38 THE QUEENS COURIER • HEALTH • AUGUST 6, 2020 FOR BREAKING NEWS VISIT WWW.QNS.COM
health
Wandering is one of the most
diffi cult management problems
encountered in the institutional
setting. Each year a resident may
wander away from a facility only
to be found later, confused and/
or injured due to the unfamiliar
surroundings.
Media attention and potential
litigation suggest that staff may
have been lax for this to occur.
Wandering in and of itself has
an upside to it. Th ere may be
times when a resident may want
to practice safe wandering. Th e
rate and amount of time wandering
that is attempted, may
appear to the untrained eye as
too excessive. However, if it is
not deemed as a problem, it
should be encouraged with minimal
staff involvement.
According to the researchers
Hussian and David, “Wandering
patterns, when fully analyzed,
suggest that the institutionalized
geriatric person off ers several
possible reasons for unsafe wandering
behavior.”
1. Neuroleptic induced ambulation
– being medicated with
long term neuroleptic drugs
can cause an inability to sit still,
that fosters random and aimless
movements and an array of other
neurological defi cits. Th e symptoms
can be mentally exhausting
and physically debilitating for
that resident.
2. Exit seeking behavior that
is highly motivated and can persist
until resident fi nds gratifi cation
in the immediate environment
that will eventually reduce
a desire to exit from facility.
3. Self-stimulation behavior
observed with the advanced
dementia resident and associated
with various stereotypical outcomes
such as endless handclapping,
persistent irritation with
others, angry tirades toward staff
or unrelieved and harsh sounding
vocalizations that make little
sense to the laity’s perception of
the resident’s actions.
4. Modeling – the resident
with dementia and confusion
will “shadow” another wanderer
by following him to the detriment
of both.
Here are several reasons that
may explain a resident’s unsafe
wandering:
Searching for food aft er the
meal has been served, eaten and
recorded by staff attending to
resident.
Repeating past work patterns
– resident acting out their past
employment that may be unsafe
to deal with.
Unrelieved boredom –
increased agitation toward residents
and staff /
Change in weather – barometric
fl uctuations that cause irrational
behavior in what psychiatrists
have identifi ed as an “emotional
storm with dangerous
reactions.”
Lack of activity encourages residents
to devise their own activities
which may prove unsafe to
self and others.
Wandering as a form of anxiety
reduction – tension wandering,
causing a climate for seeking
exit from facility.
Searching for a friendly ally
who can help – increased wandering
when an appropriate ally
cannot be found.
Fear of unfamiliar environment
– resulting in unsafe wandering,
and as a way of looking
for a quiet and secure place
to refl ect.
Case Study: Robert, a resident
in a long term care facility
was observed wandering unsafely
from his room and making a
right turn toward the door leading
to the stairs and the street.
Th is action set off an electronic
bell, sending staff running to
retrieve Robert from potential
harm. By recognizing this as a
dangerous action, staff were able
to allay a potential disaster. Aft er
numerous attempts at exiting
the facility, staff decided to have
Robert’s room changed so that a
right turn led him instead to the
facility’s lounge area, thus avoiding
the door leading to the street.
With his room changed, Robert’s
exiting the facility subsided.
Th is is but one example used
for securing a resident’s safety
who is suff ering persistent confusion.
Staff discussed the room
change with Robert’s family and
was told that in his home, the
kitchen was approximately to the
right of his bedroom. Th e case
study is but one example of how
a resident’s safety was secured
with the aid of family and staff .
Th e stimulus for wandering
arises from internal and external
sources. Th e concept known
as “agenda behaviors” was fi rst
identifi ed by the researcher
Rader, who discovered that wanderers
have specifi c patterns that
give clues as to their needs, and
when those needs are met, the
wandering tends to stop.
Another technique for dealing
with unsafe wandering is called
the “buddy system,” employed
with a willing individual (i.e. resident),
who can provide companionship
for varying periods
during the day and can account
for the confused resident’s continued
presence and safety. It is,
however, important that the resident
participating as a buddy
partner must never be coerced
into being a buddy partner indefinitely
or even wanting him to do
so in the fi rst place. Happily, the
buddy practice was successful
and is still being employed in
several other facilities with residents
who have been identifi ed
by staff as unsafe wanderers.
As stated previously, unrelieved
boredom, as a result of
poorly planned activity programs,
is a disaster waiting to
happen. Without realizable goals
that are carefully structured, the
confused individual will, inevitably,
fi nd a way of eloping from
the facility even with expensive
electronic technology designed
to thwart an incident.
Here are several suggestions
for implementing a strong activity
program, thereby lowering
unsafe wandering incidents.
Conduct programs and activities
that meet the individual’s
needs (current events, songfests,
discussion groups).
Encourage interpersonal contacts
with other residents and with
similar needs and backgrounds,
thus infl uencing camaraderie.
Employ lively activities that
can dissipate resident agitation
and restoring their focus and
participation with others.
Perform musical concerts with
classical and popular melodies
that provide friendly stimulation
and a connection with others.
Schedule n ature walks that
off er relief from daily institutional
routines and a temporary
change of venue and staff .
Distribute live plants to those
residents who will accept the
responsibility for overseeing
their care.
Th e focus of this article was
to recommend the safety measures
and anti-wandering programs
that have been successfully
employed for protecting
the nursing home resident from
unsafe wandering.
On a more personal note, I am
convinced, based on years of experience
in long term care, there will
come a time in the not too distant
future when family members
will consider admitting their loved
one to a nursing facility that advocates
for quality health care practices
and that includes a secure
and happy environment. For the
present however, I will continue
hunkering down during this global
crisis with the hope that all of
you are practicing the same. Stay
well, stay strong, stay safe, and
above all, stay mentally and physically
positive.
Sheldon Ornstein Ed.D, RN,
LNHA
Wandering
and Aging
Dr. Sheldon Ornstein is a
registered professional
nurse with a doctoral
degree in nursing organization.
He has specialized
in the care of older adults
and has published many
articles on the subject. He
has done post-graduate
work in gerontology and
has taught at several universities.
In 2013, he was
inducted into the Nursing
Hall of Fame at Teachers
College, Columbia
University.
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