Paper
Saturday, July 16, 2005
Comparison of Wandering Behavior between NH and ALF Residents with Dementia
Jun-Ah Song, PhD, RN1, Elizabeth R. Beattie, RN, PhD2, Donna L. Algase, RN, PhD, FAAN, FGSA2, and Gwi-Ryung Son, PhD, RN3. (1) School of Nursing, Oregon Health & Science University, Portland, OR, USA, (2) Division of Acute, Critical and Long Term Care, University of Michigan, Ann Arbor, MI, USA, (3) Nursing, University of Michigan, Ann Arbor, MI, USA
Wandering behavior in elderly with dementia is a problem frequently encountered in acute, extended care, and home settings, posing a great management challenge to caregivers. Knowledge of differences in wandering for different environments has important implications for the study and care of affected people. This study reports comparison of ratings on a caregiver reporting tool, the Revised Algase Wandering Scale (RAWS), obtained from two types of long term care facilities: nursing home (NH) and assisted living facility (ALF). Cognitively impaired, ambulatory, residents (N=108; mean age = 83.7) were recruited from randomly selected 15 NHs and 6 ALF. Subjects (N = 52 for NHs; N = 56 for ALFs) were evaluated for the level of cognitive impairment using the Mini-Mental State Exam (MMSE) and for the level of physical functioning using the six mobility items from the Minimum Data Set. The RAWS was completed by two nursing staff (a charge nurse and a nurse aid) to quantify wandering along six dimensions (persistent walking, specific patterns, spatial disorientation, eloping behavior, attention shift, negative outcomes); mean scores were used for analyses. Subjects' age, sex, race, MMSE, dementia type and mobility score were compared first using Chi-square test and t-tests. Although some demographic variables (i.e., race, dementia type, motor ability) were different between NH and ALF subjects, the post hoc analyses revealed that these variables did not significantly affect RAWS scores. The RAWS was then examined for difference by facility type using t-tests. Findings showed that there was no significant difference in either RAWS overall or any of the six subscale scores between NH and ALF subjects. Considering that today ALFs are not as highly regulated as NHs, this study findings call for the attention of policy makers in establishing restrictive admissions and discharge requirements for ALFs based on residents' physical and cognitive ability.