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BACKGROUND/RATIONALE:
Wandering Behaviors and associated risks (e.g. falls, accidents, fractures, weight loss, getting lost, berating and abuse) are frequent reason for nursing home placement and result in significant morbidity and mortality.
OBJECTIVE(S):
This study advances existing wandering research in the following ways: (1) extends wandering research conducted primarily in nursing homes to community-based settings; (2) examines the early trajectory of wandering, including the onset of wandering behaviors, by focusing on patients with mild dementia, and (3) tests a new conceptual model addressing factors contributing to the early onset of wandering, as well as immediate and cumulative adverse events associated with wandering behaviors over time.
Research Questions: (1) What is the incidence and prevalence of types of wandering in community-dwelling veterans with mild dementia? (2) How do the types and intensity of wandering behaviors change over time? (3) To what extent do contributing factors predict types and intensity of wandering behaviors? Secondary Research Questions: (4) What is the relationship between the types and intensity of wandering and wandering-related adverse outcomes? (5) Can immediate adverse outcomes be used to predict cumulative adverse outcomes in veterans who wander?
METHODS:
This 3 -year study employs a prospective longitudinal design with community-dwelling dyads of veterans with mild dementia and their caregivers. As association of dementia with wandering is likely to evolve, this design will allow us to study this association and to show the emergence of wandering over time. This design will provide important information regarding the developmental trajectories of wandering in community-dwelling veterans with mild dementia and will allow for identification of new cases as well as risk factors, developmental concomitants and adverse events.
Data Source: A large cohort (N-154) of community dwelling dyads (veterans with mild dementia and their caregivers) will be recruited from four dementia diagnostic clinics at two VAMCs (Tampa and Jackson) and followed for two years. The study will include (1) veterans over age 60, (2) newly diagnosed with mild dementia, (3) living in a non-institutional home-type setting, (4) independently ambulatory, (5) with a caregiver who is willing to participate in the study and (6) English-speaking. Veterans need not be identified wanderers at the onset of the study as our intent is to determine if, when, and in whom, wandering manifests. We will exclude veterans who are bilaterally deaf, blind, or have a major psychiatric disorder. Measures for several classes of concepts are included: wandering behaviors, contributing factors, and adverse outcomes. Data will be collected from the veterans using activity meters, cognitive and physical performance measures, interview, and self-report scales; interviews and multiple rating scales will be giver to a caregiver. Data will be collected at four data points; entry and subsequent eight-month intervals over a two-year period.
FINDINGS/RESULTS:
Enter text here.
IMPACT:
This study will illuminate the early trajectory of wandering, including the onset of wandering behaviors, by focusing on patients with mild dementia. Based on findings from this study we will refine the conceptual model on wandering for predicting associated adverse events. We will publish findings in peer-reviewed journals and present findings at national meetings. Data on hazardous wandering in moderate/severe dementia in nursing homes is already available. Results from this study will used to fill in the gaps on community-based persons with mild/moderate dementia. Three products will be developed as part of this study: (1) Risk Assessment Tool for Wandering to promote early case identification of veterans at risk for hazardous wandering behavior in home settings; (2) Caregiver Guide for Recognizing and Safely Managing Wandering in the Home Setting; and (3) Identification of Interventions for Safely Managing Wandering in Persons with Mild to Moderate Dementia. Wandering is a research focus for two Tampa VA Research Centers: (1) RR&D REAP on Preventing Mobility-Related Adverse Events, and (2) Patient Safety Center of Inquiry for Safe Patient Mobility.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Health Services and Systems
DRE:
Diagnosis and Prognosis, Communication and Decision Making
Keywords:
Caregivers – not professionals, Dementia, Research method
MeSH Terms:
none
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