Dementia Care

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58 Australian Journal of Dementia Care October/November 2016 Vol 5 No 5
and actually spoke in return to your
comments…; he’s just much more alert with his
facial expressions, smiling and it’s as if he’s
really happy.”
“He is very hard for us to manage with
hygiene and showering, but after walking it was
a little bit easier for us.”
Opinion was divided about howmuch
the participants walked within the care
home during the program, but there was
consensus that they seemed to spend
longer in those areas of the facility where
activities were occurring, rather than
walking alone:
“He wasn’t wandering as much. I’m not
saying it was fatigue but he was more inclined
to sit with us [as a passive participant], not just
come out into the courtyard and sit on his
own.”
Concerns
Staff thought some aspects of the program
were not positive. Some were concerned
that escorting residents on a walk every
day during the warmer weather made
them too tired and was therefore not
beneficial for the individual.
In addition, there was a perception that
going out with residents took staff away
from their nursing duties, even though the
facility rostered other staff to cover their
absence during the walks.
“It made [the participants] look really tired
and as if they had no energy… [participant’s
name] did get a little aggressive, cranky and
irritable, which is not like her…”
“If they are walking, then it’s less staff on the
floor and we find it very difficult for us…”
Despite these concerns, there was
overwhelming support from staff for the
supervised walking program to continue
as there were perceived benefits for the
participants and the staff involved in the
program:
“His wife noticed the change in him and
asked for the walking program to continue. …
She worries that he doesn’t socialise.”
“I built a bond with the resident I took, not
only that, they connected you to that walking
and that doing something and giving them a
bit of value and something to look forward to…
It’s just shown that if you spend quality time
with them it will make the job easier. …They
respond better to you. You’re building that
rapport.”
“Their mood is happy. It’s like we’ve
improved their quality of life, or enriched their
life.”
Keeping the program on track
Our research challenge now is to work
effectively with aged care facilities to
embed a walking program that shows
benefits for residents who have wandering
as part of their daily behaviour, while
fitting seamlessly into facility routines.
Staff involved in the pilot program
offered some suggestions about how the
program could be altered to ensure it was
sustainable at their facility. These included:
•Using volunteers to lead the walks.
• Conducting walks with small groups of
residents as opposed to a single resident.
• Conducting the walks at more general
times in the morning or afternoon rather
than having rigid individualised walking
schedules.
•Avoiding escorting individuals on walks
during high activity times of the day
such as meal times.
These suggestions have been considered
and some changes were made to the
program at the second site. Most
significantly, when our team last spoke
with staff from this facility, they reported
being very keen to continue a modified
version of the walking program as the
benefits were apparent.
After considering our findings, the
research teamwill concentrate on
collecting additional evidence about how
much walking helps the individual with
dementia who has wandering as a
behavioural symptom, and when the
supervised walk needs to occur to be most
beneficial. Ultimately this work will
contribute to evidence-based guidelines for
managing dementia-related wandering
more effectively in the future.
Acknowledgments
The research team would like to thank the
residents and staff who participated in the
program and Mitch McMaster for his contributions
to this project. The project is funded by a grant
from the Dementia Collaborative Research Centre:
Carers and Consumers (DCRC: CC).
References
Algase D, Moore D, Vandeweerd C, Gavin-
Dreschnack D (2007) Mapping the maze of terms
and definitions in dementia-related wandering.
Aging and Mental Health 11(6) 686-698.
MacAndrewM, Beattie E, O’Reilly M, Kolanowski
A, Windsor C (2015) The trajectory of tolerance for
wandering-related boundary transgression: an
exploration of care staff and family perceptions. The
Gerontologist pii: gnv136 (Epub ahead of print).
MacAndrew M, Fielding E, Kolanowski A, O’Reilly
M, Beattie E (2016) Observing wandering-related
boundary transgression in people with severe
dementia. Aging & Mental Health July 25 1-9
(Epub ahead of print).
MacAndrew M (2014) A descriptive study of
wandering-related boundary transgression in
persons with severe dementia in residential aged
care (PhD). Brisbane: Queensland University of
Technology, QUT eprints.
Moore H, Algase D, Powell-Cope G, Applegarth
S, Beattie E (2009) A framework for managing
wandering and preventing elopement. American
Journal of Alzheimer’s Disease And Other
Dementias 24(3) 208-219.
Dr Margaret MacAndrew is a lecturer in the
School of Nursing, Queensland University of
Technology (QUT) Brisbane and a researcher with
the DCRC: CC, QUT; Professor Elizabeth Beattie
is Director of the DCRC: CC; Dr Elaine Fielding is
DCRC: CC Senior Research Fellow; and
Catherine Wyles is the Project Manager for the
walking program. To follow up on this article
contact Margaret at:
.
* Editor’s note: While AJDC acknowledges
there is ongoing debate over the use of
terms such as ‘wandering’ (along with others
such as ‘managing behaviour’ and
‘behavioural and psychological symptoms of
dementia’) in relation to people with
dementia, our current editorial policy is to
continue publishing articles that include
these terms when it is clear they are used in
the context of the research or practice being
described and the author’s intent is to
promote person-centred care.
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Forallwhoworkwithpeoplewithdementia Vol5No3June/July2016
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