Saturday, September 28, 2002

This presentation is part of : Health Promotion in At-Risk Older Adults

Preparing the General Community to Assist in the Safe Return of Cognitively Impaired Individuals

Meredeth A. Rowe, RN, PhD, associate professor, College of Nursing, College of Nursing, University of Florida, Gainesville, FL, USA

Currently, 4 million Americans are living with Alzheimer's disease or other illnesses leading to dementia. This number is expected to rise by 340,000 individuals per year that rate will escalate as the older adult population grows. About 60% of cognitively impaired (CI) individuals will wander away from their caregivers. Because of their cognitive impairment, some of them will become lost in the community and because of their cognitive impairment will be unable to find their way home (unattended wandering) and may experience serious injury or even death. Safe Return (SR), a program administered by the Alzheimer's Association, is designed to facilitate the safe return of CI persons who have left their caregiver and have become lost in the community. Registered individuals wear identification jewelry that indicates that they have a memory problem and lists a 24-hour emergency phone number to be called in the event of a discovery. Once SR operators receive a report of a discovery, they work to ensure that the CI individual is returned in a safe and timely manner to their caregiver. Objective: The purpose of this study was to gain an understanding of the phenomenon of unattended wandering so that more targeted approaches for prevention and discovery can be devised. Design: Data for this descriptive study were compiled from registration files and missing and discovery reports collected by the SR program. Population, Sample, Setting, Years: During the 13-month study period, SR collected 675 records of missing and/or discovery incidents. Of these, 60 incidents consisted only of a missing file; limited analyses were done on these records. Of the remaining 615 incident records, 146 included both a discovery and a missing file and 469 comprised a discovery file only. Concepts or Variables Studied Together: Factors associated with CI individuals becoming lost and found. Findings: Accounts of persons found through SR clearly indicate that wandering is a completely unpredictable event. Individuals wandered from the home, professional care settings, during outings with the caregiver, and when left home alone. A CI individual who has never left the caregiver before can inexplicably leave and become lost. Unattended wandering was found to occur more frequently in certain situations: during outings with the caregiver, after agitated or difficult behavior, when the caregiver was distracted or asleep, when on a normal outing alone but unable to return home. Caregivers can be assisted to provide other means of safety during these times. Once the CI individual is lost in the community, law enforcement agencies and the general public are essential in ensuring a safe return. One problem noted in the study was that law enforcement agencies often do not have specific policies for searching for CI adults, and the policies for missing adults are not appropriate, such as waiting 24 hours for the individual to return. Ninety percent of CI individuals were found within 5 miles of their home. In the records reviewed for the study, 4 individuals were found dead. All deaths occurred in natural areas such as small woods or fields. It appears that some CI individuals will get lost or hide in these areas and succumb to natural causes before being found. Half of the CI individuals lost in the community were found by good samaritans. Conclusions: The results of this study indicated that community preparation is essential at three different levels: individual caregivers, law enforcement agencies, and the general public. The areas where they were commonly found should drive the search plan: residential yards, streets, commercial businesses, and healthcare facilities. If a CI individual has not been found in the first 6-12 hours, a shoulder-to-shoulder search of natural areas within a one mile radius of the home should occur and expand to a 5 mile radius as needed. An essential component of SR is enhancing community awareness of the problem, and instructing citizens how to identify a CI individual who may be in need and strategies to assist them. This can be done through the media, civic and other organizations. Implications: The results of this study have important implications for nurses working with CI individuals and communities in which they reside. Nurses can assist local agencies in devising plans that include areas and strategies of the search. Caregivers must be given information about the program by the health care practitioners and local Alzheimer's Association chapter, and support to complete and return the registration packet.

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