmed by the new surroundings, and seek to find familiar surroundings. Likewise, changes in medication or routine may spur bouts of wandering in nursing homes. Any change that is unwelcome and makes the patient feel uncomfortable has the potential to prompt wandering tendencies.
Unmet physical needs add to the risk that a patient will wander. If a patient has to use the restroom or is hungry, they may seek a person or place that can fulfill those needs. In these cases, patients may wander in nursing homes because they have forgotten where these areas are. Some deeper and hidden needs may cause the tendency to wander, as well. If a patient feels that there is not enough interaction, it may cause subconscious feelings of unrest that the patient seeks to fulfill by wandering.
In some cases, patients desire to go home or find relatives houses will cause incidents of wandering in nursing homes. In these cases, the patient is often unaware of actual surroundings. These incidents can be particularly traumatic for patients, as patients may feel trapped or detained when guided back to safe areas.
Types of Wandering in Nursing Homes
The different reasons for wandering in nursing homes result in different types of wandering. Understanding the type of wandering that the patient is engaging in can help staff to prevent further incidents of wandering in nursing homes. Staff must be alert to many facets of patients’ lives to determine what type of wandering the patient may be engaging in.
Environmentally Cued Wandering
Environmentally cued wandering in nursing homes occurs when a patient responds to environmental stimuli, such as sitting when there is a chair. A hallway or path will cue the patient to wander. Staff must watch these patients closely when there is an environmental factor that may trigger the wandering.
Recreational Wandering
A patient’s need or desire for more exercise can generate a case of recreational walking. This is more easily curable by staff. Allowing a patient more ample time or means to exercise, explore, and interact will likely offset mental reasons that a patient will engage in recreational wandering.
Agitated Purposeful Wandering
Patients’ reasons for engaging in agitated purposeful wandering may vary. However, this is a dangerous type of wandering in nursing homes. As the name implies, patients have a purpose for this type of wandering, and may be agitated about whatever that reason is. The reason can be real or imagined, but the patient’s emotional state is no less disrupted when the threat is imagined. When confronted, patients may respond aggressively towards staff, and be unwilling to cooperate or return to safe areas of the nursing home. If the issue is unresolved, recurring incidents of wandering may occur.
Fantasy or Reminiscent Wandering
Fantasy wandering occurs when the patient is unaware of real surroundings, and proceeds to wander according to an imagined environment. A common scenario for this type of wandering is reminiscent wandering, when a patient imagines past surroundings and responds to them. This is a difficult type of wandering to confront, as patients may be unable to grasp the situation and understand the actual surroundings.
Elopement
The most dangerous type of wandering occurs when a patient attempts to completely leave the nursing home and wander outside. Patients are often hurt or killed during this type of wandering. This type of wandering can stem from any of the other types of wandering. Staff must keep a close eye on patients that have attempted elopement, as recurrences are common.
Staff Response to Wandering in Nursing Homes
To prevent incidents of wandering, staff must carefully evaluate each patient upon admission, and assess risk of patient wandering. Most patients engage in the first incident of wandering in nursing homes less than forty-eight hours after admission. Locking all doors except those in the patients’ safe areas can be helpful in preventing wandering.
Staff must find a delicate balance between keeping residents safe while allowing patients freedom. An individualized approach is the best way to prevent wandering in nursing homes. Staff that is aware of individual patient’s personal situations and risks of wandering will be much more likely to prevent incidents of wandering than staff that does not take these factors into consideration.
Incidents of wandering in nursing homes should be recorded and reported to family members. These incidents can recur and become more dangerous, and the input of loved ones may help in preventing these incidents. If a patient continually has incidents of wandering in a nursing home, it may become necessary to alter the patient’s environment or remove the patient from the nursing home to prevent injuries. If a loved one has been injured or died because of an incident of wandering in nursing homes, an attorney should be contacted to assess the situation and provide assistance for further action.
Sources:
Beattie, E, J Song, and et al. “A comparison of wandering behavior in nursing homes and assisted living facilities.” PubMed.gov. U.S. National Library of Medicine, n.d. Web. 9 Sep 2013. <http://www.ncbi.nlm.nih.gov/pubmed/16025697>.
Boltz, Mary. “Wandering and Elopement: Litigation Issues.” NCCDP National Council of Certified Dementia Practitioners. NCCDP, n.d. Web. 9 Sep 2013. <http://www.nccdp.org/wandering.htm>.
Lester, Paula, Adrianna Garite, and et al. “Wandering and Elopement in nursing homes.” Annals of Long Term Care. HMP Communications, 19 Mar 2012. Web. 9 Sep 2013. <http://www.annalsoflongtermcare.com/article/wandering-and-elopement-nursing-homes>.