Some residents of nursing homes have cognitive impairments such as Alzheimer’s disease that make them more prone to wandering or elopement, both of which can result in life-threatening injuries or even death. Wandering may be defined as straying into unsafe territories. Wandering may be either goal-directed (the person appears to be searching for someone or something and may make gestures as if performing a task) or non-goal directed (the person appears to be wandering aimlessly and often has a very short attention span).
Elopement is the most dangerous form of wandering in which a confused person leaves an area unsupervised and unnoticed and does not return. Elopers are purposeful and intentional in their attempts to leave the premises and often attempt to leave repeatedly. Elopement exposes the person to potential serious harm such as hypothermia in the winter, injuries due to traffic accidents, or injuries due to hazards such as steps for a person with poor balance, decreased physical strength, or poor vision. Most elopements in nursing homes occur shortly after admission.
Dementia is a group of symptoms that signify the loss of intellectual functions such as thinking, remembering, and reasoning that are of sufficient severity as to interfere with the person’s daily functioning. The most common form of dementia is Alzheimer’s disease which is defined as an irreversible and progressive brain disorder that occurs gradually and results in memory loss, unusual behavior, personality changes, and a decline in thinking abilities. About 50% of people over 85 have Alzheimer’s disease and about 50% of nursing home residents suffer from some form of dementia, of which Alzheimer’s disease is the most common.
Wandering in Alzheimer’s disease patients usually occurs two to four years after the onset of the symptoms of the disease. More than 34,000 Alzheimer’s disease patients in the United States wander from their homes or their care facilities each year. About 11% to 24% of institutionalized dementia patients wander.
Risk Factors For Wandering And Elopement
A nursing home resident with a history of wandering or elopement and alteration in mental status (confusion) are major risk factors for wandering and elopement. Nursing home residents with cognitive impairments such as memory loss and decreases in awareness, reasoning, perception, and judgment are at higher risk for wandering and elopement.
Those suffering from dementia often experience severe anxiety in not knowing where they are, what they are supposed to do, and who the people are who are around them, which causes them to wander in search of answers. Their inability to express themselves may be the basis for them trying to elope to find a more secure and meaningful place. Changes in the brains of Alzheimer’s disease patients may cause them to be unable to retrace their movements after elopement and thereby become lost because they cannot form a mental map of their environment.
People who were more outgoing and socially and physically active before they began to show signs of dementia are more likely to engage in wandering. A patient with dementia who is bored, frustrated, anxious, or depressed is more prone to wandering. Patients with dementia who are sedated are at increased risk for wandering due to increased confusion. A patient who engages in wandering may have an unmet need such as hunger, thirst, pain, or discomfort that may be due to an uncomfortable bed, chair, or lighting. An undiagnosed medical condition such as an infection in a person without a history of cognitive loss may be the cause of the onset of wandering.
In some cases, wandering in a safe environment may be a positive behavior because it may fill a need for exercise, sensory stimulation, or purposeful behavior (wanderers in safe environments in nursing homes may experience better physical health and functioning and may represent a continuation of a prior pattern of exercise for the wanderers).
Reducing The Risks Of Unsafe Wandering And Elopement In Nursing Homes
Nursing home residents must be timely and adequately assessed (and re-assessed, as necessary) for their risk of wandering and elopement. Once a nursing home resident has been identified as being at risk for unsafe wandering or elopement, the nursing home must develop a care plan to address the resident’s needs. The use of physical or chemical restraints that have been used in the past have been shown to not prevent injuries, to increase the risk of injuries, and to contribute to the physical decline and depression of patients (federal regulations specifically state that nursing home residents have the right to be free from any physical or chemical restraint that is imposed for purposes of convenience and not required to treat the residents’ medical symptoms). Instead of preventing the resident’s movements, the nursing home should provide the resident with safe walking areas (uncluttered and well-lit) and safe rest areas to avoid fatigue.
Residents who are at risk for unsafe wandering or elopement may be assigned rooms far from exits. Safety locks for closets and drawers that contain potentially dangerous items may be used. Exit doors may be modified to have mechanisms that require cognitive skills that many people who wander may lack. Electronic devices placed in a bracelet worn by the resident or sewn into the resident’s clothing that triggers an alarm when the resident exits a door or enters an unsafe area may be useful, or the exit doors themselves may have alarms that are triggered when opened by unauthorized users. Video surveillance of exits may be used to reduce the likelihood that a resident who wanders into an unsafe area or attempts to elope from the nursing home will do so without being observed.
Nursing home residents who tend to wander at night or are at risk for falls are frequently provided with bed alarms that alert the nursing home staff when the residents attempt to get out of bed (the nursing home staff still needs to timely and appropriately tend to the residents’ needs, such as toileting , during the night).
Nursing homes must properly assess and treat residents’ depression and provide meaningful activities for the residents, which may help reduce the risk of residents’ unsafe wandering and elopement.
A Recent Pennsylvania Nursing Home Elopement In The News (Twice In Two Days!)
A Pennsylvania nursing home resident eloped from her nursing home on March 21, 2012 (which the nursing home reported at 8:30 p.m.) and returned to the nursing home on her own the next morning (at 4:40 a.m.).
Two days earlier, the same woman eloped from her nursing home between 2:00 a.m. and 6:00 a.m. and was found by the police later that day at a Burger King restaurant.
What will it take for the Pennsyvania nursing home to keep her safe?
If your family member or a loved one eloped from a nursing home and suffered injuries or death as a result, the nursing home may be held accountable for the incident. Medical malpractice attorneys may be able to investigate for you if the nursing home is at fault and should be held responsible.
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