Developing a Non-Pharmacological Intervention Programme for Wandering in People with Dementia: Recommendations for Healthcare Providers in Nursing Homes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Stage 1: Literature Search
2.1.1. Identification of the Research Question and Domains
2.1.2. Literature Search Strategy
2.1.3. Inclusion and Exclusion Criteria
- The participants were older adults with any form of dementia.
- The study was about specific NPIs for wandering in PwD.
- Articles meeting the following criteria were excluded:
- The study only included pharmacological interventions.
- Interventions were implemented in hospitals.
- Conference abstracts, protocols, introductions, or reviews other than systematic ones.
2.1.4. Quality Assessment of the Included Studies
2.1.5. Data Collection
2.2. Stage 2: Development of the Intervention Programme
2.3. Stage 3: Validation Process
3. Results
3.1. Search Results
3.2. Characteristics of the Included Studies
3.3. Quality Appraisal
3.4. Expert and User Validation
3.5. Recommendations Based on Levels of Evidence and Grades of Recommendation
3.6. Caregiver Education
- Keep calm.
- Contact the local police immediately and provide a recent colour photo of the missing person, a description of his or her clothes, and details about past walking experiences, favourite places, or anywhere the person may have gone.
- Search the house and the surrounding buildings immediately.
- The initial 6 to 12 h of the search should cover an eight-mile radius around the location where the lost person was last seen, concentrating on open, populated areas, including the inside of easily accessible buildings.
- If the missing person has not been found, intense foot searches should focus on natural and sparsely populated areas, beginning within a two-mile radius of the last known location and extending from there, and ponds, gardens, and tree lines should be carefully searched.
- Search strategies should not be based on personal characteristics and experiences since PwD often exhibit unpredictable behaviour when lost.
- If the missing person has not been found, searches should continue through the night.
- If PwD travelled by bus or subway, initial search efforts should focus on locating the vehicle.
3.7. Preventing Excessive Wandering
3.8. Promoting Safe Walking
3.9. Preventing PwD from Going Missing
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
Appendix A
Search | Query |
---|---|
#1 | Dementia.mp. [mp = text, heading word, subject area node, title] |
#2 | Dementias.mp. [mp = text, heading word, subject area node, title] |
#3 | Amentia.mp. [mp = text, heading word, subject area node, title] |
#4 | Amentias.mp. [mp = text, heading word, subject area node, title] |
#5 | Senile Paranoid Dementia.mp. [mp = text, heading word, subject area node, title] |
#6 | Dementias, Senile Paranoid.mp. [mp = text, heading word, subject area node, title] |
#7 | Paranoid Dementia, Senile.mp. [mp = text, heading word, subject area node, title] |
#8 | Paranoid Dementias, Senile.mp. [mp = text, heading word, subject area node, title] |
#9 | Senile Paranoid Dementias.mp. [mp = text, heading word, subject area node, title] |
#10 | Familial Dementia.mp. [mp = text, heading word, subject area node, title] |
#11 | Dementia, Familial.mp. [mp = text, heading word, subject area node, title] |
#12 | Dementias, Familial.mp. [mp = text, heading word, subject area node, title] |
#13 | Familial Dementias.mp. [mp = text, heading word, subject area node, title] |
#14 | #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 |
#15 | Wandering Behavior.mp. [mp = text, heading word, subject area node, title] |
#16 | Behavior, Wandering.mp. [mp = text, heading word, subject area node, title] |
#17 | #15 OR #16 |
#18 | #14 AND #17 |
#19 | limit #18 to yr = ”2016–2021“ |
Search | Query |
---|---|
#1 | “Dementia” [Mesh] |
#2 | Dementias [Title/Abstract] OR Amentia [Title/Abstract] OR Amentias [Title/Abstract] OR Senile Paranoid Dementia [Title/Abstract] OR Dementias, Senile Paranoid [Title/Abstract] OR Paranoid Dementia, Senile [Title/Abstract] OR Paranoid Dementias, Senile [Title/Abstract] OR Senile Paranoid Dementias [Title/Abstract] OR Familial Dementia [Title/Abstract] OR Dementia, Familial [Title/Abstract] OR Dementias, Familial [Title/Abstract] OR Familial Dementias [Title/Abstract] |
#3 | “Wandering Behavior” [Mesh] |
#4 | Behavior, Wandering [Title/Abstract] |
#5 | #1 OR #2 |
#6 | #3 OR #4 |
#7 | #5 AND #6 |
Limiters: Published Date: 20160101–20210630 |
Search | Query |
---|---|
#1 | ‘Dementia’/exp |
#2 | ‘Dementias’:ab,ti |
#3 | ‘Amentia’:ab,ti |
#4 | ‘Amentias’:ab,ti |
#5 | ‘Senile Paranoid Dementia’:ab,ti |
#6 | ‘Dementias, Senile Paranoid’:ab,ti |
#7 | ‘Paranoid Dementia, Senile’:ab,ti |
#8 | ‘Paranoid Dementias, Senile’:ab,ti |
#9 | ‘Senile Paranoid Dementias’:ab,ti |
#10 | ‘Familial Dementia’:ab,ti |
#11 | ‘Dementia, Familial’:ab,ti |
#12 | ‘Dementias, Familial’:ab,ti |
#13 | ‘Familial Dementias’:ab,ti |
#14 | #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 |
#15 | ‘Wandering Behavior’/exp |
#16 | ‘Behavior, Wandering’:ab,ti |
#17 | #15 OR #16 |
#18 | #14 AND #17 |
Limiters: Published Date: 2016–2021 |
Search | Query |
---|---|
#1 | (MM “Dementia”) |
#2 | TI(Dementias OR Amentia OR Amentias OR Senile Paranoid Dementia OR Dementias, Senile Paranoid OR Paranoid Dementia, Senile) OR AB(Dementias OR Amentia OR Amentias OR Senile Paranoid Dementia OR Dementias, Senile Paranoid OR Paranoid Dementia, Senile) |
#3 | TI(Paranoid Dementias, Senile OR Senile Paranoid Dementias OR Familial Dementia OR Dementia, Familial OR Dementias, Familial OR Familial Dementias) OR AB(Paranoid Dementias, Senile OR Senile Paranoid Dementias OR Familial Dementia OR Dementia, Familial OR Dementias, Familial OR Familial Dementias) |
#4 | (MM “Wandering Behavior”) |
#5 | TI(Behavior, Wandering) OR AB(Behavior, Wandering) |
#6 | #1 OR #2 OR #3 |
#7 | #4 OR #5 |
#8 | #6 AND #7 |
Limiters: Published Date: 201601–202106, Search modes: Boolean/Phrase, Apply related words, Full Text |
Search | Query |
---|---|
#1 | MeSH descriptor: [Dementia] explode all trees |
#2 | (Dementias OR Amentia OR Amentias OR Senile Paranoid Dementia OR Dementias, Senile Paranoid): ti,ab,kw |
#3 | (Paranoid Dementia, Senile OR Paranoid Dementias, Senile OR Senile Paranoid Dementias OR Familial Dementia OR Dementia, Familial): ti,ab,kw |
#4 | (Dementias, Familial OR Familial Dementias): ti,ab,kw |
#5 | #1 OR #2 OR #3 OR #4 |
#6 | MeSH descriptor: [Wandering Behavior] explode all trees |
#7 | (Behavior, Wandering): ti,ab,kw |
#8 | #6 OR #7 |
#9 | #5 AND #8 |
Limiters: Published Date: 20160101–20210630(Cochrane Reviews), 2016–2021(Trials) |
Appendix B
Study | Domain 1 (%) | Domain 2 (%) | Domain 3 (%) | Domain 4 (%) | Domain 5 (%) | Domain 6 (%) | Total Score Mean (SD) (%) | Overall Quality | Overall Recommendation | Quality |
---|---|---|---|---|---|---|---|---|---|---|
Futrell et al., 2014 [28] | 91.7 | 61.1 | 29.2 | 80.6 | 41.7 | 91.7 | 66.0 (26.5) | 4 | Recommended with modifications | Average |
Study | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | Q10 | Q11 | Overall Appraisal |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Husebo et al., 2020 [46] | Y | Y | Y | Y | U | U | U | U | U | Y | Y | Include |
Jensen et al., 2017 [27] | Y | U | Y | Y | U | Y | Y | Y | Y | Y | Y | Include |
Howes et al., 2021 [23] | Y | Y | Y | Y | Y | Y | Y | U | U | Y | Y | Include |
Study | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | Overall Appraisal |
---|---|---|---|---|---|---|---|---|---|---|
Bautrant et al., 2019 [25] | Y | Y | U | N | U | Y | Y | U | Y | Include |
Lau et al., 2019 [26] | Y | Y | U | N | U | Y | Y | U | U | Include |
Study | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | Q10 | Q11 | Overall Appraisal |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Sato et al., 2018 [47] | Y | Y | U | Y | Y | Y | Y | Y | Y | NA | Y | Include |
Bowen et al., 2018 [48] | Y | Y | Y | Y | Y | U | Y | Y | Y | U | Y | Include |
Study | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Overall Appraisal |
---|---|---|---|---|---|---|---|---|---|
Shih et al., 2017 [49] | Y | Y | Y | Y | Y | Y | Y | Y | Include |
Leung et al., 2020 [30] | Y | Y | U | U | U | U | U | Y | Include |
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---|---|---|
Alzheimer’s Disease International | https://www.alz.co.uk | The global |
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Dementia Australia | http://www.dementia.org.au | Australia |
Alzheimer’s Association | http://alz.org | USA |
Alzheimer’s Society | http://www.alheimers.org.uk | UK |
Hong Kong Alzheimer’s Disease Association | http://www.hkada.org.hk | Hong Kong, China |
Alzheimer’s New Zealand | http://www.alzheimers.org.nz | New Zealand |
Alzheimer’s South Africa | http://www.alzheimers.org.za | South Africa |
Dementia Singapore | http://alz.org.sg | Singapore |
Systematic Reviews (n = 3) | ||||
Study (Author, Year) | Study Type | Number of Publications Included (n) | Overall Appraisal a | |
1 | Husebo et al., 2020 [44] | Systematic Review | 34 | Include |
2 | Jensen et al., 2017 [27] | Systematic Review | 42 | Include |
3 | Howes et al., 2021 [23] | Systematic Review | 22 | Include |
Quantitative and Experimental Research (n = 6) | ||||
Study (Author, Year) | Study Type | Setting (Sample, n) | Overall Appraisal a | |
1 | Shih et al., 2017 [45] | Analytical cross-sectional study | Participants from dementia outpatient clinics of several hospitals and long-term care resource management centres in southern Taiwan (n = 184) | Include |
2 | Leung et al., 2020 [30] | Analytical cross-sectional study | Elders with dementia living in care and attention homes in Hong Kong (n = 65) | Include |
3 | Lau et al., 2019 [26] | Quasi-experimental study | Patients from a hospital-based geriatric memory clinic (n = 54) | Include |
4 | Bautrant et al., 2019 [25] | Quasi-experimental study | Patients aged 65 years or older (n = 19) | Include |
5 | Sato et al., 2018 [46] | Cohort study | People from three geriatric health service facilities (n = 242) | Include |
6 | Bowen et al., 2018 [47] | Cohort study | Older adults from a residential care facility (n = 26) | Include |
Guideline (n = 1) | ||||
Study (Author, Year) | Study Type | Overall Assessment b | ||
1 | Futrell et al., 2014 [28] | Guideline | Recommended with modifications | |
Recommended Practice, Evidence Summary, and Clinical Decision-Making (n = 5) | ||||
Study (Author, Year) | Study Type | |||
1 | JBI, 2021 [48] | Recommended practice | ||
2 | Koh, 2021 [49] | Evidence summary | ||
3 | Daniel Press, 2021 [50] | Clinical decision-making | ||
4 | Ariel B Neikrug et al., 2022 [51] | Clinical decision-making | ||
5 | Douglas P Kiel, 2022 [32] | Clinical decision-making | ||
Articles from the Alzheimer’s Society (n = 7) | ||||
Title | Date of Last Update | The Alzheimer’s Society | ||
1 | Wandering [52] | Dementia Australia | ||
2 | Wandering and getting lost: Who is at risk and how to be prepared [31] | 2020 | Alzheimer’s Association | |
3 | Home Safety [53] | Alzheimer’s Association | ||
4 | Keeping the home safe [54] | 2017 | Alzheimer’s South Africa | |
5 | Wandering [55] | Hong Kong Alzheimer’s disease association | ||
6 | Safer Walking [56] | 2019 | Alzheimer’s New Zealand | |
7 | How technology can help [57] | Alzheimer’s Society |
Feasibility | Degree of Completion | The Difference between Feasibility and Degree of Completion | ||
---|---|---|---|---|
M ± SD | M ± SD | t | p | |
Domain 2 Preventing excessive wandering | ||||
6 | 7.47 ± 2.625 | 7.47 ± 2.495 | 0.000 | 1.000 |
7 | 7.18 ± 2.622 | 7.59 ± 2.228 | –1.509 | 0.135 |
8 | 7.24 ± 2.993 | 7.41 ± 2.694 | –0.568 | 0.572 |
9 | 8.41 ± 2.258 | 8.58 ± 1.982 | –0.819 | 0.416 |
10 | 8.46 ± 2.119 | 8.30 ± 2.091 | 0.807 | 0.422 |
Domain 3 Promoting safe walking | ||||
11 | 8.64 ± 2.171 | 8.70 ± 1.973 | –0.231 | 0.818 |
12 | 8.63 ± 1.986 | 8.45 ± 2.036 | 0.935 | 0.353 |
13 | 7.80 ± 2.697 | 7.94 ± 2.228 | –0.577 | 0.566 |
14 | 8.41 ± 2.264 | 8.50 ± 2.036 | –0.357 | 0.722 |
15 | 7.21 ± 2.968 | 7.43 ± 2.754 | –0.776 | 0.440 |
Domain 4 Preventing PwD from going missing | ||||
16 | 7.37 ± 2.627 | 7.49 ± 2.615 | –0.386 | 0.700 |
17 | 7.38 ± 2.771 | 7.29 ± 2.627 | 0.288 | 0.774 |
18 | 7.36 ± 2.595 | 7.11 ± 2.721 | 0.800 | 0.426 |
19 | 7.47 ± 2.089 | 7.16 ± 2.649 | 1.168 | 0.246 |
20 | 7.21 ± 2.968 | 7.43 ± 2.754 | −0.776 | 0.440 |
21 | 8.36 ± 2.089 | 8.22 ± 2.114 | 0.756 | 0.452 |
Experts (n = 7) | |||
Professional Background | Working Unit | Seniority (Year) | |
1 | Clinical nurse assistant in dementia care | Institution | 30 |
2 | Social worker in geriatric and dementia care | College (Japan) | 38 |
3 | Geriatric psychiatrist | Hospital | 27 |
4 | Clinical nurse assistant in dementia care | Institution | 20 |
5 | Neurologist | Hospital | 17 |
6 | Specialist nurse in dementia care | Hospital | 23 |
7 | Specialist nurse in dementia care | Hospital | 10 |
End Users (n = 76) | |||
Participants | Number of Participants (n) | ||
1 | Health care professionals in hospitals | 16 | |
2 | Health care professionals in institutions | 8 | |
3 | Family members | 52 |
Recommendations | Levels of Evidence | Grades of Recommendations | |
---|---|---|---|
Domain 1 | Caregiver education | ||
1 | Wandering may provide physical exercise and social contact and improve appetite, but it can make PwD experience adverse outcomes such as physical injuries from falls and getting lost [46,47] | 3c | A |
2 | Ensure continuous supervision to prevent risky situations, as all PwD are at risk of becoming lost, including those who have never wandered before [26,28,48,50] | 2d | A |
3 | Physical restraint is an inappropriate intervention to prevent wandering, as it is considered to be ethically problematic [23,49] | / | B |
4 | Healthcare providers can choose high-tech strategies, including boundary alarm systems, monitoring systems, and electronic tracking devices for PwD, but the user’s privacy and autonomy should be respected [23,28,44,49,50,57] | 1c | B |
5 | When PwD become lost, a response plan including the following steps should be taken [31,50,52,56] | 4d | B |
- Contact local police immediately, provide information about PwD who got lost, and extend the search through social networks such as WeChat platforms and TikTok short video platforms | |||
- Search the house and the surrounding buildings immediately | |||
- The initial 6 to 12 hours of the search should cover an eight-mile radius around the location where he/she disappeared, concentrating on open, populated areas | |||
- If initial search efforts fail, intense foot searches should focus on natural and sparsely populated areas, beginning within a two-mile radius of the location where he/she disappeared and extending from there | |||
- Search strategies should not be based on personal characteristics and experiences | |||
- Searches should continue throughout the night if necessary | |||
- If PwD travelled by automobile or subway, initial search efforts should focus on locating his/her vehicle | |||
Domain 2 | Preventing excessive wandering | ||
6 | Listen to music chosen according to the patient’s preferences [27,28] | 2d | B |
7 | Provide opportunities to engage in social interactions or meaningful activities when PwD are most likely to wander, such as folding laundry, preparing dinner, receiving visitors, or participating in live violin recitals, depending on their ability [28,31,48] | 2d | B |
8 | Choose oversized clocks to hang in a prominent position in corridors [25] | 2d | B |
9 | Ensuring adequate light during the day (e.g., keeping the environment bright during the day and providing regular supervised exercise, such as walking after meals) helps to reduce wandering at night [25,28,45,48,50,51,55] | 1c | A |
10 | Keep the environment dark during the night, and eliminate unnecessary night-time awakenings (e.g., noise) [25,51] | 1c | B |
Domain 3 | Promoting safe walking | ||
Provide an environment as safe as possible | |||
11 | - Keep the floor clean and remove tripping hazards to promote safe walking, such as excessive clutter, loose mats, and extension cords [28,48,53,54] | / | A |
12 | - Minimise stressors from the environment, such as changes in daily routines and furniture arrangements [28,30] | 4b | B |
13 | Provide a secure place for PwD to exercise to reduce the risk of falls and fall-related injuries [28,31,47,52] | 3c | A |
Prepare for a walk | |||
14 | - Wear appropriate footwear and walk in the company of healthcare providers [26,50,54] | 2d | A |
15 | - Monitoring devices should be used to prevent injuries, such as alarm systems or automatic lights [27] | 1c | B |
Domain 4 | Preventing PwD from going missing | ||
Wayfinding cues may reduce disorientation | |||
16 | - Provide environmental cues to help PwD find their way, including photographs, posters and murals on walls, and extra-large signage, which should be salient and simple [27,28,30,48] | 4b | B |
17 | - Handrails in hallways installed throughout the house should be oriented, continuous, and conspicuous to support dementia patients’ mobility [30] | 4b | B |
Reduce attempts at exiting | |||
18 | - Take advantage of visual stop barriers to reduce attempts at exiting, including camouflaged doors, horizontal grids of black tape in front of exits, safety covers, and cloth of the same colour as the door in front of exit doors [27,28,31] | 2d | B |
19 | - Divert attention by using tactile boards, interactive walls, and 3D wall art [28] | 2d | B |
20 | - Use high-tech strategies, such as warning bells above doors, monitoring systems, and tracking devices with GPS [26,44,48,50,52] | 1c | B |
21 | Don’t leave PwD unsupervised [26] | 2d | A |
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Wang, J.; Zhang, G.; Min, M.; Xing, Y.; Chen, H.; Li, C.; Li, C.; Zhou, H.; Li, X. Developing a Non-Pharmacological Intervention Programme for Wandering in People with Dementia: Recommendations for Healthcare Providers in Nursing Homes. Brain Sci. 2022, 12, 1321. https://doi.org/10.3390/brainsci12101321
Wang J, Zhang G, Min M, Xing Y, Chen H, Li C, Li C, Zhou H, Li X. Developing a Non-Pharmacological Intervention Programme for Wandering in People with Dementia: Recommendations for Healthcare Providers in Nursing Homes. Brain Sciences. 2022; 12(10):1321. https://doi.org/10.3390/brainsci12101321
Chicago/Turabian StyleWang, Jing, Ge Zhang, Min Min, Ying Xing, Hongli Chen, Cheng Li, Caifu Li, Hanhan Zhou, and Xianwen Li. 2022. "Developing a Non-Pharmacological Intervention Programme for Wandering in People with Dementia: Recommendations for Healthcare Providers in Nursing Homes" Brain Sciences 12, no. 10: 1321. https://doi.org/10.3390/brainsci12101321
APA StyleWang, J., Zhang, G., Min, M., Xing, Y., Chen, H., Li, C., Li, C., Zhou, H., & Li, X. (2022). Developing a Non-Pharmacological Intervention Programme for Wandering in People with Dementia: Recommendations for Healthcare Providers in Nursing Homes. Brain Sciences, 12(10), 1321. https://doi.org/10.3390/brainsci12101321