In a study involving over 15,000 cognitively impaired VA nursing home patients, researchers from the International Research Consortium on Wandering found that one in five were prone to aimless wandering through nursing home facilities, putting themselves at increased health risk and creating additional strain on nursing staff. This presents a challenging behavior problem and safety issue.

Adverse outcomes associated with wandering include an increased incidence of weight loss, fatigue, sleep disturbance, getting lost, injuries as a result of falling and untimely death. Wandering can also lead to increased caregiver stress, stress among other residents due to intrusions into their rooms and safety concerns that challenge care providers responsible for managing behavior problems.

"Our findings indicate that the patients most likely to wander exhibit other antisocial behavior, often resist care, take anti-psychotic medication and depend heavily on others for basic hygiene needs and feeding themselves," says study co-author Dr. Lawrence Schonfeld. The study also found that patients diagnosed with a combination of dementia and other psychological disorders, such as depression or schizophrenia, were particularly vulnerable.

Although this study was performed in a predominantly male veteran population, wandering is also prevalent in non-VA males and in women with cognitive impairment. Schonfeld and his co-authors also discovered that this behavior is not exclusively related to a patient's mobility. 25 percent of wanderers studied required wheelchair assistance. "This phenomenon is understudied, so some health care staff may not see these patients as being prone to wandering," says Dr. Schonfeld.

Under controlled conditions for wandering, which some facilities have, this behavior can have a positive effect. Wandering may actually serve as a form of physical exercise by increasing the muscle strength needed to maintain mobility. It may also provide opportunities for social interactions with residents who have become isolated in their rooms, when the visits are welcomed. Wandering has also been shown to relieve anxiety and reduce the potential for physical agitation and aggression in some patients.

The researchers hope their findings can be used to establish a list of criteria that will allow institutions to target those most at risk for the negative implications of wandering. "If we can find a way to flag the at-risk patients early on, caregivers can be made aware of these risks and monitor patients for the activity," says Dr. Schonfeld.

Dr. Lawrence Schonfeld is Professor and Chair of the Department of Aging and Mental Health at the Louis de la Parte Florida Mental Health Institute,University of South Florida. His numerous research publications focus on substance abuse in older adults, elder abuse, and behavior problems in long-term care.

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