Activity Directors - Wandering Residents - Activity Director Certification Training - ActivityDirectorUniversity.org - Starts October 5th

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Wandering Residents In residential aged care facilities there are many factors that may influence residents to wander. These commonly include: Inactivity/boredom – lack of activity may lead the person to wander around looking for something to do. In some instances wandering dissipates loneliness and the behavior in and of itself, is often a substitute for lack of social interaction. In contradiction, wandering surprisingly may also be a response to overstimulation and overwhelming situations. Fear, agitation, and confusion commonly lead to “dementia” wandering outdoors or in public environments. Some emotional cues that can cause wandering include: increased levels of stress or fear. Residents with “dementia” who wander are moving about in ways that may appear aimless but often have purpose. People may wander in response to an unmet basic need like human contact, hunger, or thirst; a noisy or confusing environment; or because they are experiencing some type of distress, like pain or the need to use the toilet. Wandering can be helpful or dangerous, depending on the situation. The Balancing Act It’s a balancing act for sure but it is important to look beyond the words or behaviors to discover the feelings that the resident might earnestly be trying to express. Strong emotions may also be caused by unmet needs. Staff must implement the process of deduction to work out what needs are not being addressed and meet the resident “where they are” when possible. Residents may wander for any number of reasons: Physical needs Psychological and social needs Cognitive needs Non-goal-directed wandering requires a response in a manner that addresses both safety issues and an evaluation to identify root causes to the degree possible. Moving about the facility aimlessly may indicate that the resident is frustrated, anxious, bored, hungry, or depressed. Although people who wander may gain social contact, exercise, and stimulation, the resident may consequently become lost or exhausted. Hence, they may become overwhelmed and over tired, which predictably causes sudden outwardly hasty behaviors such as wandering or higher probability of injuries to self and/or others. Person-Centered Care for Wandering Behavior Simply stated, some basic principles for people with dementia stems from understanding and supporting the residents’ rights. To be sure, the onset of dementia does not preclude inherently due personal rights. Understand that the individual beyond the “dementia” is becoming increasingly hidden rather than lost. This means that he/she is still there, and it’s your mission to reclaim the essence of the individual that once was and bring them out of hiding. Those who were highly sociable and had an active lifestyle prior to having mental decline are most likely to wander. The use of certain antipsychotic medications can cause side effects that increase the desire to wander and be in perpetual motion. Sedating medications can also increase the risk for wandering due to confusion. Other causes of wandering include the following: Memory deficits Poor vision Disorientation Language deficits Searching for security Searching to fulfill an unmet need such as to relieve hunger, thirst, pain, constipation, and the need to urinate Searching for a loved one Boredom Person centered care plans must consequently demonstrate this principle. Here are some examples of appropriate goals: Personalize the resident’s surroundings. Interpret behavior from the resident’s viewpoint. Acknowledge and validate the resident’s feelings. Involve the resident with dementia in decision-making. Create target goals for the resident to achieve based on resident history and his/her skills that have not yet been lost. Focus on the journey- not the results. Evaluate the Behavior Physical Needs: Does the resident need to use the bathroom? Is the behavior due to medication side affects? Is the resident: Hungry, thirsty, or generally uncomfortable? Searching for a place that is warmer or cooker, darker or lighter? Looking for a place that is more familiar (does the resident have familiar belongings in his/her room)? Responding to physical illness, e.g., dehydration, infection, congestive heart failure, etc.? Psychological and Social Needs: Is the resident: Restless or agitated and trying to relieve anxiety? Bored, lonely, or seeking company? Following a previously familiar imprinted routine: acting out movement to and from the bus stop to pick up the children – going to work? Cognitive Needs: Is the resident: Disoriented or lost? Disoriented due to medication side affects Overstimulated or understimulated? For the resident, wandering may be positive if it fulfills a need for exercise, sensory stimulation, or purposeful behavior. Many nursing homes provide a safe environment on a locked unit for this reason. The negative side of wandering is it may lead to falls, excess fatigue, anxiety, accidental exposure to certain chemicals, altercations with other residents and unintended wandering outdoors where more danger may be waiting to cause harm. Make it your mission to find the balance in the day and life of your resident by looking beyond the words or behaviors to discover the feelings that the resident might earnestly be trying to express. Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org

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