NonPharmacological interventions for managing wandering in the community: A narrative review of the evidence base

Abstract

Dementia-related wandering is exhibited by as many as 63% of people with dementia living in the community. There is strong evidence that people with dementia who wander are at risk of life-threatening outcomes including injury from falls, exhaustion, weight loss, and becoming lost. Furthermore, carers have reported that fear of a person with dementia becoming lost contributes to them taking extreme measures in an attempt to maintain safety at home and there are few guidelines to direct care practices. Previous literature reviews of interventions to manage wandering have been inconclusive as the quality of research resulted in most studies being excluded. This narrative review aimed to report on the current state of wandering intervention science for people with dementia cared for in the community. An extensive search of articles and grey literature published between January 1999 and November 2017 was conducted and included quantitative studies that reported findings of nonpharmacological interventions for people with dementia living in the community that reported outcome measures of wandering characteristics (e.g., frequent ambulation, pacing, and boundary transgression). Eleven papers met the inclusion criteria, the majority of which were small nonrandomised studies or case studies with interventions that focused on: engaging the person with dementia in an activity, improving safety with environmental modifications, and technology to improve navigation or to monitor movement. While the strength of the evidence was low, the review has identified some promising interventions that carers of people with dementia could trial to reduce risky aspects of wandering, as well as identifying potential directions for future research.

An exploration of the experiences of informal carers supporting a relative living with dementia during and after the move to technology-enriched supported accommodation

“…This change in the care-giving role was a natural transition that emerged from the need to support their loved one move into TESA and emerged from the ‘hitting the crisis point’ theme where ICs identified the provision of safety as a key issue. For example, in line with other reported research (Brittain et al, 2017; MacAndrew et al, 2018), ICs’ responses to wander walking were particularly stressful, with some ICs feeling morally conflicted by the methods required to avoid risks that emerged by wander walking. This is an important finding for two reasons.…”

User experience and clinical effectiveness with two wearable global positioning system devices in home dementia care

“…Although the selected products were similar, usability ratings by dyads of product B were significantly better than ratings of product A throughout the study. Differences in ratings of usability and design features within dyads are in line with previous studies, which have suggested that the needs and preferences of PwDs and CGs with GPS devices need to be taken into consideration as they may differ [7,8,42,43]. Also, the finding that usability ratings with both products decreased after 4 weeks of use, but not significantly, seems to imply that users' expectations could not be fully met, but that they were not entirely dissatisfied.…”

“…In spite of the mentioned limitations, this study provides a starting point for research on UX and clinical effectiveness with wearable GPS devices. Future studies using a randomized mixed-method dyadic approach with standardized and validated outcome measures are needed [43] , [53] .

Research in Context Systematic review: The authors reviewed all relevant publications on the user experience and clinical effectiveness with wearable global positioning system (GPS) devices for persons with dementia (PwDs) and caregivers (CGs) using PubMed, meeting abstracts, and presentations.

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“…Also, the selected products were not specifically designed for PwDs and CGs, but rather for a heterogeneous population, which is typical for most commercial GPS devices. Proactive ways to address these issues include designing products that are adaptive to the changing needs of specific end users and that are tested in large, randomized controlled studies that follow a user‐centered design [8,20,43]. We also did not focus on the cost of either product, although this has been found to influence product acceptability [49].…”

“…In spite of the mentioned limitations, this study provides a starting point for research on UX and clinical effectiveness with wearable GPS devices. Future studies using a randomized mixed‐method dyadic approach with standardized and validated outcome measures are needed [43,53].

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