Management of Wandering Behavior
The wandering associated with Alzheimer’s disease is a behavior that challenges caregivers in long-term care facilities and at home. In the past, caregivers have resorted to physical restraints and pharmacological solutions to discourage wandering, but the indiscriminate use of these methods is a violation of the legal rights and an ethical affront to the dignity of patients. Studies show that patients fell more frequently in settings where restraints were used, and as many as 20% of staff at a number of long-term care facilities were aware of at least one incident that resulted in the serious injury or death of a wanderer. A study at the Corinne Dolan Alzheimer Center showed that negative aggressive behaviors were reduced when patients had an opportunity to wander freely in a protected environment. (See related notes on Pertinent Autonomy.)
This study examined the effectiveness of seven different visual barrier conditions to test whether patients with Alzheimer’s disease could be discouraged from exiting a secured unit through an emergency door. The study included a “no barrier” condition and the following modifications: (1) strips of brown tape placed on the floor parallel to the door and extending 35″ into the hall; (2) strips of beige masking tape placed in the same position as in condition 1; (3) strips of black tape extending 36″ out into the hall and continuing 28″ up onto the door; (4) an 18″ wide beige cloth (matching door color) attached to the door frame with Velcro extending across the door and concealing the doorknob; (5) a green patterned cloth barrier with the same specifications as condition 4; (6) the doorknob painted the same color as the door; (7) a doorknob cover placed over the doorknob of the exit door.
Results show that during the observation period, seven out of nine patients attempted to exit a total of 43 times. Exiting occurred at all times during the day and night but took place frequently during the two hours after a meal. Strips of colored tape (conditions 1-3) were least effective, and in fact, increased exiting behaviors. The doorknob alterations reduced exits only minimally. Concealing the doorknob behind a cloth panel was the most successful (conditions 4 and 5) and produced no exit behaviors.
Concealing the doorknob behind an 18″ cloth barrier helped to reduce the attempts of wanderers to exit through an emergency door. The success of the cloth panel, irrespective of the color, appears to be due to the visual agnosia (mental inability to interpret images that are seen) that was characteristic of all the wanderers in this project. When visual accessibility is restricted, exiting behavior may be reduced. Visual barriers can help redirect wanderers without jeopardizing safety and fire laws. Individual differences in patients may cause other wanderers to experience frustration with some of the suggested approaches to manage wandering behavior, especially the tamper-proof doorknob covers. Caregivers must evaluate the effects of any modifications to determine how changes effect the overall behavioral patterns intervention.ion.