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Older adults who wander often do so in search of home, a loved one, the bathroom or even food. Wandering also can indicate the person's needs are not being met, said Marie Boltz, MSN, APRN, BC, director of Practice Initiatives at the Hartford Institute for Geriatric Nursing at New York University and consultant for long-term care (LTC) facilities in the Philadelphia area.
Therefore, she said, LTC facilities should assess the meaning behind wandering and create stimulating and supervised environments. Nursing staff and activities coordinators should keep residents at risk for elopement active and frequently seek to meet their basic needs.
For an additional layer of safety, wandering prevention systems alert staff to residents about to exit a unit or rise out of a wheelchair or bed without assistance.
"Alarm devices have become one of the primary ways of ensuring a resident with dementia remains safe," said Gary S. Latimer, BA, RN-EMT, LNHA, director of nursing, Pine Brook Care Center & Rehabilitation, Englishtown, NJ. "While not entirely fool-proof, nor a guarantee the person utilizing the alarm will never elope or be injured, such devices dramatically aid in the rapid detection of elopement or activities that are detrimental to the individual."
Mobile & Safe
For mobile residents who tend to wander, commonly used alarm systems come as bracelets worn on the arm or ankle, or attached to a wheelchair or walker.
At St. John Neumann Nursing Home, Philadelphia, two systems in place keep residents at risk for elopement safe. The Memory Support Unit has doors that are secure with a four-digit code to open/close the doors. Additionally, residents at risk for elopement wear a special bracelet interfaced with an alarm system. The alarm, which has been installed in the front entrance of the building, will sound when the resident with the bracelet approaches the door.
"When a resident with the bracelet nears a door, the door will lock and an alarm will sound for someone to come," explained Tina Cheftalian, BSN, RN, assistant director of nursing. "The bracelets are worn around the wrists unless a resident can remove them and then they could be placed on the ankle."
Every night staff test the bracelets with a device that blinks red if the battery needs to be changed. Bracelets are changed once a month at St. John Neumann Nursing Home.
These kinds of alarm bracelets usually are set up as a two-step system, Latimer told ADVANCE. The first step acts as an automatic door lock for those egresses that would otherwise allow a resident to elope. The second system sounds the alarm should a resident get too close to a means of egress.
"This two-step system is highly effective in preventing a confused 'wanderer' from leaving a secure unit or facility," Latimer explained. Such systems "allow the resident free mobility throughout the nursing home, hospital unit or Alzheimer's unit. Depending on the system, the staff would be alerted by an audible and/or visual alarm when a resident who is wearing a bracelet or anklet approaches an alarmed egress door. In most scenarios, the door also is set up to automatically lock-down, making elopement impossible."
Locating Wanderers
Another system can function like a GPS locator, allowing staff to spot wanderers within the facility as well as outside via the use of radio transmitters.
GPS and alarm bracelet systems are preferable methods of maintaining the safety of a confused resident, Latimer said. "Because the resident is allowed to ambulate freely about the facility with the exception of main egress doors, there is limited loss of dignity or loss of control," he added. "In fact, it allows for healthy exercise, decreased anxiety and [increased] social interaction."
These systems augment "the staff's responsibility of frequently checking wandering residents, but adds an element of security in that there is minimal risk of a confused resident eloping from a secured facility," Latimer said.
Future systems will employ "true-time" GPS monitoring so any resident who elopes can immediately be tracked via satellites, he added.
Systems to Prevent Falls
For residents who are less mobile, another type of alarm is a magnetic device attached via a string to the resident's wheelchair or bed. The other end is connected to a loud alarm box. If the resident rises out of the chair or bed without assistance, the magnetic connection will break from the alarm box, and an alarm will sound.
"These devices are quite effective at preventing unwanted falls, which can be devastating to the elderly population," Latimer said.
A similar type of wandering prevention system is a self-release Velcro alarm seatbelt. A minimal type of restraint, the seatbelt can be released by the resident. However, in doing so, an alarm will sound to alert staff. "While considered a restraint, the fact that the resident can self-release it makes it a viable alternative," Latimer said.
Securing Exits
As a fail-safe measure, many LTC facilities secure main doors and elevators, requiring staff or family to punch in a code to exit.
Michael C. LaFerney, APRN,BC, behavioral health nurse at Arbour Senior Care, Rockland, MA, has seen these measures, in addition to camouflaged doors. Doors can be painted to appear as a bookcase, for example.
Coded alarms at the main exits and elevators should be changed monthly, and staff should not shout the code because residents can memorize them even when it seems their memories are failing, LaFerney cautioned.
Often, nursing homes will keep photos of residents at risk for wandering near the main reception area. All staff must be aware of who is at risk for wandering. "It has to be a team approach," LaFerney said.
Keeping Residents Active
It also has to be a team approach to keep residents at risk for wandering active to prevent elopement and boost their quality of life. This is the key method at Presbyterian Homes, Evanston, IL. In addition to elopement alarm systems, "staff on the unit know which residents are likely to try to leave the area," said Linda Schuetz, BSN, RN, director of nursing.
"There are residents who like to go to more places than others, so we have staff and volunteers to accompany the resident for walks," she said, adding that there are numerous gardens to explore on campus that help to foster exercise and the feeling of independence.
In addition to activity, residents need positive reinforcement. "Nursing staff [can] spend a lot of negative energy to block people from walking places," LaFerney said. "If a patient does not wander, every 2-4 hours reinforce that he stayed on the unit and give him a reward, like a cup of coffee. That makes the quality of life better for the patient."
Erin James is associate editor at ADVANCE.
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