Archive for October, 2013


Dementia Care Certificate Program

Caring for those living with Alzheimer’s disease or a related dementia can be challenging work and requires the use of skills and techniques designed to safely support these individuals. The need for professionals with expertise in dementia care is growing rapidly as the prevalence of dementia continues to increase world-wide. In response, Schoolcraft College Continuing Education and Professional Development, in collaboration with the Alzheimer’s Association-Greater Michigan Chapter, are offering a Dementia Care Certificate for professionals working with individuals living with dementia. Classes are interactive and provide practical learning which can be applied in the workplace immediately. CEUs are also available for certain professions. To learn more about the Dementia Care Certificate program or to register, click here.

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Wandering behavior is a common phenomenon among those that are diagnosed with dementia. Approximately 60%-67% of those with a diagnosis will exhibit wandering behavior over the course of their illness. Despite the prevalence of wandering, it remains a difficult issue to tackle and the consequences of a wandering incident can be dire. However, there are benefits to wandering, if done is a safe, supervised environment.

What is wandering?    

Wandering has proven difficult  to define because it is an inherently broad concept. In fact, a US Department of Veterans Affairs study (1985) concluded that its imprecision “defies definition”. Although there is not consistent agreement on what constitutes wandering some definitions include:

  • Behavioral problem of AD patients that involves cognitive impairment affecting abstract thinking, language, judgement, and spatial skills
  • Disorientation and difficulty relating to the environment
  • Aimless or purposeful motor activity that causes a social problem such as getting lost, leaving a safe environment, or intruding in inappropriate places
  • Meandering, aimless or repetitive locomotion that exposes the individual to harm; frequently incongruent with boundaries, limits, or obstacles

Wandering statistics

  • Up to 67% of those with dementia will wander.
  • 45% of wanderers will perish if not found in the first 24 hours
  • 83% have wandered before
  • 95% are found within 1.5 miles

Why does wandering occur?

The reasons why wandering occurs are as varied as the individuals that exhibit this pattern of behavior. Although it may not be readily apparent why the person with dementia is exhibiting wandering behavior, it likely originates from a physical, mental, or social need.

Determining Risk

  • Consider premorbid personality and lifestyle
  • Sleep disturbances sometimes predictive of wandering
  • Increased cognitive impairment correlated with increased likelihood of wandering behavior
Other Indicators:

  • Returns from a regular walk or drive later than usual.
  • Tries to fulfill former obligations, such as going to work.
  • Tries or wants to “go home,” even when at home.
  • Is restless, paces or makes repetitive movements.
  • Has difficulty locating familiar places like the bathroom, bedroom or dining room.
  • Asks the whereabouts of current or past friends and family.
  • Acts as if doing a hobby or chore, but nothing gets done.
  • Appears lost in a new or changed environment.

One interesting theory suggests that wandering in outdoor or woodland settings is a natural, human impulse and should be embraced rather than stymied. In Mape’s (2012) study, researchers piloted the idea of facilitating controlled wandering in a woodland environment in their study Wandering in the Woods. Researchers found after participants were exposed to outdoor exercise, subjects exhibited improved sleep, improved dietary intake, multi-sensory engagement and associated joy, increased verbal expression, and improved memory.

Where do they go?

Picture1

Evidence-Based Interventions

Environmental Modifications

  • Provide safe place for person to wander, such as walking path or ‘man cave’.
  • Enhance visual appeal of environment with interesting décor.
  • Maintain safety by removing clutter and dangerous objects.
  • Remove ‘triggers’, such as car keys, from the environment.
  • Place locks out of the line of sight. Install either high or low on exterior doors.
  • Subjective barriers, such as camouflage doors and doorknobs, and dark floor mats.
  • Use devices that signal when a door or window is opened.
  • Use confounding locks on doors to prevent exit/entry.
  • Provide supervision. Never lock the person with dementia in at home or leave him/her in a car without supervision.
  • Use large print signs/photographs to assist in finding key areas.
  • Ensure pathway to bathroom is clear and accessible, especially at night. Restrict fluids an hour or two before bed to avoid nighttime wandering.
  • Avoid environments that are confusing and can cause disorientation, such as grocery stores, shopping malls, or large holiday gatherings.

Physiological and Psychosocial Interventions

  • Having a routine can provide structure and reduce restlessness.
  • Encourage regular exercise, such as walking after meals.
  • Identify the times of day that wandering may occur. Plan activities at that time.
  • Ensure all basic needs are met. Has the person gone to the bathroom? Is he/she thirsty or hungry?
  • Assess for and treat depression.
  • Provide social interaction and engagement.
  • Encourage the person to engage in meaningful activities.
  • Reassure the person if he or she feels lost, abandoned, or disoriented.  Validate feelings.
  • Engage person in stress relieving activities, such as music, art, massage, etc.

References

Bushnell, R., & Collins-Fadell, C. (2012, September 1). For those who wander. The Best of Aging(11).

Futrell, M., Melillo, K., & Remington, R. (2010). Evidence-based guideline: wandering [corrected] [published erratum appears in J GERONTOL NURS 2010 Mar;36(3):1p]. Journal Of Gerontological Nursing36(2), 6-16. doi:10.3928/00989134-20100108-02

Lai, C., & Arthur, D. (2003). Wandering behaviour in people with dementia. Journal Of Advanced Nursing44(2), 173-182.

Mapes, N. (2012). Have you been down to the woods today? Working with Older People18 (1), 7-16. doi:10.1108/13663661211215105

Robinson, L., Hutchings, D., Dickinson, H. O., Corner, L., Beyer, F., Finch, T., Hughes, J., Vanoli, A., Ballard, C., & Bond, J. (2007). Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review. International Journal of Geriatric Psychiatry22, 9-22. doi:10.1002/gps.1643

US Department of Veterans Affairs (1985) Dementia Guidelines for
Diagnosis and Treatment. Author, Washington, DC.

I’m Still Here by Dr. John Zeisel represents a paradigm shift in the field of dementia care. In place of the traditional deficit-focused assessments and intervention strategies, Zeisel encourages care partners to instead capitalize on the remaining strengths and abilities possessed by the person living with the disease. Alzheimer’s disease is, for many, a long journey — perhaps lasting a decade or more. Over the course of this journey, the person still has the capacity to participate meaningfully in life and form new, rich memories. He/she still has access to many well-preserved abilities; in fact, some abilities become more acute after the onset of dementia. The person with Alzheimer’s disease, for instance, may excel at tasks that require artistic expression or emotional intelligence. In the absence of self-censorship, the person may become more creative. By relying more heavily upon innate non-verbal communication, the person may become more emotionally perceptive and sensitive.

Zeisel outlines in his book practical and strategic methods for implementing a strength-based, compassionate approach to Alzheimer’s care. Various nonpharmacological methodologies are explored, such as use of visual and dramatic arts in care provision, effective communication strategies, and caregiver mindfulness. I’m Still Here is a book rich in information and is touted by many as a must-read for anyone affected by a diagnosis of dementia. Don’t miss out on your opportunity to learn more about this innovative care model. Call (248) 996-1053 to purchase this book today!

Learn more about the book and its mission at John Zeisel’s blog www.imstillhere.org. Hear Dr. Zeisel’s keynote presentation at our Fall Conference on November 5th!