A framework to describe the levels of risk associated with dementia-related wandering

• Author / Creator

  Neubauer, Noelannah

• Introduction: Critical dementia-related wandering has been of significant concern in recent years, in part due to the rising prevalence of lost and missing persons involving older adults with dementia. Few resources exist to help guide families and persons with dementia to select and adopt proactive strategies to manage the risks associated with persons who are getting lost. The purpose of this thesis was to develop and validate a conceptual framework and series of guidelines that will help stakeholders, such as families and persons with dementia, choose specific high and low tech strategies to manage challenging behaviours associated with critical dementia-related wandering.
  Methods: A scoping review was first conducted to identify the range and extent of wander-management, product readiness and associated outcomes within the scholarly and grey literature. Following this, semi-structured individual phone interviews containing 12 questions were conducted with family and formal caregivers, persons with mild dementia, health practitioners, police, social workers, industry and staff from community organizations that work with people affected by dementia. The purpose of the interviews was to determine what strategies were used or suggested by participants and what factors influenced their adoption of the specific strategy. A secondary study involved family and paid caregivers identifying antecedent behaviours indicative of “critical” wandering, or wandering associated with getting lost through recording daily observations for two to four weeks. Responses from the scoping review, interviews and observations were used to develop the conceptual framework and guidelines for strategy adoption of wander-management strategies. Face and content validity of the guideline was then assessed using eight focus groups and six interviews across participants, and were subsequently disseminated for use by community organizations and health professionals.
  Results: A total of 96 participants participated in the development of the conceptual framework and guidelines, 34 assessed their face and content validity and 73 provided final feedback through an online and paper survey. Responses from the interviews produced four contextual factors that influenced the adoption of specific high and low tech wander-management strategies: (1) Risk associated with wandering; (2) Culture; (3) Geography; (4) Stigma. Common antecedent behaviours of critical wandering events included packing of belongings, preparing to go outside, and door lingering or tampering within continuing care facilities. The relationships of these four factors and antecedent behaviours were used in the development of the conceptual framework and guidelines. Overall impression of the conceptual framework and guidelines was positive according to users. Participants used the guidelines to choose proactive wander-management strategies. They suggested changes in some of the terminology and additional factors and strategies be added to the framework and guidelines.
  Conclusion: This is the first study to describe and validate factors that influence strategy adoption for critical dementia-related wandering. The guideline for strategy selection and use was made available nationally for use by caregivers, health and community service providers to identify strategies to mitigate the risks associated with critical wandering. The findings from this thesis reinforce the importance of proactive strategies to mitigate the risks associated with getting lost and illuminate the need to balance between safety and independence when trying to mitigate this issue. It also highlights the significance of knowledge translation practices in critical wandering

• Subjects / Keywords

  • strategies
  • risk
  • dementia
  • wandering
  • guidelines
  • framework

• Graduation date

  Fall 2019

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-z0nz-0p16

• License

  Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.