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Wandering, in persons with dementia, is a common behavior that causes great risk for the person and concern for caregivers. Although it occurs in several types of dementia, wandering is especially problematic in persons with Alzheimer's disease (AD). This is because AD frequently produces impaired memory: persons with impaired memory are likely to become disoriented and lost simply because they do not recognize where they are nor remember how they came to be there.
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Elopement
Unattended wandering that goes out of bounds, a behavior known as elopement, is a special concern for caregivers and search and rescue responders. Because elopement often follows from a combination of wandering and sundowning, it typically results in the person being lost out of doors at night, dressed inappropriately, and unable to take many ordinarily routine steps to ensure their personal safety and security. This is a situation of great urgency, and the necessity of searching at night imposes added risks on the searchers.
In some countries the social costs of elopement, already significant, are increasing rapidly.1 A SAR mission lasting more than a few hours is likely to expend many hundreds to thousands to tens of thousands of skilled man hours and, per mission, those involving subjects with dementia typically expend significantly more resources than others.1
Prevention
The most effective methods of preventing wandering, particularly wandering out of bounds, are physical restraint, physical barriers, 24-hour real time surveillance, and the use of tracking devices. All of these methods have ethical issues and one, physical restraint, is widely considered to be inhumane.2 Tracking devices of several kinds have been evaluated.34
Management
To mitigate the problem of wandering, in the United States the Alzheimer's Association has developed a program called "Safe Return".
Technology
In other efforts to help mitigate liability, Long Term Care and Assisted Living Facilities may use radio frequency (rfid) products to protect their residents. A resident wears a wrist or ankle transmitter. This rfid tag can read by receive antennas, which are placed usually at door or hallway locations that are deemed likely routes of escape and will need monitoring. The system will then either sound an alarm or lock a door when a door system reads a resident transmitter worn by a resident that is at risk for wandering. This helps prevent an elopement as staff can be notified by alarms at the door, pocket pagers, and email. A well trained staff will be able to quickly find the person at risk and keep them safely inside.
Newer versions of this equipment have become more advanced. The newest types of systems may have the ability to: identify a rfid tag by a specific resident and forward that name to the staff; give staff a last known location of the resident; show a photo of the resident at the staff station with a mapped out door location; report the the frequency, times and severity of the incidents; and finally, integrate with other access control sytems, HVAC, fire alarm equipment and phone equipment.
The reason this type of system seems to be preferrable is that it helps monitor those at risk for wandering and elopements while not infringing on the freedom of other residents or visitors to a facility.
While many companies compete in this market, the two oldest and most well known companies that provide this equipment are generally considered to be RF Technologies[1]and their Code Alert[2]brand and Stanley Senior Technologies [3]with their Wanderguard [4] brand.
The companies have been around so long and are in so many facilities that regionally their brands have become synonomous with the generic term for this type of equipment.
References
- ^ a b "Wandering and Alzheimer's overview". dbs-sar.com. Retrieved on 2008-08-26.
- ^ PMID 16849002
- ^ PMID 16107453
- ^ PMID 15082438
Wandering and elopement technologies: a guide - health care risk management - includes related article on action recommendations Nursing Homes, Oct, 1996 [5]
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- This page was last modified on 22 November 2008, at 07:47.
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