Professional Documents
Culture Documents
net/publication/6719140
Article in The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists · September 2006
DOI: 10.4140/TCP.n.2006.608 · Source: PubMed
CITATIONS READS
18 162
2 authors:
All content following this page was uploaded by Jeannette Wick on 04 June 2016.
and they may secure a vehicle of not wandering-related injuries or The latter is particularly signifi-
some sort. Often, they get lost. comorbid diseases. cant. An analysis4 found that in 53%
Outcome correlates closely with Facility factors also contribute to of cases, staff were ignorant of the
the length of time the patient has elopement. A recent study associated elopement until contacted by out-
wandered; 24 hours appears to be elopement with: siders who found the patient. In
! Verbally desiring to engage in a past practice (e.g., visit a relative) ! It is not caused by preventable
reasons
! The behavior is causing resi-
Source: Reference 14.
dents to present a danger to them-
selves or others and is not being
some instances the patient was ments. He says, “Caregivers and adequately managed
nearby or gone only minutes; never- families need to know that 72% ! If they continuously scream,
theless, it is a disturbing finding.The of patients who elope once will yell, or pace and these behaviors
same study found four major trends attempt to do it again.” Moseley cause an impairment in functional
associated with ineffective alarm elaborates, “The most important capacity
systems: residents interfered with factor is getting accurate informa- Wandering that does not cause
the alarm; the alarm was inaudible tion during the admissions process. a danger to residents or others
to staff; staff ignored the alarm, Sometimes families are reluctant to is never an indication for an
believing they knew who just left give accurate information, but it’s antipsychotic.1,5
the unit; or the alarm was turned essential to know if the resident has Most programs typically employ
off or malfunctioned. a history of wandering or elope- one or more strategies:
ment.” Staff must take any state- ! Physical environment modifica-
Resident Risk ment indicating a desire to leave the tion (e.g., disguising exits, circular
Mark L.Warner, an architect and facility or engage in retired past pathways in the unit)6
gerontologist, has made a career of practices (e.g., “I need to go back to ! Creating program units
trying to understand the machina- work”) seriously, especially during specifically for wanderers
tions of the mind when people with the first few days after admission. ! Monitoring patients and
dementia wander. He has reviewed Several triggers (see Table 1) are environment electronically with
police reports, newspaper articles, associated with individual wander- bracelets, door alarms, and closed
and case reports that describe ing and should be addressed pre- circuit monitors
wanderers who found themselves emptively, with close monitoring. Because spatial disorientation
in predicaments incomprehensible correlates strongly with wandering,
to their decaying minds. He has Prevention environmental cues are critical.The
tried to identify clues that did or Historically, clinicians often used wanderer’s response to directional
might prevent wanderers from physical restraints to prevent wan- cues is often impaired.When they
falling or succumbing to the ele- dering.Today, regulations prohibit see a dock, it looks like a path—
that it has an abrupt end does not sugar packets. Knowing that prompt- who coordinates a search of the inte-
register. Place large signs on bath- ed first responders to successfully rior of the home for 15 to 30 min-
room doors to avoid searching for intensify their search when they utes. Stage 2 (a search of the grounds
toilets. Railings are good directional found a stray packet by a lake. and a call for additional help) might
cues. Use pictures on resident doors The second is an example of how begin at 15 to 30 minutes, or sooner
and above each resident’s bed. If pos- stress can cause family to omit if clues indicate that the resident has
sible, eliminate items suggesting important information when briefing left. After 15 minutes, Stage 3 would
travel, like coats and hats. Some authorities. He tells of
facilities design walking paths with an elderly woman who
interesting object and spatial cues for called the ambulance
safe wandering.14 Units without alarm because her sister had
systems need childproof doorknob a heart attack. Stress
covers or other safety devices, and was a factor in her
one staff member should be respon- inability to tell respon-
sible for resident surveillance and ders her sister’s name,
accountability. thus impeding the
search. Long-term
Policy on Wandering care staff should docu-
Most facilities consider their policies ment the answers to
proprietary and are unwilling to questions described in
share them, but several did provide Table 2 and have them
copies for this article. Effective pre- ready for first respon-
vention and training involves all staff, ders. In anticipation of
including dietary workers, beauti- a successful outcome,
cians or barbers, housekeeping per- searchers should
sonnel, and facility staff. All staff
should rehearse the rescue plan to
assemble a box of
photos or belongings
Statistics are sobering: of
be invoked once elopement occurs, that the resident will
using drills or mock elopements recognize and enjoy. wanderers located after 24
at least annually, and if possible, Define search and
more often.
According to Warner, whose book,
rescue processes in
stages or phases, indi-
hours, 46% are found dead.
In Search of the Alzheimer’s Wanderer, cating who will be
was published by Purdue University involved, the exact Only 20% of those located after
Press in September 2005, “It is areas to be searched,
incredible how many clues wander- and a reasonable time 72 hours are found alive.
ers leave, and how often caregivers frame that the stage or
and loved ones omit important clues phase will last. Stage
when briefing first responders.” He 1, for example, may
cites two examples. In the first, the involve notifying the
wanderer was a hoarder of blue director of nursing
Table 2. Facts to Know About a Resident Who May Elope can walk right past them and then
expand the search.”
! What does the resident enjoy, and what upsets him? Family members may be angry if
! What names do the resident’s loved one use to address him? they are not notified immediately,
but the patient’s whereabouts
! What topics does the resident enjoy discussing?
and welfare must be the primary
! Does the resident respond better to women or men? Do uniforms concern. Long-term care manage-
or any other traits frighten the resident? ment coordinates searching with
! Who is the resident’s best friend?
first responders (police, fire, or
other agencies); maintaining recent
! Did the resident work or live in the area? photographs of all residents helps
! If the resident recently lost a pet, what kind was it? searchers unfamiliar with the resi-
dent identify him or her. Engaging
! If the resident lost a relative, what was their relationship?
law enforcement personnel is not
! What item does the resident always have in his possession? permission for long-term care
staff to stop searching.They must
re-search areas close to the facility
while the search expands.
n Elopement policies must also
indicate when and how to involve
Table 3. Who Should Be involve notifying local police and a the media. A flurry of premature
Notified if a Resident Elopes? chain of other internal and external coverage is unnecessary, but if the
notifications (see Table 3). authorities have been notified and
! Facility director or administrator Searchers should remember the resident’s life is in danger, the
! Medical director (in a nursing home) that the wanderers will use their media can be an ally that increases
remaining resources, (vision, smell, the likelihood of success.The
! Police
money), sometimes successfully elopement policy should indicate
! Physician and sometimes not.They will who will call the media and how
! Family member/responsible party
react in the usual way to change, they will present the information.
so when the elevation changes, A good policy:
! Executive director they will take the path of least ! Is facility- and locale-specific,
3. Algase DL.Wandering in dementia. In ing home residents. J Am Geriatr Soc ions). Alzheimer’s disease and related disorders,
Fitzpatrick JJ (ed.): Annual review of nursing 2003;51:1213-8. wandering incident: planning and response.
research. New York, NY: Springer; 1999. 10.Vieweg V, Blair CE,Tucker R et al. Factors Available at http://www.dbs-sar.com. Accessed
4. Aud MA. Dangerous wandering: elopements precluding patients’ discharge to the communi- April 25, 2005.
of older adults with dementia from long-term ty. A geropsychiatric hospital survey.Va Med Q 15. American Society of Consultant
care facilities. Am J Alzheimers Dis Other 1995;122:275-8. Pharmacists.The consultant pharmacists hand-
Demen 2004;19:361-8. 11. Koester R, Stooksbury D. Lost Alzheimer’s book. Alexandria,VA: American Society of
5. Algase DL, Beattie ER, Bogue EL et al.The subjects—profiles and statistics. Response Consultant Pharmacists; 2004.
Algase Wandering Scale: initial psychometrics of 1992;11:20-6.
a new caregiver reporting tool. Am J 12. Search and Rescue Research (dbS
Alzheimers Dis Other Demen 2001;16:141-52. Productions). Alzheimer’s
6. Logsdon RG,Teri L, McCurry SM et al. disease and related disor-
Wandering: a significant problem among com- ders, wandering overview.
munity-residing individuals with Alzheimer’s Available at http://www.
disease. J Gerontol B Psychol Sci Soc Sci dbs-sar.com. Accessed April
1998;53:294-9. 25, 2005.
7. Lucero M, Hutchinson S, Leger-Krall S et al. 13. Search and Rescue
Wandering in Alzheimer’s dementia patients. Research (dbS
Clin Nurs Res 1993;2:160-75. Productions). Alzheimer’s
8.Walsh JS,Welch HG, Larson EB. Survival of disease and related
outpatients with Alzheimer-type dementia. Ann disorders, wandering char-
Intern Med 1990;113:429-34. acteristics. Available at
9. van Doorn C, Gruber-Baldini AL, http://www.dbs-sar.com.
Zimmerman S et al. Epidemiology of dementia Accessed April 25, 2005.
in nursing homes research group. Dementia as a 14. Search and Rescue
risk factor for falls and fall injuries among nurs- Research (dbS Product-