Dementia, walking outdoors and getting lost: incidence, risk factors and consequences from dementia-related police missing-person reports

White, Eleanor Bantry; Montgomery, Paul

doi:10.1080/13607863.2014.924091

Cited by 68 publications

(57 citation statements)

References 30 publications

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“…There still remains an issue separating individuals with dementia who are simply missing, from those who have actively wandered off . The overall rate of getting lost in a regional dementia population in the United Kingdom was 0.5%; those who had either died or sustained significant harm were older, and had been missing for longer periods of time, often during winter . For example, deaths occurred in winter in 56% of the cases in the present series.…”

Section: Discussionmentioning

confidence: 61%

“…The etiology of wandering is complex involving dementia‐related changes as well as environmental and psycho‐social factors. It affects 10–35% of demented patients at some stage in the course of their disease , although the incidence may be as high as 63% in community dwellers . Abnormalities have been described in right parietal lobe function, left parieto‐temporal blood flow, fronto‐temporal glucose metabolism, and dopamine metabolism in the striatum, with associated disorders of memory and spatial perception .…”

Section: Discussionmentioning

confidence: 99%

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Wandering Dementia—A Syndrome with Forensic Implications

Byard

Langlois

2018

Journal of Forensic Sciences

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Wandering behavior in dementia may result in significant injury or death. Search of files at Forensic Science South Australia over a 20-year period (1998-2018) identified nine individuals with dementia who were found deceased having been reported as missing from home/residential facilities (M:F, 6:3; age range, 54-92 years; average, 77.7 years; median, 80 years). The established clinical diagnoses were of dementia in seven cases and Alzheimer disease in two. Deaths were unnatural in six cases: hypo/hyperthermia three, drowning two, train impact one; natural in two cases due to ischemic (N=1) and valvular heart disease (N=1); and undetermined in one case due to marked decomposition. There were five fatalities in winter. Exposure and drowning were significant causes of death. The increasing aging population means cases of lethal wandering dementia will be more often encountered among forensic cases in future. Issues around duty of care and suicide should be considered in evaluating cases.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Wandering Dementia—A Syndrome with Forensic Implications

Byard

Langlois

2018

Journal of Forensic Sciences

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“…Respondents were asked to estimate how many individuals with dementia (out of 1,000) they would expect to experience four severe, low‐probability risk outcomes within the next 12 months: (1) causing a home fire; (2) driving collision; (3) hospitalised after a fall; and (4) having a missing person's report filed. Accuracy of professionals’ estimates was judged against data on frequency of risks having severe outcomes: (1) records on accidental dwelling fires (Northern Ireland Fire and Rescue Service, ); (2) driving collisions involving over 65s (Police Service of Northern Ireland, ); (3) hospitalisation following over 60s population (Department of Health [Belfast], 2014); and (4) police missing person records in one United Kingdom policing area (Bantry White & Montgomery, ). Prevalence of these incidents among the population of interest was based on an estimated dementia population of 19,765 in Northern Ireland (Alzheimer's Society, ).…”

Section: Methodsmentioning

confidence: 99%

“…As half of all accidental dwelling fires affect those over 65 (Department for Communities and Local Government, ), a rate of 22.7 out of 1,000 was assumed. Incidence of having a missing person's report filed was estimated at 5 in 1,000 (Bantry White & Montgomery, ).…”

Section: Methodsmentioning

confidence: 99%

Communicating risk in dementia care: Survey of health and social care professionals

Taylor

Stevenson

McDowell³

2017

Health Soc Care Community

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Supporting people to live at home in line with community care policies requires increasing attention to assessing, communicating and managing risks. There is a challenge in supporting client choices that include risk-taking while demonstrating professional accountability. Risk communication becomes increasingly important with the need to engage clients and families in meaningful shared decision-making. This presents particular challenges in dementia services. This survey of risk communication in dementia care was administered to all health and social care professionals in community dementia services in Northern Ireland: June-September 2016. Of 270 professionals, 70 questionnaires were fully completed, with 55 partial completions. Scores on the Berlin Numeracy Test plus Schwartz items was low-moderate (mean 2.79 out of 7). This study did not find a significant association between numeracy and accurate perceptions of risk likelihoods in practice-based scenarios. Although 86% reported using numeric information in practice (mostly from assessment tools), respondents rarely communicated themselves using numbers. As in other domains, participants' responses were widely variable on numeric estimates of verbal terms for likelihood. In relation to medication side effects, few participants provided responses that were concordant with those in the guidance of the European Union. The risks most commonly encountered in practice were (in rank order): falls, depression, poor personal hygiene, medicines mismanagement, leaving home unsupervised, financial mismanagement, malnutrition, swallowing difficulties, abuse from others, risks to others, home appliance accidents and refusing equipment. Respondents generally overestimated the likelihood of serious harmful events by approximately 10-fold (having a missing person's report filed with the police; having a fall resulting in hospitalisation) and by approximately double (being involved in a car accident; causing a home fire), and with wide variation between respondents. There is potential in icon arrays for communicating risks. Risk literacy among dementia care practitioners needs to be developed.

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“…Although it appears to be a low‐frequency event, getting lost can result in injury and death (Koester & Stooksbury , Rowe & Glover , Rowe & Bennett , Hunt et al . , Bantry White & Montgomery ). However, strategies of management are often detrimental to a person's quality of life: people with dementia who get lost are at far greater risk of being admitted to long‐term care or locked in at home (McShane et al .…”

Section: Introductionmentioning

confidence: 99%

Supporting people with dementia to walkabout safely outdoors: development of a structured model of assessment

White

Montgomery

2015

Health Soc Care Community

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People with dementia while missing are at risk of harm including death. Yet, welfare concerns arise when freedom to walkabout outdoors is restricted and in particular, getting lost is a risk factor for admission to long-term care. Accurate methods of assessing the risks posed to community-dwelling people with dementia from getting lost are needed to ensure intervention is proportionate. Currently available assessment tools focus upon the identification of dementia-related changes in a person's walking behaviour, traditionally referred to as 'wandering'. 'Wandering' and getting lost are conceptually distinct; measures of 'wandering' are not sufficient to support the assessment of risk while walking outdoors. The objective of this study was to develop an assessment schedule that can evaluate safety in community-dwelling people with dementia who walkabout outdoors. A structured assessment schedule was generated from research on the aetiology of getting lost, a review of existing assessment tools, an observational study of incidents of getting lost and qualitative data from families experiencing this issue. A content validity study was then undertaken with a panel of 17 health and social care practitioners and researchers in the field. A schedule of 7 domains and 38 items was generated, 33 of which were deemed valid by the expert panel. Panel feedback suggests the schedule needs to be used flexibly to reflect an individual's unique living circumstances. Reflecting the complex aetiology of getting lost, considerable challenges exist when assessing risk in this field. The implications of this study for practitioners are discussed with reference to the merits of narrative and structured models of assessment, and the balance between objective safety and subjective well-being that is required when making decisions about intervention. The direction of further research is examined as a means of supporting professional assessment of this complex issue.

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Dementia, walking outdoors and getting lost: incidence, risk factors and consequences from dementia-related police missing-person reports

Cited by 68 publications

References 30 publications

Wandering Dementia—A Syndrome with Forensic Implications

Wandering Dementia—A Syndrome with Forensic Implications

Communicating risk in dementia care: Survey of health and social care professionals

Supporting people with dementia to walkabout safely outdoors: development of a structured model of assessment

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