Approach to Management of Wandering in Dementia: Ethical and Legal Issue

Abstract

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

Data silos undermine efforts to characterize, predict, and mitigate dementia-related missing person incidents

“…Studies have examined the ethical considerations related to the use of electronic tracking devices with people living with dementia. 38,39 This literature emphasizes the importance of balancing the risks to the privacy and autonomy of a person with dementia when using tracking devices intended to provide peach of mind to caregivers. Dementia is associated with continuous change in cognitive function, and therefore requires ongoing monitor of capacity and consent.…”

The swinging pendulum of risk management: is it time to reimagine risk in dementia care?

“…Despite this, their usefulness is limited when it comes to predicting rare outcomes such as suicides (Runeson et al, 2017). Whilst some adverse events for PLwD are more frequent, for example falls (Agrawal et al, 2021), Hoe et al (2023) have still highlighted that there are no widely acceptable and useful assessment scales available to guide risk management in this area. What is more, only one risk assessment scale included a question about insight, despite reduced awareness amongst PLwD being associated with greater exposure to dangerous behaviors (Fischer et al, 2023).…”

“…When compared with people without a diagnosis of dementia, PLwD have a higher rate of falls, accidents, accidental poisoning, accidental death, fractures, wandering, and increased mortality (Agrawal et al ., 2021; An et al ., 2019; Piovezan et al ., 2020). Substitute decision-makers and health practitioners may attempt to minimize these risks by making specific environmental modifications, potentially at the expense of reduced patient autonomy.…”

“…Despite this, their usefulness is limited when it comes to predicting rare outcomes such as suicides (Runeson et al ., 2017). Whilst some adverse events for PLwD are more frequent, for example falls (Agrawal et al ., 2021), Hoe et al . (2023) have still highlighted that there are no widely acceptable and useful assessment scales available to guide risk management in this area.…”

A Night-Time Monitoring System (eNightLog) to Prevent Elderly Wandering in Hostels: A Three-Month Field Study

“…The prevalence of wandering has varied among studies, with 17.4% of community-residing seniors [ 25 ] and 63% in community dwellings having been reported to have exhibited wandering behaviour [ 26 ]. More than 60% of people with different levels of dementia will develop wandering behaviour [ 27 ]. Wandering can lead to severe injuries, patients going missing, and fatal accidents.…”