Academic journal article Research and Theory for Nursing Practice

A Comparison of Wandering Behavior in Nursing Homes and Assisted Living Facilities

Academic journal article Research and Theory for Nursing Practice

A Comparison of Wandering Behavior in Nursing Homes and Assisted Living Facilities

Article excerpt

Wandering, a challenging behavior associated with dementia, affects many residents of long-term care facilities and can result in elopement, injury, and death. Most studies of wandering have taken place in nursing homes (NH). Expansion of the long-term care sector over the last 2 decades has resulted in a surge in options such as assisted living facilities (ALF). This study compared wandering behavior of residents (N = 108) in 21 long-term care facilities (15 NH, 6 ALF). Staff used the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH) to quantify wandering. While there were some differences in demographic variables (i.e., race, motor ability) between NH and ALF participants, no significant differences were found in either RAWS-NH overall or any of the 6 subscale scores. This suggests that the expression of wandering is similar in long-term care residents across all dimensions of the RAWS-NH regardless of facility type. Findings are of concern for those involved in the safe management and protection of residents at risk for wandering, particularly in long-term care facilities with underregulated staffing and training requirements.

Keywords: wandering; dementia; assisted living facilities; RAWS-NH; environment; characteristics

Wandering affects many people with dementia and does so in a sustained manner across all levels of cognitive impairment (Holtzer et al., 2003; Teri, Larson, & Reifler, 1988). Negative outcomes of wandering include falls, accidents, fractures and other injuries, weight loss, fatigue, sleep disturbances, berating and abuse, getting lost, and untimely death (Algase, Kupferschmid, Beel-Bates, &Beattie, 1997; Fopma-Loy, 1988; Gruber-Baldini, Boustani, Sloane, &Zimmerman, 2004; Jost & Grossberh, 1995; Rowe & Bennett, 2003; Rowe, Feinglass, & Wiss, 2004; Rowe & Glover, 2001; Schonfeld, 2003; Shinoda-Tagawa et al., 2004; Volicer & Hurley, 2003). While many of these outcomes are potentially amenable to change, most are arguably preventable with appropriate management of wandering behavior.

As people age, their behavior is known to become increasingly more sensitive to environmental factors (Lawton, Nahmenow, & Tsong, 1980), and even more so in the presence of dementia (Algase et al., 1996; Hall & Buckwalter, 1987). Thus, looking to the environment as a factor in wandering behavior is reasonable. A better understanding of wandering as it manifests in various environments may give clues to contributing factors. Further, knowledge of how wandering varies across environments can illuminate the need for prevention and management strategies appropriate to different settings.

Since most studies of wanderers and wandering have taken place in nursing homes (NH), with a few studies of wanderers living at home in the community, little is currently known about the manifestation of wandering in other environments housing people with dementia. The burgeoning of assisted living facilities (ALF) within the long-term care sector in the US has broadened residential options for such people, including those who wander. A recent study (Golant, 2004) identified ALF as the fastest-growing noninstitutional long-term care alternative for frail older persons in the US, offering diverse and highly variable care alternatives. In fact, many ALF are specifically designed to provide dementia care. In an effort to determine whether knowledge of wandering drawn from NH is applicable to ALF or whether wandering in ALF is of a different character, this study compared the wandering behavior of residents with dementia living in NH and ALF using the Revised Algase Wandering Scale-Nursing Home Version (RAW-NH).


In the US the two primary long-term care (LTC) housing options for individuals with dementia are NH and ALF. NH accommodate individuals requiring 24-hour supervision and/or skilled nursing care, are reimbursed by Medicare and Medicaid when applicable, and tend to have somewhat uniform physical features, services, and regulations across states (Rosenblatt et al. …

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