practical approaches to dementia care -...

Practical Approaches to

Dementia Care -

Wandering

Daneill Haberfield, Behaviour Consultant / Occupational Therapist

Behaviour Assessment & Intervention Service (BASIS), NSCCAHS.

Email: dahaberfield@nsccahs.health.nsw.gov.au

Phone: 0421839173

NSW Falls Prevention Network Meeting

Wednesday June 23rd 2010

Dementia – Brief overview

Behavioural and

psychological

symptoms

Cognitive

Symptoms

Alzheimers‟

Lewy Body

Fronto temporal

VascularParkinson‟s

Focus today on wandering

Wandering as “pathology”

Meandering, aimless, or repetitive locomotion

that exposes a person to harm…(North American

Nursing Diagnosis Association, 2001).

More likely to experience adverse

events…(Siders et al 2004)

http://wanderingnetwork.co.uk

Wandering can be therapeutic and improve

the person‟s sense of wellbeing and agency

(Wigg, 2010).

Physiological benefits of exercise

Stimulating appetite

Relieving boredom

Improves mood / Coping with stress

Feeling of empowerment & better self-esteem

May improve sleep

Wandering can be purposeful

Dewing, J (2005) Screening for wandering among

older persons with dementia.

Risky wandering vs safe wandering

Depends on a number of factors including:

The person doing the wandering

Knowledge & skills of the caregiver

Context or setting of care

Workplace culture

In general…

Efforts to reduce wandering

should be attempted only

when… (Siders et al 2004).

(Jayasekara 2009)

Research suggests…

Assessment should include:

Identification of the reason for wandering

An examination of wandering patterns

(type, time of day, consequences etc)

Interventions:

A range of that are tailored to the

individual‟s need, the specific behaviour in

question and the underlying reasons for it (Robinson et al 2006)

Medications for wandering??

Some people who wander are

prescribed psychotropic medications to

reduce wandering, but …(Siders et al 2004).

Antipsychotic “drugs appear to have

only a limited positive effect in treating

symptoms but can cause significant

harm to people with dementia” (Banerjee,

2009)

Practical & non-

pharmacological ideas in

working with people who

wander

A person-centred approach

Risk versus Benefit

“„Risk assessments‟ should be

replaced by „risk-benefit

assessments‟. (Nuffield Bioethics, 2009)

Wandering – Non-pharmacological

interventions

1. We are not aiming to stop wandering.

2. We are aiming to reduce risks associated

including:

Fractures

Absconding

Intrusiveness

Worsening mobility

Restraint

Reducing risk of fractures

Environmental assessment

Equipment

Nutrition & Hydration

www.alzstore.com

Reducing risks associated with

absconding

Identification bracelet

Names on clothes

Safe 2 walk

www.safe2walk.com.au$9.90 plus GST per week (Alzheimer's Australia member)

or $12.90 plus GST per week (non members).

Reduce intrusiveness

Boredom is a big issue!!

Engage the person in something

that matches their skill & interest

Try to get into their reality.

Grace O'Sullivan 2010

Cupboards - Themed nooks

Sensations Dementia Care Products 2009

Sensory aprons & boxes

Maintaining mobility

Exercise programs or structured

mobility.

Give the person a reason or meaning to

wander.

Poor balance, mobility & muscle

strength are confirmed risk factors for

falls in community dwelling older people (NSW DOH, 2009).

Staff supervision issues

CCTV

Boundary fence laser

Volunteer „sitters‟ program

Summary

Assess the whole person (bio-psycho-

social / person centred model)

Match interventions to the needs that

are identified in the assessment.

Weigh up risks versus benefits & get the

family involved.

Enable “Safe walking” rather than

stopping them “wandering”

References

Brodaty, H.Draper, B, Saab, D. Low, L.Richards, V. Paton H. Lie, D. 2001. Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. International Journal of Geriatric Psychiatry. Vol 16 Issue 5, Pages 504 - 512 Published Online: 21 May 2001

Dewing, J.2005, Screening for wandering among older persons with dementia. Nursing Older People. Proquest Health and Medical Complete, pg 20.

Edgerton, E. & Richie, L. 2010. Improving Physical Environments for Dementia Care: Making Minimal Changes for Maximum Effect. In Annals of Long Term Care – Clinical Care and Aging. American Geriatric Society.

NSW Dept of Health 2009, Prevention of falls in residential aged care. Centre for health advancement population health division.

Jayasekara, R. 2009. Dementia: Wandering. Evidence Based Summaries. Joanna Briggs Institute. Adelaide.

Robinson, L. Hutchings D.Dickinson O.,Corner L., Beyer, F., Finch, T., Hughes, J., Vanoli, A. Ballard, C. Bond, J. 2006. Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review. Int J Geriatr Psychiatry 2007; 22: 9–22.

References continued

www.alzstore.com

www.alzheimers.org.uk

www.safe2walk.com.au

Siders, C. Nelson, A. Brown, L. Joseph, I. 2004, Evidence for Implementing Nonpharmacological Interventions for Wandering. Rehabilitation Nursing. Glenview:. Vol. 29, Iss. 6; pg.195.

State of Wisconsin 2009, Person-centred dementia care assessment tool. Department of health and family services, division of Disability and Elder Services.

Tilly J, Reed P, 2006. Dementia care practice recommendations for assisted living residences and nursing homes. Washington (DC): Alzheimer's Association.

Sensations in dementia care catalogue 2009.

Wigg, J. 2010, Liberating the wanderers: using technology to unlock doors for those living with dementia. Sociology of Health & Illness. Oxford: Feb 2010. Vol. 32, Iss. 2; pg. 288