Estimates of Stability of Daily Wandering Behavior Among Cognitively Impaired Long-Term Care Residents

Abstract

Direct observation and time-study techniques were used with a sample of 25 ambulatory, cognitively impaired subjects drawn from two long-term care settings to evaluate wandering behavior. The purposes of this study were (a) to describe the 24-hour distribution of wandering and direct ambulating cycles, (b) to examine the stability of wandering behavior over a 3-day interval, (c) to evaluate whether wandering during a 2-hour epoch is representative of that of a 24-hour day, and (d) to evaluate whether large-scale integrated (LSI) activity meters can substitute as an index or proxy for direct observation in the study of wandering behavior. Subjects displayed a daily average of 20.1 cycles encompassing 43.9 minutes of wandering ambulation and 28.8 cycles encompassing 40.4 minutes of direct ambulation. Wandering behavior was present in all subjects. However, wandering was highly variable from subject to subject. For a given subject, wandering was only moderately stable over a 3-day interval, but more so than direct ambulation. Similarly, a standard 2-hour epoch was moderately representative of daily wandering ambulation, but more so than for direct ambulation. Finally, LSI meters, when applied at the ankle and worn over longer (24-hr) rather than shorter (2-hr) intervals, are a promising means to index wandering behavior.

A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use

“…Random and lapping patterns of wandering increased as a percentage of overall ambulation as cognitive function declined, while the pacing pattern remains stable through all levels of impairment. 7 Also Algase and colleagues 138 reported that severely impaired patients ambulate more. However, it has been highlighted that although wandering behaviour (as other behavioural symptoms) becomes more common as cognitive impairment increases, the relationship is not linear but can be represented by a concave function.…”

“…Algase and colleagues 138 reported that, for a group of 25 residents with dementia who were ambulant, the proportion of people who wandered increased as the day progressed: 23% during the night shift, 39% during the day and approximately 57% during the evening. Peak times for frequency of wandering episodes were 5 and 6 p.m. and for minutes of wandering were 9.00 a.m. and 6.00 p.m. hours.…”

“…Algase and colleagues 138,[140][141][142] described wandering as a rhythmic ambulation yielding cycles which have two phases, a locomoting phase when the subject ambulates, and a non-locomoting phase, when the subject sits, lies or stands. In an observational study of 25 residents in a long-term care institution, mean age 85 years with a distribution of cognitive impairment from mild to severe, on average 19.7 wandering cycles were observed during a 24-hour observation period (SD 27.5, range 0-120), corresponding to a cycle length of 73 minutes (range 12 minutes to 1 day).…”

“…Frequency and total duration of wandering were moderately stable over a 3-day period. 138 Because of the reported diurnal variation in wandering behaviour, the cycle assumed for the Markov model was 24 hours.…”

Wandering Behavior in Korean Elders with Dementia Residing in Nursing Homes

“…외국의 선행 연구들에 따르면, 지역사회에 거주하는 치 매노인 중 2-70%가, 너싱홈 등 장기 요양시설에서 4-24%의 배 회증상을 보인다고 보고되었다 (Algase, 1999). 또 다른 연구 (Algase, Kupferschmid, Beel-Bates, & Beattie, 1997 (Everitt, Field, Soumerai, & Avon, 1991). 한국에서도 배회 는 치매노인 가족 부양자의 85%에서 부담감을 주는 주요 문제 행동들 중 하나임이 보고 되었다 (Kim & Jun, 1996;Kwon, 1995).…”