Donna L. Algase

Background/Rationale: Guided by the need-driven dementia-compromised behavior (NDB) model, this study examined influences of the physical environment on wandering behavior. Methods: Using a descriptive, cross-sectional design, 122 wanderers from 28 long-term care (LTC) facilities were videotaped 10 to 12 times; data on wandering, light, sound, temperature and humidity levels, location, ambiance, and crowding were obtained. Associations between environmental variables and wandering were evaluated with chi-square and t tests; the model was evaluated using logistic regression. Results: In all, 80% of wandering occurred in the resident’s own room, dayrooms, hallways, or dining rooms. When observed in other residents’ rooms, hallways, shower/baths, or off-unit locations, wanderers were likely (60%-92% of observations) to wander. The data were a good fit to the model overall (LR [logistic regression] χ ² (5) = 50.38, P < .0001) and by wandering type. Conclusions: Location, light, sound, proximity of others, and ambiance are associated with wandering and may serve to inform environmental designs and care practices.

OBJECTIVES: To develop and validate a wandering typology. DESIGN: Cross‐sectional, correlational descriptive design. SETTING:: Twenty‐two nursing homes and six assisted living facilities. PARTICIPANTS: One hundred forty‐two residents with dementia who spoke English, met Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition , criteria for dementia, scored less than 24 on the Mini‐Mental State Examination (MMSE), were ambulatory (with or without assistive device), and maintained a stable regime of psychotropic medications were studied. MEASUREMENTS: Data on wandering were collected using direct observations, plotted serially according to rate and duration to yield 21 parameters, and reduced through factor analysis to four components: high rate, high duration, low to moderate rate and duration, and time of day. Other measures included the MMSE, Minimum Data Set 2.0 mobility items, Cumulative Illness Rating Scale—Geriatric, and tympanic body temperature readings. RESULTS: Three groups of wanderers were identified through cluster analysis: classic, moderate, and subclinical. MMSE, mobility, and cardiac and upper and lower gastrointestinal problems differed between groups of wanderers and in comparison with nonwanderers. CONCLUSION: Results have implications for improving identification of wanderers and treatment of possible contributing factors.

Original Research: Descriptive Correlational Donna L. Algase, PhD, RN; Cathy L. Antonakos, PhD; Elizabeth Beattie, PhD, RN; Cynthia A. Beel-Bates, PhD, RN; Lan Yao, PhD, RN This study aimed to describe wandering using new parameters and to evaluate parameters as a function of cognitive impairment and mobility. Forty-four wanderers in long-term care settings were videotaped 12 times. Rate and duration of wandering episodes were plotted and used to derive parameters from values above and below case medians, proportion of hours wandering, and time of day. Participants wandered during 47% of observations; on average, the hourly rate was 4.3 episodes, the peak hourly rate was 18 episodes, and the peak hourly duration was 19.9 minutes. Mini-Mental State Examination (MMSE) scores was negatively correlated with overall duration and number of observations during which duration exceeded 15 minutes per hour, was positively correlated with number of observations without wandering, and was not significantly correlated with rate-related parameters. Mobility correlated positively with rate and duration parameters. Interaction of MMSE score and mobility was the strongest predictor of wandering duration. Parameters derived from repeated measures provide a new view of daytime wandering and insight into relationships between MMSE score and mobility status with specific parameters of wandering. Dr. Algase is Professor and Faculty Associate, Institute of Gerontology, and Director, Center on Frail and Vulnerable Elders, Dr. Antonakos is Assistant Research Scientist, Statistical Consulting Team, and Dr. Yao is Assistant Research Scientist, University of Michigan School of Nursing, Ann Arbor, Michigan. Dr. Beattie is Professor of Nursing, Dementia Collaborative Research Centre: Consumers, Carers and Social Research, School of Nursing, Faculty of Health, Queensland University of Technology, Queensland, Australia, and Dr. Beel-Bates is Associate Professor of Nursing, Grand Valley State University, Grand Rapids, Michigan. Address correspondence to Donna L. Algase, PhD, RN, Professor and Faculty Associate, Institute of Gerontology, University of Michigan School of Nursing, 400 North Ingalls Building, Room 2303, Ann Arbor, MI 48109-0482; e-mail: dalgase@umich.edu. 10.3928/19404921-20090101-02 Healio is intended for health care provider use and all comments will be posted at the discretion of the editors. We reserve the right not to post any comments with unsolicited information about medical devices or other products. At no time will Healio be used for medical advice to patients.

This study evaluates three versions of the Wayfinding Effectiveness Scale (WES), developed to differentiate problems of wayfinding and wandering behavior of community-residing elders with dementia (EWD), in 266 dyads (EWD and caregiver) recruited from Alzheimer's Association chapters. Factor analyses yield a five-factor solution (explained variance = 62.6%): complex wayfinding goals, analytic strategies, global strategies, simple wayfinding goals, and being stimulus bound. Overall, internal consistencies are high: WES (.94-.95), and subscales are stable across all versions. Testretest reliability is acceptable for the overall WES and two subscales (complex and simple wayfinding goals) for the care recipient current behavior version. Construct validity is supported by the pattern of correlations among subscales and analyses of variance (ANOVAs) showing significant differences among the care recipient (current vs. prior behavior) and caregiver versions overall and for all subscales. Results support the WES as a valid and reliable measure of wayfinding effectiveness in persons with dementia.

Our purpose was to evaluate the psychometric properties of the Ambiance Scale (AS), a new instrument that assesses the capacity of long-term care environments for generating affective and behavioural responses in people with dementia. Within the context of three parent studies of dementia-related behaviour in long-term care settings, we conducted a cross-sectional correlational study by creating two separate samples of ratings from among all those available. Factor analysis revealed a two-factor structure (engaging, soothing) for the AS. Internal consistency and evaluation of inter- and intra-rater reliability were favourable. A consistent pattern of ratings on the AS and its subscales, moderate subscale correlations, and significant differences between facility types: nursing homes (NH) vs assisted living facilities (ALF) and among selected locations (residents’ rooms, dining rooms, halls) within facility types support construct validity of the scale.

Problem.  The number and quality of studies on wandering and other behaviours has lagged that of biological sciences in the field of dementia research. Recent studies of wandering are examined for quantity, rigour, and findings.Approach.  Medline, CINAHL and PsychInfo were searched systematically for studies of wandering. Research reports were reviewed and data was abstracted to characterise quantity and rigour. Study findings were organised by topic and summarised.Results.  Between 2003 and 2005 inclusive, 47 studies met inclusion criteria. The largest proportion of studies was quantitative and descriptive; an explicit theory or framework guided about half of the studies. Major findings encompassed quantification and description, epidemiology, associated factors, and intervention and management of wandering.Conclusions.  The growing body of research on wandering in becoming more rigorous. Newer measures of wandering have strong psychometric properties. Wandering occurs in multiple dementias and affects patients in larger numbers as dementia worsens. Wandering manifests similarly across cultural/ethnic groups and care settings and is associated with falls and increased mortality. A variety of interventions have been evaluated, but studies lack rigour.

This study examined the psychometric properties of an expanded version of the Algase Wandering Scale (Version 2) (AWS-V2) in a cross-cultural sample. A cross-sectional survey design was used. Study subjects were 172 English-speaking persons with dementia (PWD) from long-term care facilities in the USA, Canada, and Australia. Two or more facility staff rated each subject on the AWS-V2. Demographic and cognitive data (MMSE) were also obtained. Staff provided information on their own knowledge of the subject and of dementia. Separate factor analyses on data from two samples of raters each explained greater than 66% of the variance in AWS-V2 scores and validated four (persistent walking, navigational deficit, eloping behavior, and shadowing) of five factors in the original scale. Items added to create the AWS-V2 strengthened the shadowing subscale, failed to improve the routinized walking subscale, and added a factor, attention shifting as compared to the original AWS. Evidence for validity was found in significant correlations and ANOVAs between the AWS-V2 and most subscales with a single item indicator of wandering and with the MMSE. Evidence of reliability was shown by internal consistency of the AWS-V2 (0.87, 0.88) and its subscales (range 0.88 to 0.66), with Kappa for individual items (17 of 27 greater than 0.4), and ANOVAs comparing ratings across rater groups (nurses, nurse aids, and other staff). Analyses support validity and reliability of the AWS-V2 overall and for persistent walking, spatial disorientation, and eloping behavior subscales. The AWS-V2 and its subscales are an appropriate way to measure wandering as conceptualized within the Need-driven Dementia-compromised Behavior Model in studies of English-speaking subjects. Suggestions for further strengthening the scale and for extending its use to clinical applications are described.

The aim of this study was to evaluate the relationship of wandering and wayfinding and validate the Revised Algase Wandering Scale – Community Version (RAWS-CV) using a community sample of persons with dementia. Adult caregivers (n = 266) completed the RAWS-CV and the Wayfinding Effectiveness Scale (WES). Four aspects of wandering were confirmed (persistent walking, repetitive walking, spatial disorientation, eloping behavior), and two new aspects were also validated (negative outcomes, mealtime impulsivity). The spatial disorientation subscale of the RAWS-CV had significant (p < 0.01) negative correlations with all WES subscales. The global strategies and simple wayfinding goals subscales of the WES correlated significantly with all RAWS-CV subscales except repetitive walking and mealtime impulsivity. ANOVAs comparing wayfinding at 4 levels of wandering revealed differences only for the simple wayfinding goals subscale. Studies examining the relationship of wandering and wayfinding at various levels of cognitive impairment are suggested to further understand these phenomena.