A supervised walking program to reduce risky wandering in people with severe dementia in residential aged care: A feasibility study

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Dementia-related wandering is very common and has been observed in 100% of ambulant people with dementia in RAC (Algase, Kupferschmid, Beel-Bates, & Beattie, 1997). Anecdotal evidence suggests that, when wandering occurs within safe limits, some benefits may be experienced such as physical activity, stimulation, the provision of meaningful activity and improved quality of life (J Dewing, 2006; Martino-Salzman, Blasch, Morris, & McNeal, 1991). However, evidence suggests that when wandering goes beyond safe limits, adverse outcomes for the person who wanders can be experienced (malnutrition and dehydration, sleep deprivation, increased potential for injury from falls and resident to resident violence, becoming lost, and death) (Algase, Beattie, & Son, 2004). For the person with dementia being cared for in RAC, unique problems associated with wandering are experienced. In the RAC setting the person with dementia who wanders can enter out of bounds areas, such as the bedroom of another resident, which can result in loss of privacy. Due to cognitive impairment, the person with dementia who has had their privacy invaded by a person who wanders may respond to the invasion with verbal and physical abuse, which exposes the person who wanders and their co-resident to increased risk of harm (Shinoda-Tagawa et al., 2004; Talerico, Evans, & Strumpf, 2002). The aspect of wandering resulting in these outcomes is known as boundary transgression (BT), defined as a dimension of wandering that takes the person who wanders to out of bounds or hazardous areas. InRAC when wandering takes the person with dementia into the private space of a co-resident, wandering could result in resident to resident violence, loss of privacy and increased agitation for the recipient of the intrusion, and social isolation for the person who wanders (MacAndrew, 2014). Staff and family members also reported that from their experience, wandering-related BT was very common in RAC, was difficult to manage as carers could not predict where and when a BT would occur and if it would be disruptive to others, and often resulted in physical and verbal abuse. Despite the known asdverse outcomes of wandering in RAC, in the absence of RCTs, there is not strong evidence to support the effectiveness of interventions, and there remains a dearth of evidence-based guidelines for the management of wandering in RAC . The aims of this pilot study are, in people with dementia living in residential aged care, to explore 1. the feasibility of using a supervised walking program delivered before peak ambulation periods 2. to examine if taking a person with severe dementia who wanders for a daily 30 minute walk for 3 weeks will: a. Reduce risky wandering including boundary transgression (BT); b. Improve quality of life (QoL), and sleep quality; c. Reduce agitation, falls and weight loss. A quasi-experimental study design will be used

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