Wandering in Hospitalized Older Adults
By: Nina M. Silverstein, PhD, University of Massachusetts Boston, and Gerald Flaherty, Executive Council, AARP Massachusetts
WHY: Hospitalized patients with Alzheimer’s disease or other types of dementia are at risk for wandering and getting lost either in or outside the hospital. Once lost, they are in danger of injury and even death from falls, accidents, and exposure. The acute medical conditions that initially brought these patients to the hospital compound the likelihood of serious negative outcomes from wandering and getting lost.
Research shows that the majority of older adults with dementia who are ambulatory wander at some time, whether they live at home or in a residential care facility (Silverstein, Flaherty, & Salmons Tobin, 2006). The number of patients with dementia who exhibit this behavior in the hospital is not known. Some characteristics of the hospital setting may discourage wandering, but other characteristics of the setting and hospital experience probably promote the behavior. In general, people with dementia wander because they are disoriented, restless, agitated, or anxious; because they are looking for something (e.g., the bathroom, something to eat, or a familiar person or place); or because they think they need to fulfill former obligations, such as work or child care (Algase, 1999). As a result of disturbed sleep patterns, they may wander unexpectedly at night. When they are hospitalized, the strange environment, unfamiliar faces and sounds, and increased confusion due to delirium, their acute medical condition, pain, medications or other treatments may trigger or exacerbate wandering behavior. For these reasons, even individuals with dementia who do not wander at home or in their residential care facility might wander and get lost in the hospital. Researchers have identified periods of high activity such as shift changes, meal times, and visiting hours when there is an elevated risk of agitation and wandering behavior (Lucero, 2002). Although many older hospital patients have dementia and are therefore at risk for wandering and getting lost, hospital nurses may not know how to identify this risk. They may also not be aware of approaches they can use to reduce wandering and avoid its potentially dangerous outcomes.
Best practice in care of hospitalized older adults with dementia involves: 1) identifying risk for wandering, including interviews with caregivers, 2) providing appropriate supervision, 3) reducing environmental triggers for wandering, and 4) using individualized nursing interventions to address the causes of wandering behavior.
For hospitals, a lost patient is an emergency. Given the large number of older patients with dementia and the associated risk for wandering, it is important that hospitals have protocols in place for finding lost patients and notifying police and relatives, but many do not (Silverstein, Flaherty, & Salmons Tobin, 2006). Hospital nurses can help by advocating for the development of such protocols with hospital administrators.
TARGET POPULATION: Older adults with dementia diagnoses and other older adults whose memory loss and other dementia symptoms have not been diagnosed or may not even have been recognized prior to hospitalization.
MORE ON THE TOPIC:
Best practice information on care of older adults: www.ConsultGeri.org.
Algase, D.L. (1999). Wandering: A dementia-compromised behavior. Journal of Gerontologic Nursing, 25(9), 10-17.
Algase, D.L., Beattie, E.R., & Therrien, B. (2001). Impact of cognitive impairment on wandering behavior. Western Journal of Nursing Research, 23(3), 283-295.
Koester, R.J., & Stooksbury, D.E. (1995). Behavioral profile of possible Alzheimer’s patients in Virginia search and rescue incidents. Wilderness and Environmental Medicine, 6(1), 34-43.
Lucero, M. (2002). Intervention strategies for exit-seeking wandering behavior in dementia residents. American Journal of Alzheimer’s Disease and Other Dementias, 17(5), 277-280.
Silverstein, N.M., & Flaherty, G. (2003). Dementia and Wandering Behaviour in Long-term Care Facilities. Geriatrics and Aging, 6, 47-52.
Silverstein, N.M., Flaherty, G., & Salmons Tobin, T. (2006). Dementia and wandering behavior: Concern for the lost elder. New York: Springer Publishing Company, Inc.
Silverstein, N.M., & Maslow, K. (Co-Editors) (2006). Improving hospital care for persons with dementia. New York: Springer Publishing Company, Inc.