Study sheds light on wandering risks

Dr Margaret MacAndrew, a nursing lecturer and former aged care nurse, spent hours following residents with dementia as they wandered, to see where they go and what they do. Her surprising findings will be used to develop a new intervention.

Dr Margaret MacAndrew
Dr Margaret MacAndrew. Photo: Erika Fish, QUT

Dr Margaret MacAndrew, a nursing lecturer and former aged care nurse, spent hours following residents with dementia as they wandered, to see where they go and what they do. Her surprising findings will be used to develop a new intervention.

During her time as a registered nurse in aged care, Dr Margaret MacAndrew saw her fair share of wandering.

“We had a lot of residents who exhibited this behaviour; they would go in and out of other people’s bedrooms,” she said.

Mostly it was considered “just a bit of an annoyance”, particularly when staff had to locate a resident.

But one day Dr MacAndrew witnessed a male resident being dragged from another resident’s bedroom after he had wandered into the room and lied down on his bed.

“He was dreadfully injured as a result,” she said.

That incident set her off on the search for guidance on how best to handle the risks posed by wandering – in particular, wandering into out-of-bounds or hazardous areas, such as other residents’ bedrooms.

“I found there were no evidenced- based management strategies, because it hadn’t previously been studied.”

Dr MacAndrew’s resulting study, conducted as part of her PhD at Queensland University of Technology, aimed to understand the characteristics of “wandering related boundary transgression” or “intrusive wandering behaviour” so that an intervention could be developed.

Through her many conversations with staff and families as part of her research, it became clear that wandering and the resulting intrusions were very common behaviours in residential aged care. It was seen all the time, and it was very time consuming for staff.

Dr MacAndrew told Australian Ageing Agenda:

“It was very challenging for staff to manage because they could not tell on what occasions this intrusive behaviour was going to cause problems. It was very hard for them to know how to manage it, and there weren’t any clear guidelines for them to use.”

A frequent observation from staff was that tensions and incidents arose when people wandered into other residents’ bedrooms when they were present. “That’s where you had the verbal and physical abuse occurring,” she said.

Staff reported they were unable to tell when that would occur, and that uncertainty was potentially dangerous in their opinion.

Wandering: what really happens          

But when Dr MacAndrew walked with seven residents who wandered, she found they went into harm’s way much less frequently than staff had feared.

“Of the 36 and a half hours observation time we had, I found only 5 per cent of that time was spent in another person’s private space, predominantly their bedroom.

“Certainly as the staff had indicated, when the other resident wasn’t in their room it didn’t cause a problem, but when they were there I did observe outcomes for both the person with dementia and the resident who had their private space invaded.”

Significantly, Dr MacAndrew said her study revealed which residents might be more at risk of the type of wandering that created tension, and where it was most likely to occur.

“Wandering out of bounds is most likely to occur in residents who are more mobile, and those who have more random patterns of walking.

“Also, the time of highest potential for intrusion is during a person’ peak activity periods, which are highly individual,” she said.

New intervention in development

Dr MacAndrew was recently awarded a grant from the Dementia Collaborative Research Centre: Carers and Consumers to trial an intervention she has developed based on her research as well as her conversations with aged care managers and people living with dementia and their carers.

“From that I’ve developed a walking-based program that will be supervised. The interventionist will take these people for a 30 to 40 minute walk immediately before their peak ambulation period.

“We’re not looking at stopping them walking, it’s having it done within safe limits to try and reduce the risky aspects of this behaviour,” she said.

Tags: dementia, dr margaret macandrew, intervention, privacy, queensland-university-of-technology, resources, risk-management, slider, wandering,

1 thought on “Study sheds light on wandering risks

  1. A new aged care algorithm…

    5.2 hrs x 7 residents + 1 conclusion (mobile residents are mobile) = 1 PhD/Research Grant

    OK Christopher Pyne, you win

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