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Alzheimer's, Dementia & Mental Health
Efforts to Keep Dementia Patients from Wandering
Just Not Working
Wandering not always a problem and safe walking
should be promoted
By Becky Ham, Science Writer
Health Behavior News Service
July 21, 2006 - Everything from multicolored lights
to garden walks has been suggested as ways to keep people with dementia
from wandering, but there is little evidence to show that any of these
interventions work, according to a new analysis.
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pacing, but sometimes any type of
excessive activity that occurs in 15 percent to 60 percent of people
with dementia. Although wandering may provide good exercise and calm
some people with dementia, the behavior can also put them in harm’s way,
particularly if they wander away from care or become agitated while
moving about.
Although tranquilizer and antipsychotic drugs have
been used to control wandering in people with dementia, the drugs are
only modestly successful and may have serious long-term side effects.
Instead, health care workers have turned increasingly to drug-free ways
to prevent wandering, such as music therapy, aromatherapy, exercise
programs and even electronic tracking devices.
However, “there is no robust evidence so far” to
recommend any of these alternatives, according to Dr. Louise Robinson of
the University of Newcastle upon Tyne in the United Kingdom and
colleagues.
The review is published in the latest issue of
Health Technology Assessment, the international journal series of the
Health Technology Assessment Programme, part of the National Institute
for Health Research in the United Kingdom.
Robinson and colleagues reviewed 10 studies of
wandering prevention strategies and 27 studies on the acceptability and
ethics of the techniques. There were no studies on the
cost-effectiveness of the strategies.
The researchers found some evidence that exercise
programs and “multisensory environments” in the form of light and sound
relaxation sessions can reduce wandering and restlessness, but the
single studies supporting these techniques are of poor quality, the
analysis concludes.
The average age of participants was 79 years, from
the seven studies that reported age.
Robinson and colleagues also discussed the ethics
of physical restraints and electronic tracking to prevent wandering with
professional and family caregivers and a few dementia patients.
“None of the participants felt that physical
restraints were an acceptable approach to manage wandering,” Robinson
said.
Opinions were mixed on electronic tracking
strategies, such as giving patients mobile phones that could be located
with satellite tracking technology. In both studies and focus groups,
caregivers felt the devices could keep patients safer and reduce
healthcare worker and family stress. But they worried that the devices
might be impinging on patients’ privacy and freedom.
Dr. Francis Miskelly, a researcher at Imperial
College in the United Kingdom who studied mobile phone tracking among 50
dementia patients for several years, says, “the patients and relatives
welcomed the technology as a solution to a difficult problem, no ethical
issues at all.”
“We took the view that it was the least restrictive
method of restraint,” Miskelly said, adding that the program eventually
“fizzled out from lack of funding.”
People with dementia who were interviewed for the
focus group were concerned that mobile phone tracking might be
embarrassing or hard to use, the researchers found, reporting that
patients preferred more traditional ways of tracking.
“For example, participants felt they would be happy
to carry identity cards, because they were used to carrying them during
the Second World War,” Robinson said.
Future studies should include more information on
what kinds of monitoring and help people with dementia would prefer when
wandering, Robinson and colleagues say.
Patients and caregivers seem open to the idea that
wandering is not always a problem, and that safe walking should be
promoted rather than discouraged in people with dementia, the
researchers say.
More about report:
Robinson L, et al. (2006) A systematic literature
review of the effectiveness of non-pharmacological interventions to
prevent wandering in dementia and evaluation of the ethical implications
and acceptability of their use. Health Technology Assessment, 10[26].
The HTA programme produces high-quality research
information about the effectiveness, costs, and broader impact of health
technologies for those who use, manage and provide care in the NHS. It
is a program of the National Institute for Health Research and publishes
about 50 reports each year, all available for free download from the
website. Visit www.hta.ac.uk for more information
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