ArticlePDF AvailableLiterature Review

Wandering and dementia

  • Hospital of Versilia
  • Azienda Sanitaria Locale Pisa

Abstract and Figures

Wandering represents one of many behavioural problems occurring in people with dementia. To consider the phenomenon of wandering behaviour in demented patients, we conducted searches using Medline and Google Scholar to find relevant articles, chapters, and books published since 1975. Search terms used included 'wandering', 'behavioural and psychological symptoms', 'dementia', 'nursing', and 'elopements'. Publications found through this indexed search were reviewed for further relevant references. The term 'wandering' covers different types of behaviour, including aimless movement without a discernible purpose. It is associated with a variety of negatives outcomes. The aetiology of wandering is poorly understood and it remains an unsolved riddle. Wandering is an acutely distressing problem worldwide, both for the patients and caregivers, and it is a major reason for nursing home admission. Evidence on the effectiveness of pharmacological and non-pharmacological interventions is limited. It is possible that management of coexistent psychopathology would help to ameliorate this problematic behavioural disorder.
Content may be subject to copyright.
Wandering and dementia
Gabriele CIPRIANI, Claudio LUCETTI, Angelo NUTI and Sabrina DANTI
Neurology Unit, Hospital of Viareggio, Lido di
Camaiore, Lucca, Italy
Correspondence: Dr Gabriele Cipriani MD,
Department of Neurology, Versilia Hospital, Via
Aurelia, Lido di Camaiore, Lido di Camaiore, 55060
Lucca, Italy. Email:
Received 2 October 2013; revision received 10 January
2014; accepted 21 January 2014.
Wandering represents one of many behavioural problems occurring in
people with dementia. To consider the phenomenon of wandering behaviour
in demented patients, we conducted searches using Medline and Google
Scholar to find relevant articles, chapters, and books published since 1975.
Search terms used included ‘wandering’, ‘behavioural and psychological
symptoms’, ‘dementia’, ‘nursing’, and ‘elopements’. Publications found
through this indexed search were reviewed for further relevant references.
The term ‘wandering’ covers different types of behaviour, including aimless
movement without a discernible purpose. It is associated with a variety of
negatives outcomes. The aetiology of wandering is poorly understood and it
remains an unsolved riddle. Wandering is an acutely distressing problem
worldwide, both for the patients and caregivers, and it is a major reason for
nursing home admission. Evidence on the effectiveness of pharmacological
and non-pharmacological interventions is limited. It is possible that man-
agement of coexistent psychopathology would help to ameliorate this prob-
lematic behavioural disorder.
Key words: behavioural and psychological
symptoms (BPSD), dementia, elopements, nursing,
Dementia as a clinical syndrome is characterized
by global cognitive impairment, which represents a
decline from previous levels of functioning. It is asso-
ciated with impairment in functional abilities and,
in many cases, behavioural and psychiatric distur-
bances. Wandering is a frequent behavioural disorder
in demented patients and one of the most exhausting
for caregivers.1The term ‘wandering’ describes a
series of different behaviours based on the attributes
walking and locomotion.2Although wandering is com-
monly recognized clinically, lack of a standard defini-
tion has been a persistent problem. In addition, the
term ‘wandering’ is often conflated within agitated
behaviour.3It is frequently used in the literature as a
broad term encompassing a diverse set of behaviours
(Table 1), but most researchers and health-care
providers agree that wandering refers to seemingly
aimless or disoriented ambulation throughout a facil-
ity, often with observable patterns such as lapping,
pacing, or random ambulation.21,24 Only two features
among various definitions of wandering seem to be
common to all: those of an individual moving through
space and of being cognitively impaired.25 In 2007,
a team of researchers proposed the following defini-
tion of wandering: ‘a syndrome of dementia-related
locomotion behavior having a frequent, repetitive,
temporally-disordered, and/or spatially-disordered
nature that is manifested in lapping, random, and/or
pacing patterns some of which are associated with
eloping, eloping attempts, or getting lost unless
accompanied’.15 Although mobility is a prerequisite for
wandering, caregivers may not recognize that it can
occur when residents use alternative modes of mobil-
ity, including assistive devices (e.g. walker or cane) or
wheelchairs (propelled forward or backward).18
A 2006 study reported that one in five people with
dementia wander,26 but estimates of the prevalence
of wandering vary, with rates having been reported
as 17.4% in community-residing seniors,27 50% in
severe dementia,29 and 63% in community dwellers.29
Peak incidence of ambulation in the nursing home
doi:10.1111/psyg.12044 PSYCHOGERIATRICS 2014; ••: ••–••
1© 2014 The Authors
Psychogeriatrics © 2014 Japanese Psychogeriatric Society
Table 1 Varying definitions of wandering published in the scientific literature upon the last 30 years
Type of
Category of
definition Definition of wandering Main topic of article
Applied to
Cohen-Mansfield &
Billig (1986)4
O Challenging behaviour A type of challenging behaviour with a manifestation of agitation Conceptual framework of agitation Not only
Hope & Fairburn5O Spectrum of
Wide range of distinct behavioural abnormalities Descriptive typology of wandering Not only
Allan2C Acts of locomotion Series of types of behaviour based on the attributes walking and
Management of wandering Yes
Morris et al.6C Behavioural symptom Locomotion with no discernible, rational purpose; may be manifested by
walking or by wheelchair
Assessment and management of wandering Yes
Matteson & Linton7O Challenging behaviour The most difficult aimless behaviour to menage in demented patients Aetiological factors and factors related to
Coltharp et al.8C Goal-directed
The natural consequence of a search for something that becomes
threatening for people with dementia
Causes and management of wandering Not only
Kiely et al.9O Challenging behaviour Serious problem for nursing home staff and wanderers Risk factor and causes of wandering Yes
Maher10 C Goal-directed
A motor behaviour driven by an intention not always understood by
Revising the definition of wandering and its
Not only
Lai & Arthur11 O Spectrum of motor
A multitude of behaviours, frequently aimless, charateristic of cognitively
impaired individuals that moving through space
Integrative review and meta-analysis of
wandering in subjects with dementia
Not only
Rowe & Bennet12 O Challenging behaviour Significant behavioural problem in dementia different from becoming lost in
the community
Consequences of wandering Not only
Silverstein & Flaherty13 C Challenging behaviour A common life-threatening behaviour associated with Alzheimer’s disease
and related disordes
Costs and consequences of wandering and
its management
Dewing14 C Acts of locomotion A complex and necessary activity for many persons with dementia Screening tools for wandering Not only
Algase et al.15 O Acts of locomotion A form of locomotion, most often walking, with a frequency or rate that can
be problematic in people with dementia
Finding a standardized definition of
Not only
Marcus et al.16 C Challenging behaviour A major issue in the behavioural management of Alzheimer’s disease that
often places patients at great risk
Assessment of wandering Not only
Robinson et al.17 O Spectrum of motor
A wide range of agitated behaviours common in people with dementia that
may be beneficial (i.e. form of exercise) but also harmful
Management of wandering Not only
Schonfeld et al.18 O Challenging behaviour Seemingly aimless or disoriented ambulation throughout a facility often with
observable patterns such as lapping, pacing, or random ambulation
The factors associated with male residents
who wander and the extent of this
Algase et al.19 O Challenging behaviour Wandering pattern is a specific clinical phenomenon, deals with a discrete
behaviour within a limited class of motor behaviours (i.e. walking), also
reflected within but not exclusively byphysically nonaggressive agitation
Definition of wandering Not only
Rowe et al.20 O Challenging behaviour Unique locomotion behaviour characterized by repeated and frequent
activity with temporal and spatial disorientation that is conceptually
different from missing incidents
Definitions and management of wandering Not only
Carr et al.21 O Challenging behaviour Challenging behaviour for caregivers of individuals with dementia who may
become lost and find themselves in dangerous situations
National health policy and consequences of
Not only
Volicer et al.22 O Acts of locomotion Aimless motor activity that is not always undesiderable but sometimes has
adverse consequences, that can increase caregiver distress, and that
may be a symptom of agitation; Possible to distinguish patients with
modifiable wandering from those whose wandering is not
Relationship between wandering and
residential activities
The Task Force on the
Effect of Alzheimer’s
Disease in Arkansas23
C Motor behaviour To move about without a definite destination or purpose; less commonly
moving with a goal
National health policy and consequences of
Not only
C, clinical definition; O, operational definition.
G. Cipriani et al.
2© 2014 The Authors
Psychogeriatrics © 2014 Japanese Psychogeriatric Society
occurs between 5 p.m. and 7 p.m.30 Variation is partly
accounted for by the variety of definitions used and
the differing time periods covered. Sink et al. studied,
the prevalence of dementia-related behaviours in
a large, multiethnic sample of community-dwelling
patients with moderate to severe dementia.31 They
observed that wandering was the most prevalent
dementia-related behaviour within each of three
ethnic groups: White (58%), Black (67%), and Latino
(63%) Americans. After multiple confounds were con-
trolled, increased risk of wandering was found for
Blacks (odds ratio =1.40; 95% confidence interval =
1.08–1.81; P=0.012) and Latinos (odds ratio =1.59;
95% confidence interval =1.21–2.26; P=0.009).
In a study performed in a long-term care service,
wandering was the second most frequently reported
behaviour problem.32 Wanderers and non-wanderers
do not differ by gender or age.33 Some consider
pacing more prevalent in men.9,27 Consistent with
some studies, use of antipsychotic medication was
also associated with greater chance of being classi-
fied as a wanderer.9,18 Colombo et al. studied an
inpatient special care dementia unit and found that
wanderers (51% of the sample) were somewhat
younger (76.4 vs. 80.5 years old) than non-
wanderers.34 Furthermore, 70% of the caretakers see
wandering as a risk for the care of the patients.35
The aetiology of wandering is poorly understood and
it remains an unsolved riddle. Three major approaches
can be identified from the literature: biomedical, psy-
chosocial and person–environment interaction. A bio-
medical hypothesis involves right parietal dysfunction,
positing that a functionally impaired neural circuit
leads to wandering.11 Wandering might also result
from dysfunction in spatial perception and memory.11
Another approach has been to focus on impairments
in visual attention and an inability to perceive radial
motion of optic flow as the basis for wandering in
some Alzheimer’s disease (AD) patients.36,37 Lateral
asymmetric hypoperfusion is frequent during AD and
generally more pronounced on the left side, but its
consequences are not well known. However, wander-
ers have a more severely reduced regional cerebral
blood flow in the left temporalparietal region than AD
subjects without wandering behaviour.38 Based on
positron emission tomography, Meguro et al. reported
that wandering patients with AD showed decreased
frontotemporal glucose utilization and decreased
dopamine metabolism in the striatum.39 Like other
complex repetitive routines, wandering may also
result from or be facilitated by aberrant motor plans
and more elementary behaviours than disinhibited
motor programmes.40 Circadian rhythm disturbances,
particularly sleep disturbances, have also been inves-
tigated as a basis for wandering.37 Monsour and Robb
studied the lifestyle of 22 matched pairs of wanderers
and non-wanderers, and found that wanderers had a
higher motor reaction to stress and a more motor
behavioural style earlier in life than non-wanderers.41
From a psychosocial perspective, unmet needs
and environmental factors can also contribute to wan-
dering risk: the aberrant behavioural symptom can
emerge when internal discomfort, especially when
coupled with external demands (e.g. a noisy environ-
ment), exceed the individual’s threshold.42 Dementia
patients with unmet physical or psychosocial needs,
such as the need for toileting assistance or the need
to find a place of safety or someone familiar, may be
more prone to wandering. Three psychosocial factors
were identified as possibly influencing wandering: life-
long pattern of coping with stress, previous work
roles, and a need to search for people or places asso-
ciated with security.43 Clinical observations support
the inference that certain emotions and behaviours in
dementia are associated.44 According to Lee et al.,45
positive emotional expression is positively related to
wandering rates, whereas negative emotional expres-
sion and higher cognitive status were negatively
related to wandering rates after controlling for other
predictors (age, education, gender, facility type,
mobility, and time of day). They noted that one pos-
sible explanation for these results is that persons with
dementia who are sad or angry may respond by sitting
alone or staying in their rooms for periods, rather than
walking around. In contrast, demented patients who
are happy or experiencing pleasant emotions may
respond to this state by engaging in physical activity
such as walking around.
Wandering behaviour sounds innocent enough, but it
quickly takes on special meaning: adverse outcomes
associated with this aberrant behaviour include acci-
dents, getting lost,46 malnutrition because the patients
are unable to sit down for meals and because exces-
sive wandering significantly increases their caloric
3© 2014 The Authors
Psychogeriatrics © 2014 Japanese Psychogeriatric Society
requirements,1weight loss,47 fatigue, sleep distur-
bance,48 social isolation,49 earlier institutionalization,42
and injury.50 Wanderers fall thrice as much as non-
wanderers, (with statistical significance according
to various statistical tools, especially non-parametric
ones); over a 3-month observation, wanders fell 1.6
times compared to non-wnaderer’s 0.6 falls.34
Wick and Zanni reported that nursing home resi-
dents who wander have double the risk of fracture
compared with residents who do not wander.26 Wan-
dering behaviour has been shown to be a key deter-
minant of patient’s death.51 For example, Kibayashi
and Shojo reported two cases of fatal accidental
hypothermia in an 89-year-old woman and a 76-year-
old man who were found dead and unclothed; in both
cases, wandering due to AD was determined as the
cause.52 In a facility, wandering may result in an activ-
ity that is undesirable (e.g. entrance into another
resident’s room) that results in resident-to-resident
violent incidents or may prevent desirable caregiving
activity (e.g. eating and toileting).22,53 Wandering may
elicit the use of restraints or excess sedation.54 It
has also been reported to require costlier care.55 Wan-
dering can lead to an increase in caregiver stress
and safety concerns that challenge care providers
responsible for managing behaviour problems.34
Furthermore, it causes problems in the hospital
Wandering correlates with the severity of cognitive
impairment,56 problems in recent and remote memory,
orientation to time and place, and the ability to
respond appropriately to a given conversation topic.55
According to Hope et al.,57 wandering behaviour
occurs in patients who have scored 13 or less on the
Mini-Mental State Examination and it lasts for a period
of several years. Conversely, functional impairment,
especially as it reflects ability to walk, limits who
can wander, and relatively preserved activities of
daily living was closely associated with wandering
behaviour.58 Patients with AD are more likely to be
wanderers than those with a vascular dementia
(VaD).59 Data from a sample of 1312 patients revealed
that wanderers constituted 26% of AD patients and
18% of VaD patients.60 For both diagnoses, rates were
low (12% and 9%) in the early stages and higher (37%
and 28%) as each disease progressed to the later
stages. Klein et al. replicated this trend in the moder-
ate and severe range of dementia: of the 638
community-residing dementia patients examined, 111
(17.4%) had exhibited wandering behaviour.27 The fre-
quency of wandering varied within each severity range
of dementia for patients with AD, VaD, and other types
of dementia. Patients diagnosed with AD were overall
significantly more likely to wander than those with VaD
or other types of dementia, although this difference
did not achieve statistical significance within indi-
vidual severity ranges. The frequency of VaD did
not significantly differ between wanderers and non-
The close relationship between wandering and
severe cognitive dysfunction is transcultural.61 A
wide range of behavioural abnormalities have been
reported in frontotemporal dementi,a including repeti-
tive behaviours.62 They occur in the verbal domain in
the form of stereotyped use of words or phrase, and
in the motor domain as wandering and pacing.63,64
Patients with dementia with Lewy bodies (DLB) share
many clinical signs and symptoms with patients diag-
nosed with AD, but according to Knuffman et al.,65
patients with DLB have a higher incidence of wander-
ing. However, according to Chiu et al.,64 AD and DLB
patients have a similar proportion of activity distur-
bances (i.e. purposeless activity, wandering and
inappropriate activities) when considered altogether.
Despite this, to the best of our knowledge, there have
been no systematic studies about wandering in
frontotemporal dementia and in DLB.
Lachs et al. suggested that wandering is more
common among delusional than in non-delusional
patients.66 According to Hope et al.,57 there is a cor-
relation between persecutory ideas and increased
walking, a correlation between persecutory ideas and
attempts to leave home, a correlation between perse-
cutory ideas and aimless walking and a weaker rela-
tionship between hallucinations and increased walk-
ing. Anxious states may justify wandering behaviour:
an anxious resident may move about in an effort to
relieve anxiety, discomfort, or unsettled state, but
such motivation may be unknown to observers, so the
movement may be perceived as aimless.9
Moderate to severe depression was found more
frequently in demented wanderers.27 Lyketsos et al.
G. Cipriani et al.
4© 2014 The Authors
Psychogeriatrics © 2014 Japanese Psychogeriatric Society
found an association between major depression
and wandering in Alzheimer’s dementia outpatients.67
Consistent with the findings of a previous study,68
Schonfeld et al. observed that being classified as
a wanderer was found to be associated with other
disruptive activities such as socially inappropriate
behaviour and resisting care.18 Wandering and delu-
sions were the only clinical predictors of aggressive
behaviour in a case mix of Alzheimer’s patients.69
Negative behaviours associated with wandering
include non-aggressive agitation, screaming and
calling out, physical aggression, and disturbed night-
time sleep.34,70 With regard to the premorbid charac-
teristics and wandering behaviour of persons with
dementia, Song and Algase’s research revealed that
premorbid extroversion and premorbid negative ver-
balization stress response are significant negative
predictors of wandering.71
Of all the behavioural symptoms associated with
dementia, wandering is one of the most problematic
from the perspective of patient management and
safety. The first step in any systematic investigation of
wandering involves reliable and valid measurement of
the phenomenon. A psychometric instrument admin-
istered to caregivers, the Algase Wandering Scale,
has been developed to characterize a given patient’s
tendency to wander.72 It is a 28-item questionnaire
examining the pattern and rhythm of wandering.
Interrater reliability results were not provided but were
reported as moderately strong. To the extent possible
with current assessment strategies, clinical evaluation
is important in distinguishing wandering from similar
behavioural problems such as anxiety, agitation due
to depression, hypomania, and medication-related
mobility disorders (e.g. akathisia).18 Accurate and
prompt diagnosis of underlying psychiatric, physical,
or iatrogenic conditions that may be triggering and
maintaining wandering is essential.
Traditional management comprised physical barri-
ers and physical restraints, but a new ethos in the
management of wandering has evolved with a move
towards promoting safe walking rather than prevent-
ing wandering; this aims to balance a person with
dementia’s need for autonomy with the need to
minimize risk.73 Overall, programmes implemented to
reduce use of physical restraints have not resulted in
greater harm or injury to residents.74 A wide range of
intervention studies are reported, but these are often
weakened by poor conceptualization and design.
Robinson et al. performed a systematic review to
evaluate the effectiveness of these interventions and
to assess acceptability associated with their use.73
They concluded that there is currently no adequate,
robust evidence from controlled trials to recommend
the use of any non-pharmacological intervention to
reduce wandering in dementia; the authors added
that, from both a practical and moral perspective,
acceptable interventions included walking/exercise
and music therapy. Hermans et al. evaluated the
effectiveness and safety of non-pharmacological
interventions in reducing wandering in the domestic
setting.75 As no randomized controlled trials were
found, no results could be reported. According to
Schonfeld et al.,18 use of interventions such environ-
mental alterations and social therapeutic activities
may help create a safe and pleasant environment for
staff and residents while delivering meaningful pro-
gramming to people with dementia who wander. A
walking programme for physically active persons with
severe dementia reduced interpersonal tension on the
dementia unit of a nursing home.76
Miskelly tested a system of electronic tagging
using an electronic bracelet on patients with dementia
and wandering in three different scenarios: for 4
weeks in two wards at a large teaching hospital, 6
months in a medium-sized residential home, and 8
weeks in clients’ own homes in the community.77 The
equipment had excellent performance and demon-
strated none of the inadequacies of earlier studies.78
However, even when technology is successfully
applied, there are substantial ethical issues to be
addressed that have already generated considerable
controversy.79 The risks and restrictions of alternatives
to tagging, including the loss of privacy entailed
in benign surveillance, should be kept in mind.79
Also recently it was discussed whether patients
with dementia who wander should be electronically
tagged.80,81 Nishigaki et al. developed a support
system that employs image processing technology
based on fluorescent dye that is painted in a simple
shape on the clothes of an elderly person.82 The aim
of this technology is to prevent elderly people with
dementia from wandering. The fluorescent colour
becomes visible by irradiation with a long wavelength
of ultraviolet light. Then, a 3-D video camera was used
to acquire a 3-D image and detect the simple shape.
5© 2014 The Authors
Psychogeriatrics © 2014 Japanese Psychogeriatric Society
Several medications are used on residents who
exhibit undesirable wandering, but strong evidence
for their effectiveness is lacking and they can produce
undesirable side-effects.84 According to Meguro
et al.,84 risperidone has some benefit over placebo in
reducing wandering, but it increases fall risk. It has
the antagonistic potency of serotonin and dopamine
Although definitions vary, most researchers and
health-care providers agree that wandering refers to
seemingly aimless ambulation, often with observable
patterns such as lapping, pacing, or random
ambulation. It is one of the most frequently encoun-
tered dementia-related behavioural disturbances and
has been associated with negative consequences
such as higher morbidity and mortality. It can pose very
severe problems in caring for people with dementia.
The basis of wandering is multifactorial; biomedical,
psychosocial and person–environment factors must
be considered. These factors encompass personal
needs, both physical and emotional, and physical
and social aspects of the environment. Evidence on
the effectiveness of pharmacological interventions is
limited. High-quality studies, preferably randomized
controlled trials, are needed to determine the clinical
and cost-effectiveness of non-pharmacological inter-
ventions that allow safe wandering and that are con-
sidered practically and ethically acceptable by carers
and people with dementia.
1 Rolland Y, Gillette-Guyonnet S, Nourhashemi F et al. Wandering
and Alzheimer’s type disease. Descriptive study. REAL.FR
research program on Alzheimer’s disease and management.
Rev Med Interne 2003; 24: 333s–338s.
2 Allan K. Dementia in acute units: wandering. Nurs Stand 1994;
9: 32–34.
3 Cohen-Mansfield J, Werner P, Marx MS. The social environment
of the agitated nursing home resident. Int J Geriatr Psychiatry
1992; 7: 789–798.
4 Cohen-Mansfield J, Billig N. Agitated behaviors in the elderly. I.
A conceptual review [Review]. J Am Geriatr Soc 1986; 34: 711–
5 Hope RA, Fairburn CG. The nature of wandering in dementia—a
community based study. Int J Geriatr Psychiatry 1990; 5: 239–
6 Morris J, Murphy K, Nonemake S. Long Term Care Resident
Instrument User’s Manual. Baltimore, MD: Health Care Financ-
ing Administration, 1995.
7 Matteson MA, Linton A. Wandering behaviors in institutionalized
persons with dementia. J Gerontol Nurs 1996; 22: 39–46.
8 Coltharp W Jr, Richie MF, Kaas MJ. Wandering. J Gerontol Nurs
1996; 22: 5–10.
9 Kiely DK, Morris JN, Algase DL. Resident characteristics asso-
ciated with wandering in nursing homes. Int J Geriatr Psychiatry
2000; 15: 1013–1020.
10 Maher LA. Wandering. Repaving the way you think. Contemp
Longterm Care 2001; 24: 8–10.
11 Lai CK, Arthur DG. Wandering behaviour in people with demen-
tia [Review]. J Adv Nurs 2003; 44: 173–182.
12 Rowe MA, Bennet V. A look at deaths occurring in persons with
dementia lost in the community. Am J Alzheimers Dis Other
Demen 2003; 18: 343–348.
13 Silverstein NM, Flaherty G. Dementia and wandering behaviour
in long term care facilities. Geriatr Aging 2003; 6: 47–52.
14 Dewing J. Screening for wandering among older people with
dementia. Nurs Older People 2005; 17: 20–22.
15 Algase DL, Moore DH, Vandeweerd C, Gavin-Dreschnack DJ.
Mapping the maze of terms and definitions in dementia-related
wandering. Aging Ment Health 2007; 11: 686–698.
16 Marcus JF, Cellar JS, Ansari FP, Bliwise DL. Utility of the Algase
Wandering Scale in an outpatient Alzheimer’s disease sample.
Int J Geriatr Psychiatry 2007; 22: 801–805.
17 Robinson L, Hutchings D, Corner L et al. Balancing rights and
risks: conflicting perspectives in the management of wandering
in dementia. Health Risk Soc 2007; 9: 389–406.
18 Schonfeld L, King-Kallimanis B, Brown LM et al. Wanderers with
cognitive impairment in Department of Veterans Affairs nursing
home care units. J Am Geriatr Soc 2007; 55: 692–699.
19 Algase DL, Antonakos C, Yao L, Beattie ER, Hong GR,
Beel-Bates CA. Are wandering and physically nonaggressive
agitation equivalent? Am J Geriatr Psychiatry 2008; 16: 293–
20 Rowe M, Vandeveer S, Greenblum C et al. Persons with demen-
tia missing in the community: is it wandering or something
unique? BMC Geriatr 2011; 11: 28.
21 Carr D, Muschert GW, Kinney J et al. Silver alerts and the
problem of missing adults with dementia. Gerontologist 2010;
50: 149–157.
22 Volicer L, van der Steen JT, Frijters DH. Involvement in activities
and wandering in nursing home residents with cognitive impair-
ment. Alzheimer Dis Assoc Disord 2013; 27: 272–277.
23 The Task Force on the Effect of Alzheimer’s Disease in
Arkansas. 2011 Final Report. Chicago, IL: Alzheimer’s Associa-
tion, 2011.
24 Algase DL, Beel-Bates C, Beattie ER. Wandering in long-term
care. Ann Longterm Care 2003; 11: 33–39.
25 Algase DL, Struble L. Wandering: what, why & how? In:
Buckwalter K, ed. Geriatric Mental Health Nursing: Current and
Future Challenges. Thorofare, NJ: SLACK Incorporated, 1992;
26 Wick JY, Zanni GR. Aimless excursions: wandering in the
elderly. Consult Pharm 2006; 21: 608–612, 615–618.
27 Klein DA, Steinberg M, Galik E et al. Wandering behaviour in
community-residing persons with dementia. Int J Geriatr Psy-
chiatry 1999; 14: 272–279.
28 Teri L, Larson EB, Reifler BV. Behavioral disturbance in demen-
tia of the Alzheimer’s type. J Am Geriatr Soc 1988; 36: 1–6.
G. Cipriani et al.
6© 2014 The Authors
Psychogeriatrics © 2014 Japanese Psychogeriatric Society
29 Hope T, Tilling KM, Gedling K, Keene JM, Cooper SD, Fairburn
CG. The structure of wandering in dementia. Int J Geriatr Psy-
chiatry 1994; 9: 149–155.
30 Martino-Saltzman D, Blasch BB, Morris RD, McNeal LW. Travel
behavior of nursing home residents perceived as wanderers and
nonwanderers. Gerontologist 1991; 31: 666–672.
31 Sink KM, Covinsky KE, Newcomer R, Yaffe K. Ethnic differences
in the prevalence and pattern of dementia-related behaviors. J
Am Geriatr Soc 2004; 52: 1277–1283.
32 Brazil K, Hasler A, McAiney C, Sturdy-Smith C, Tettman M.
Perceptions of resident behavior problems and their clinical
management in Long Term Care facilities. J Ment Health Aging
2003; 9: 35–42.
33 Algase DL. Wandering in dementia [Review]. Annu Rev Nurs Res
1999; 17: 185–217.
34 Colombo M, Vitali S, Cairati M et al. Wanderers: features, find-
ings, issues. Arch Gerontol Geriatr Suppl 2001; 7: 99–106.
35 Utton D. The design of housing for people with dementia. J Care
Serv Manag 2009; 3: 380–390.
36 Kavcic V, Duffy CJ. Attentional dynamics and visual perception:
mechanisms of spatial disorientation in Alzheimer’s disease.
Brain 2003; 126: 1173–1181.
37 Tetewsky SJ, Duffy CJ. Visual loss and getting lost in
Alzheimer’s disease. Neurology 1999; 52: 958–965.
38 Rolland Y, Payoux P, Lauwers-Cances V, Voisin T, Esquerre JP,
Vellas B. A SPECT study of wandering behavior in Alzheimer’s
disease. Int J Geriatr Psychiatry 2005; 20: 816–820.
39 Meguro K, Yamaguchi S, Yamazaki H et al. Cortical glucose
metabolism in psychiatric wandering patients with vascular
dementia. Psychiatry Res 1996; 67: 71–80.
40 Chiu YC, Algase D, Whall A et al. Getting lost: directed attention
and executive functions in early Alzheimer’s disease patients.
Dement Geriatr Cogn Disord 2004; 17: 174–180.
41 Monsour N, Robb SS. Wandering behavior in old age: a psy-
chosocial study [Review]. Soc Work 1982; 27: 411–416.
42 Phillips VL, Diwan S. The incremental effect of dementia-related
problem behaviors on the time to nursing home placement in
poor, frail, demented older people. J Am Geriatr Soc 2003; 51:
43 Snyder LH, Rupprecht P, Pyrek J, Breckhus S, Moss T. Wan-
dering. Gerontologist 1978; 18: 272–280.
44 Mayhew M. The growing challenge of Alzheimer disease part 2.
J Nurse Pract 2005; 1: 149–156.
45 Lee KH, Algase DL, McConnell ES. Relationship between
observable emotional expression and wandering behavior of
people with dementia. Int J Geriatr Psychiatry 2014; 29: 85–92.
46 Gurwitz JH, Sanchez-Cross MT, Eckler MA, Matulis J. The epi-
demiology of adverse and unexpected events in the long-term
care setting. J Am Geriatr Soc 1994; 42: 33–38.
47 Morley JE. Nutrition assessment is a key component of geriatric
assessment. In: Vellas B, Guigoz Y, Garry P, eds. Facts,
Research and Intervention in Geriatrics. Paris, France: Serdi
Publishing Company, 1997; 5–10.
48 Yang CH, Hwang JP, Tsai SJ, Liu CM. Wandering and
associated factors in psychiatric inpatients with dementia
of Alzheimer’s type in Taiwan: clinical implications for manage-
ment. J Nerv Ment Dis 1999; 187: 695–697.
49 Beattie ER, Song J, LaGore S. A comparison of wandering
behavior in nursing homes and assisted living facilities. Res
Theory Nurs Pract 2005; 19: 181–196.
50 Aud MA. Dangerous wandering: elopements of older adults with
dementia from long-term care facilities. Am J Alzheimers Dis
Other Demen 2004; 19: 361–368.
51 Ballard C, O’Brien J, James I, Swann A. Dementia: Management
of Behavioural and Psychological Symptoms. Oxford: Oxford
University Press, 2001.
52 Kibayashi K, Shojo H. Accidental fatal hypothermia in elderly
people with Alzheimer’s disease. Med Sci Law 2003; 43: 127–
53 Shinoda-Tagawa T, Leonard R, Pontikas J, McDonough JE,
Allen D, Dreyer PI. Resident-to-resident violent incidents in
nursing homes. JAMA 2004; 291: 591–598.
54 Fopma-Loy J. Wandering: causes, consequences, and care
[Review]. J Psychosoc Nurs Ment Health Serv 1988; 26: 8–11,
55 Lam D, Sewell M, Bell G, Katona C. Who needs psychogeriatric
continuing care? Int J Geriatr Psychiatry 1989; 4: 109–114.
56 Holtzer R, Tang MX, Devanand DP et al. Psychopathological
features in Alzheimer’s disease: course and relationship with
cognitive status. J Am Geriatr Soc 2003; 51: 953–960.
57 Hope T, Keene J, McShane RH, Fairburn CG, Gedling K,
Jacoby R. Wandering in dementia: a longitudinal study. Int
Psychogeriatr 2001; 13: 137–147.
58 Song JA, Lim YM, Hong GR. Wandering behaviour of persons
with dementia in Korea: investigation of related factors. Aging
Ment Health 2008; 12: 366–373.
59 Thomas DW. Understanding the wandering patient. A continuity
of personality perspective. J Gerontol Nurs 1997; 23: 16–24;
quiz 54–55.
60 Cooper JK, Mungas D. Risk factor and behavioral differences
between vascular and Alzheimer’s dementias: the pathway
to end-stage disease. J Geriatr Psychiatry Neurol 1993; 6:
61 Ata T, Terada S, Yokota O et al. Wandering and fecal smear-
ing in people with dementia. Int Psychogeriatr 2010; 22: 493–
62 Cipriani G, Vedovello M, Ulivi M, Nuti A, Lucetti C. Repetitive
and stereotypic phenomena and dementia [Review]. Am J
Alzheimers Dis Other Demen 2013; 28: 223–227.
63 Snowden JS, Neary D, Mann DM. Frontotemporal dementia
[Review]. Br J Psychiatry 2002; 180: 140–143.
64 Chiu MJ, Chen TF, Yip PK, Hua MS, Tang LY. Behavioral and
psychologic symptoms in different types of dementia. J Formos
Med Assoc 2006; 105: 556–562.
65 Knuffman J, Mohsin F, Feder J, Grossberg GT. Differentiating
between lewy body dementia and Alzheimer’s disease: a retro-
spective brain bank study. J Am Med Dir Assoc 2001; 2: 146–
66 Lachs MS, Becker M, Siegal AP, Miller RL, Tinetti ME. Delusions
and behavioral disturbances in cognitively impaired elderly
persons. J Am Geriatr Soc 1992; 40: 768–773.
67 Lyketsos CG, Steele C, Baker L et al. Major and minor depres-
sion in Alzheimer’s disease: prevalence and impact. J
Neuropsychiatry Clin Neurosci 1997; 9: 556–561.
68 Ott BR, Lapane KL, Gambassi G. Gender differences in the
treatment of behavior problems in Alzheimer’s disease. SAGE
Study Group. Systemic assessment of geriatric drug use via
epidemiology. Neurology 2000; 54: 427–432.
69 Gormley N, Rizwan MR, Lovestone S. Clinical predictors of
aggressive behaviour in Alzheimer’s disease. Int J Geriatr Psy-
chiatry 1998; 13: 109–115.
70 Dawson P, Reid DW. Behavioral dimensions of patients at risk
of wandering. Gerontologist 1987; 27: 104–107.
71 Song JA, Algase D. Premorbid characteristics and wandering
behavior in persons with dementia. Arch Psychiatr Nurs 2008;
22: 318–327.
7© 2014 The Authors
Psychogeriatrics © 2014 Japanese Psychogeriatric Society
72 Algase DL, Beattie ER, Bogue EL, Yao L. The Algase Wandering
Scale: initial psychometrics of a new caregiver reporting tool.
Am J Alzheimers Dis Other Demen 2001; 16: 141–152.
73 Robinson L, Hutchings D, Dickinson HO et al. Effectiveness and
acceptability of non-pharmacological interventions to reduce
wandering in dementia: a systematic review. Int J Geriatr Psy-
chiatry 2007; 22: 9–22.
74 Tilly J, Reed P, eds. Dementia Care Practice Recommendations
for Assisted Living Residences and Nursing Homes Phase 2
Alzheimer’s Association. Chicago: Alzheimer’s Association,
75 Hermans DG, Htay UH, McShane R. Non-pharmacological
interventions for wandering of people with dementia in the
domestic setting [Review]. Cochrane Database Syst Rev 2007:
76 Holmberg SK. Evaluation of a clinical intervention for wanderers
on a geriatric nursing unit. Arch Psychiatr Nurs 1997; 11:
77 Miskelly F. A novel system of electronic tagging in patients with
dementia and wandering. Age Ageing 2004; 33: 304–306.
78 McShane R, Hope T, Wilkinson J. Tracking patients who
wander: ethics and technology. Lancet 1994; 343: 1274.
79 Hughes JC, Louw SJ. Electronic tagging of people with demen-
tia who wander [Editorial]. BMJ 2002; 325: 847–848.
80 McShane R. Should patients with dementia who wander be
electronically tagged? Yes. BMJ 2013; 346: f3603.
81 O’Neill D. Should patients with dementia who wander be elec-
tronically tagged? No. BMJ 2013; 346: f3606.
82 Nishigaki Y, Tanaka K, Kim J, Nakajima K. Development of an
image processing support system based on fluorescent dye to
prevent elderly people with dementia from wandering. Conf
Proc IEEE Eng Med Biol Soc 2013; 2013: 7302–7305.
83 Castle SC, Rutledge MK. Pharmacological interventions asso-
ciated with wandering. In: Nelson AL, Algase DL, eds. Evidence-
Based Protocols for Managing Wandering Behaviors. New York:
Springer Publishing Company, 2007; 215–250.
84 Meguro K, Meguro M, Tanaka Y, Akanuma K, Yamaguchi K, Itoh
M. Risperidone is effective for wandering and disturbed sleep/
wake patterns in Alzheimer’s disease. J Geriatr Psychiatry
Neurol 2004; 17: 61–67.
G. Cipriani et al.
8© 2014 The Authors
Psychogeriatrics © 2014 Japanese Psychogeriatric Society
... 11,12 Persons with Dementia (PwD) on antipsychotic treatment or who had comorbid depression, psychosis, or externalizing behaviors like arguing and threatening were more likely to wander. [13][14][15] The causes of wandering are elusive, though hypotheses have been proposed ranging from biomedical to biopsychosocial to person-environment interactions. 14 This includes the following: 1. ...
... 14,18 3. Wandering can be a result of person-environment interaction. 14,18,19 Other reasons can be the unfamiliar environment to the patient, recent medication changes, the severity of cognitive decline, changes in schedule, and loss while searching for things in need. 19 These are all the most important aspects of wandering as finding. ...
Full-text available
Wandering behavior is one of the most important and challenging management aspects in persons with dementia. Wandering behavior in people with dementia (PwD) is associated with an increased risk of falls, injuries, and fractures, as well as going missing or being lost from a facility. This causes increased distress in caregivers at home and in healthcare facilities. The approach to the comprehensive evaluation of the risk assessment, prevention, and treatment needs more strengthening and effective measures as the prevalence of wandering remains high in the community. Both the caregiver and clinicians need a clear understanding and responsibility of ethical and legal issues while managing and restraining the PwD. Ethical and legal issues especially in the light of the new Indian Mental Healthcare Act of 2017, related to confinement by family members in their homes by family caregivers, seclusion, physical or chemical restraints, other pharmacological and behavioral treatment, highlighting their effectiveness as well as adverse consequences are discussed. This article attempts to address an approach in managing wandering behavior in PwD in light of MHCA, 2017
... It is also rightfully suggested for senior institutional authorities and members of the society to take responsibility of at least ensuring admissions of those people who may be found wandering and in need of help. Rehabilitation of lonely patients of dementia calls for the attention, sensitivity and responsible action of institutional authorities and individuals in order to meet the needs of those may not be able to garner support otherwise (Cipriani et al., 2014). ...
The paper attempts to explore different forms of suffering that the elderly (60 years and above) in Kashmir face within families and the broader society. It argues that the changes which the society has witnessed over a period of time have created an atmosphere of individualism and opportunism among the youth and a spontaneous hostility towards the elderly. The sociocultural and religious values of Kashmiri society situated the elderly at a dignified place; however, the recent advancements within the society and the lack of preparedness to deal with the subsequent challenges have further marginalized and alienated the elderly in and outside the family setting. The paper draws its inferences from the oral narratives conducted with 50 elderly persons and 10 semi-structured interviews with different resource persons.
Studies reported an association between impaired hearing and vestibular function with the risk of dementia. This study investigated the association between Ménière’s disease (MD) and the risk of dementia using a nationwide cohort sample of data obtained from the South Korea National Health Insurance Service. The MD group (n = 496) included patients aged over 55 years and diagnosed between 2003 and 2006. The comparison group was selected using propensity score matching (n = 1984). Cox proportional hazards regression models were used to calculate incidence and hazard ratios for dementia events. The incidence of dementia was 14.3 per 1000 person–years in the MD group. After adjustment for certain variables, the incidence of dementia was higher in the MD group than in the comparison group (adjusted hazard ratio (HR) = 1.57, 95% confidence interval = 1.17–2.12). Subgroup analysis showed a significantly increased adjusted HR for developing Alzheimer’s disease (1.69, 95% confidence interval = 1.20–2.37) and vascular dementia (1.99, 95% confidence interval = 1.10–3.57) in the MD group. Patients with dementia experienced a higher frequency of MD episodes than those without dementia. Our findings suggest that late-onset MD is associated with an increased incidence of all-cause dementia, and it might be used as a basis for an earlier diagnosis of dementia.
Dementia is characterized by significant cognitive deterioration, behavioral and psychological symptoms, and expanding disability. The well-being of people with dementia is influenced by the support provided by caregivers and health professionals. Especially in the past two decades, advancements in digital technology have helped reshape the way care and treatment are delivered. The main goal of the chapter is to describe technological solutions aimed at supporting the independence and safe participation of people with dementia in meaningful activities, as well as promoting their involvement in engaging experiences that seek to delay cognitive decline and diminish behavioral and psychological symptoms. These technologies include distributed systems, robotics, wearable devices, application software, and virtual reality.
Dementia care in India is under-recognized, and there is a lack of specialized rehabilitation centres focusing solely on dementia rehabilitation. The present chapter unfolds the various challenges in dementia rehabilitation within the Indian cultural context and the need for geriatric mental health experts to take cognizance of the same. Dementia rehabilitation in India is riddled with difficulties across various spheres which include financial deficiencies, lack of trained staff, non-desire of caregivers to admit their patients into a rehabilitation centre and the lack of expert dementia care specialists to manage these patients. The interface of medical problems with dementia, multiple medical professionals managing the same patient, increased pill count, lack of systematized occupational therapy and psychosocial care along with ever-increasing caregiver strain and burden are some of the reasons for dementia care to receive serious setbacks in the Indian setting. This is coupled with a lack of knowledge among primary care physicians and poor awareness in the general public about this condition. Behavioural and psychological issues in dementia coupled with legal issues related to testamentary capacity, wills, property matters and family disputes complicate efforts at dementia rehabilitation further. The chapter outlines probable solutions to these challenges and tries to provide and erudite framework for clinically viable and practical dementia rehabilitation in hospital and home-based settings.
We compared the efficacy of tailored non pharmacological therapies (NPT) on specific nocturnal behavioral and psychological symptoms of dementia (BPSD). This retrospective 1-year study included 84 older dependent patients institutionalized in 7 long-term care home. Dedicated assistants, who were taught by experts how to use NPT, were asked to record the occurrence of each BPSD episode, to choose a given NPT on the basis of their knowledge of the patient and the type of BPSD and to estimate its efficacy. Wandering was the most prevalent BPSD followed by agitation/aggression and screaming. The most used therapy was cognitive stimulation, followed by multisensory stimulation, reminiscence and Montessori-based. Regarding wandering, multisensory stimulation was found to be the most efficacious NPT significantly different from Montessori-based, cognitive stimulation or reminiscence. With regards to agitation/aggression or screaming, Montessori-based was found to be the most efficacious NPT significantly different from multisensory stimulation, reminiscence and cognitive stimulation.
This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
We present associations between neuropsychiatric symptoms (NPS) and brain morphology in a large sample of patients with mild cognitive impairment (MCI) and Alzheimer’s disease with dementia (AD dementia). Several studies assessed NPS factor structure in MCI and AD dementia, but we know of no study that tested for associations between NPS factors and brain morphology. The use of factor scores increases parsimony and power. For transparency, we performed an additional analysis with selected Neuropsychiatric Inventory – Questionnaire (NPI-Q) items. Including regional cortical thickness, cortical and subcortical volumes, we examined associations between NPS and brain morphology across the whole brain in an unbiased fashion. We reported both statistical significance and effect sizes, using linear models adjusted for multiple comparisons by false discovery rate (FDR). Moreover, we included an interaction term for diagnosis and could thereby compare associations of NPS and brain morphology between MCI and AD dementia. We found an association between the factor elation and thicker right anterior cingulate cortex across MCI and AD dementia. Associations between the factors depression to thickness of the banks of the left superior temporal sulcus and psychosis to the left post-central volume depended on diagnosis: in MCI these associations were positive, in AD dementia negative. Our findings indicate that NPS in MCI and AD dementia are not exclusively associated with atrophy and support previous findings of associations between NPS and mainly frontotemporal brain structures.
King Yeongjo, the 21st king of Joseon (18th Century Korea), reigned during the prime years of the dynasty and was its oldest king. Despite his many accomplishments, debate surrounds his reputed display of the symptoms of dementia during the last years of his life. The King showed signs of dementia after 40 years of his regency in 1762 at the age of 69 years, including disorientation, cognitive impairment, amnestic disorder and so on. We examined evidence from the Annals of the Joseon Dynasty and related research papers. Additionally, dementia specialists were asked to undertake a survey to provide objectivity to the literary findings. Prior to his death in 1776, 25 meaningful dementia symptoms were recorded in the Annals across a 10-year period. However, despite indications of dementia, the Joseon dynasty supported him as a king and helped him retain his dignity until the end. This suggests that historical perception changes regarding dementia may also inform current-day attitudes to improve the living standards of patients suffering from dementia and related neuropsychiatric disorders.
Full-text available
The wandering behavior of persons with dementia is a common problem in long-term care. However, in the design of interventions, the emphasis is on safety, and little consideration has been given to the meaning of the behavior for the person who wanders. This paper uses the Need-driven Dementia-compromised Behavior (NDB) model to demonstrate that the expression of wandering is unique to a given person in a particular context or situation. Elements of the model illustrate how particular patterns and amounts of wandering may reflect different bases of the behavior, such as global cognitive decline, visual spatial deficits, or perseveration. Differing bases for wandering would consequently call for different intervention strategies. Studies about wandering that examine the phenomenon in greater detail and consider more than its overall amount or related outcomes, such as eloping, are needed. Findings from such studies can help health care professionals to better detect probable causes of wandering in the dinical setting and to design appropriate interventions that target an individual's unique wandering experience.
Full-text available
This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2013, Issue 12 Buprenorphine for treating cancer pain (Protocol)
Frontotemporal dementia accounts for up to 20% of cases of dementia in the presenium, yet remains poorly recognised. Diagnostic criteria have been devised to aid clinical diagnosis. To provide an overview of clinical and pathological characteristics of frontotemporal dementia and its nosological status. The review summarises consensus diagnostic criteria for frontotemporal dementia and draws on the authors' clinical experience of 300 frontotemporal dementia cases, and pathological experience of 50 autopsied cases. Frontotemporal dementia is characterised by pronounced changes in affect and personal and social conduct. Some patients also develop motor neuron disease. Mutations in the tau gene account for some but not all familial cases of frontotemporal dementia. Frontotemporal dementia is a focal form of dementia, which is clinically and pathologically distinct from other dementias. It represents an important model for understanding the functions of the frontotemporal lobes.
Objectives. This retrospective cohort study examined the association between resident characteristics and the development of wandering behavior. Methods. Subjects included a total of 8982 residents from the states of Mississippi, Texas, and Vermont who had baseline and 3-month follow-up Minimum Data Set assessments between 1 January 1996 and 31 December 1997. Results. Residents who had a short-term memory problem (Odds Ratio (OR) = 3.05), had pneumonia (OR = 3.15), asked repetitive questions (OR = 2.19), had a long-term memory problem (OR = 2.06), exhibited dementia (OR = 19.4), constipation (OR = 1.82), expressed sadness or pain (OR = 1.65), and used antipsychotic medication (OR = 1.70), were at an increased risk for developing wandering behavior compared to residents without these characteristics. Residents with functional impairment(OR = 0.28) and women(OR = 0.61)were less likely to develop wandering behavior. Conclusions. Results of this study may be useful in constructing causal theories for the development of wandering behavior. Copyright (C) 2000 John Wiley & Sons, Ltd.
The objective of this study was to describe the perceptions of Long Term Care (LTC) service providers in urban Canadian care facilities regarding the prevalence and nature of resident behavior problems and how staff manage these problems. Key informants from 15 LTC facilities housing 1,928 residents, participated in a cross sectional survey which employed semi-structured telephone interviews. Respondents estimated that on average 61% (n = 1,176) of residents had some type of mental health/behavioral problem, with facility estimates ranging from 20% to 90%. The most frequently reported problem behaviors included: general agitation and restlessness (36%); pacing and aimless wandering (28%); hoarding things (24%); hitting either self or others (23%); and verbal aggression (22%). Behaviors reported by respondents as "disruptive" or "very disruptive" were screaming (13%), sexual disinhibition (10%), and hitting either self or others (10%). The most common interventions used by staff were behavioral interventions followed by the use of medications. Low levels of staffing and educational training of staff were among the most common factors recognized as contributing to the difficulty in caring for residents with mental health needs.
Nearly half of all residents in long-term care settings suffer from some type of dementing illness, with Alzheimer disease by far the most common type. People with dementia should be presumed at high risk for wandering due to their cognitive deficits and unpredictable behaviour. Recommendations are shared to minimize attempts to wander and actual wandering episodes by promoting a more therapeutic environment both through the physical structure and through staff training. In addition, effective strategies to follow in situations when a resident is, in fact, missing are presented.
Objective: To define gender differences in noncognitive behavioral problems of patients with AD and differences in the associated treatment of those problems. Design/Methods: We performed an observational study using the Systematic Assessment and Geriatric drug use via Epidemiology (SAGE) database, which contains data collected with the Minimum Data Set on a cross- section of nursing home residents in five US states. Behavior problems were documented at the first assessment of 28,367 residents with AD. We evaluated the role of gender differences in behavior as predictors of differences in nonpharmacologic versus specific pharmacologic therapies with psychoactive medications using logistic regression. Results: Men were more likely than women to exhibit behavior problems such as wandering, abusiveness, and social impropriety (59% versus 50% for any behavior problem). Hallucinations and delusions as well as depression were equally prevalent in men and women. Nevertheless, men were more likely to receive psychoactive medications. Among the specific drug categories examined, and controlling for age and degree of cognitive impairment, men were more likely to receive antipsychotic drugs and less likely to be receiving antidepressants. Conclusion: Gender appears to play an important role in determining the frequency of behavioral problems in nursing home residents with AD, which may influence choice of treatments as well as the decision whether to treat. The use of more potent tranquilizers in men with problem behaviors has potential implications for morbidity, deserving further investigation.