Practical Approaches to Dementia Care - Wandering NSW Falls Prevention Network Meeting Wednesday June 23rd 2010 Daneill Haberfield, Behaviour Consultant / Occupational Therapist Behaviour Assessment & Intervention Service (BASIS), NSCCAHS. Email: dahaberfield@nsccahs.health.nsw.gov.au Phone: 0421839173
Dementia Brief overview Alzheimers Cognitive Symptoms Behavioural and psychological symptoms Fronto temporal Lewy Body Vascular Parkinson s
Focus today on wandering
Wandering as pathology Meandering, aimless, or repetitive locomotion that exposes a person to harm (North American Nursing Diagnosis Association, 2001). More likely to experience adverse events (Siders et al 2004)
Wandering can be purposeful Wandering can be therapeutic and improve the person s sense of wellbeing and agency (Wigg, 2010). Physiological benefits of exercise Stimulating appetite Relieving boredom Improves mood / Coping with stress Feeling of empowerment & better self-esteem May improve sleep http://wanderingnetwork.co.uk
Risky wandering vs safe wandering Depends on a number of factors including: The person doing the wandering Knowledge & skills of the caregiver Context or setting of care Workplace culture Dewing, J (2005) Screening for wandering among older persons with dementia.
In general Efforts to reduce wandering should be attempted only when (Siders et al 2004).
Research suggests Assessment should include: Identification of the reason for wandering An examination of wandering patterns (type, time of day, consequences etc) Interventions: A range of that are tailored to the individual s need, the specific behaviour in question and the underlying reasons for it (Robinson et al 2006) (Jayasekara 2009)
Medications for wandering?? Some people who wander are prescribed psychotropic medications to reduce wandering, but (Siders et al 2004). Antipsychotic drugs appear to have only a limited positive effect in treating symptoms but can cause significant harm to people with dementia (Banerjee, 2009)
Practical & nonpharmacological ideas in working with people who wander A person-centred approach
Risk versus Benefit Risk assessments should be replaced by risk-benefit assessments. (Nuffield Bioethics, 2009)
Wandering Non-pharmacological interventions 1. We are not aiming to stop wandering. 2. We are aiming to reduce risks associated including: Fractures Absconding Intrusiveness Worsening mobility Restraint
Reducing risk of fractures Environmental assessment Equipment Nutrition & Hydration www.alzstore.com
Reducing risks associated with absconding Identification bracelet Names on clothes Safe 2 walk www.safe2walk.com.au $9.90 plus GST per week (Alzheimer's Australia member) or $12.90 plus GST per week (non members).
Reduce intrusiveness Boredom is a big issue!! Engage the person in something that matches their skill & interest Try to get into their reality.
Cupboards - Themed nooks Grace O'Sullivan 2010
Sensory aprons & boxes Sensations Dementia Care Products 2009
Maintaining mobility Exercise programs or structured mobility. Give the person a reason or meaning to wander. Poor balance, mobility & muscle strength are confirmed risk factors for falls in community dwelling older people (NSW DOH, 2009).
Staff supervision issues CCTV Boundary fence laser Volunteer sitters program
Summary Assess the whole person (bio-psychosocial / person centred model) Match interventions to the needs that are identified in the assessment. Weigh up risks versus benefits & get the family involved. Enable Safe walking rather than stopping them wandering
References Brodaty, H.Draper, B, Saab, D. Low, L.Richards, V. Paton H. Lie, D. 2001. Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. International Journal of Geriatric Psychiatry. Vol 16 Issue 5, Pages 504-512 Published Online: 21 May 2001 Dewing, J.2005, Screening for wandering among older persons with dementia. Nursing Older People. Proquest Health and Medical Complete, pg 20. Edgerton, E. & Richie, L. 2010. Improving Physical Environments for Dementia Care: Making Minimal Changes for Maximum Effect. In Annals of Long Term Care Clinical Care and Aging. American Geriatric Society. NSW Dept of Health 2009, Prevention of falls in residential aged care. Centre for health advancement population health division. Jayasekara, R. 2009. Dementia: Wandering. Evidence Based Summaries. Joanna Briggs Institute. Adelaide. Robinson, L. Hutchings D.Dickinson O.,Corner L., Beyer, F., Finch, T., Hughes, J., Vanoli, A. Ballard, C. Bond, J. 2006. Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review. Int J Geriatr Psychiatry 2007; 22: 9 22.
References continued www.alzstore.com www.alzheimers.org.uk www.safe2walk.com.au Siders, C. Nelson, A. Brown, L. Joseph, I. 2004, Evidence for Implementing Nonpharmacological Interventions for Wandering. Rehabilitation Nursing. Glenview:. Vol. 29, Iss. 6; pg.195. State of Wisconsin 2009, Person-centred dementia care assessment tool. Department of health and family services, division of Disability and Elder Services. Tilly J, Reed P, 2006. Dementia care practice recommendations for assisted living residences and nursing homes. Washington (DC): Alzheimer's Association. Sensations in dementia care catalogue 2009. Wigg, J. 2010, Liberating the wanderers: using technology to unlock doors for those living with dementia. Sociology of Health & Illness. Oxford: Feb 2010. Vol. 32, Iss. 2; pg. 288