Resident Wandering

Wandering may be a behavioral expression of a basic human need such as the need for social contact, or a response to environmental irritants, physical discomforts, or psychological distress.

Care goals for resident wandering

* Encourage, support, and maintain a resident's mobility and choice, enabling him or her to move about safetly and independently.

* Ensure that causes of wandering are assessed and addressed, with particular attention to unmet needs.

* Prevent unsafe wandering and successful exit seeking.

What to look for: Assessment for resident wandering

* Assess each resident's desire and ability to move about and associated risks such as becoming lost, entering unsafe areas, or intruding on another resident's private space.

* When evaluating the triggers of wandering and a resident's wandering patterns, determine the following:

* Whether wandering is a new occurrence

* Wandering patterns

* Contributing medical conditions (eg, urinary tract infections, pain)

* Cognitive function, including safety awareness

* Vision and hearing

* Balance, gait, and transfer ability

* Sleep patterns

* Resident life history (occupation, daily routines)

* Toileting routines

* Emotional or psychological conditions

* Interest in social interactions

* Environmental hazards (lighting, flooring)

* History of falls or near falls

* Clothing and footwear

* Access and response to safeguards (eg, door alarms, handrails)

Resident Falls

People with dementia are at risk of falls because of their neurological impairments. The environment may also contribute to risk conditions.

Care goals for resident falls

* Promote safety and preserve mobility by reducing risk of falls and fall-related injuries.

* Minimize fall-related injuries by avoiding physical restraints.

What to look for: Assessment for resident falls

* A comprehensive assessment includes both identification of resident risk factors and evaluation of environmental conditions related to falls. It also includes collecting information from a resident as well as his or her family or caregivers about the history of falling and any other factors that may contribute to falls.

* When conducting a resident assessment for fall risk, consider the following:

* History and patterns of near-falls, recent falls, and fall-related injury

* Cognitive impairment and capacity for safe and proper use of adaptive equipment and mobility aids

* Functional mobility factors (eg, muscle tone and strength, transfer ability, balance, stance, and gait)

* Sensory function, including vision, ability to sense position of limbs, and tactile senses

* Medical conditions that may contribute to falls (eg, pain, infections, osteoporosis, and deconditioning)

* Hallucinations and delirium

* Presence of restraints

* Nutritional status and recent weight loss

* Medication regimen and use or recent changes in medication

* History of presence of substance abuse or withdrawal symptoms

* Depression and anxiety

* Resident life history, such as occupation and daily routines

* When conducting an environmental assessment for fall risk, consider the following:

* Environmental layout (shape of space and ease of getting around)

* Presence of obstructions in both resident rooms and common areas

* Accessibility, visibility, and safety of bathroom and dining room

* Sturdiness and visibility of handrails and furniture

* Contrast of the toilet and sink from the wall and the floor

* Safety and working condition of equipment and fixtures (eg, wheel chairs, shower chairs)

* Lighting and glare

* Appropriate use of personal safety devices, such as canes, walkers, or wheelchairs

* Bathing facilities with nonslip surfaces

* Floor surfaces, textures, and patterns

* Fit and use of resident footwear

* Use of housekeeping equipment