Longitudinal investigation of wandering behavior in department of veterans affairs nursing home care units

Abstract

Objectives: To explore the extent of and factors associated with male residents who change wandering status post nursing home admission. ---------- Design: Longitudinal design with secondary data analyses. Admissions over a 4-year period were examined using repeat assessments with the Minimum Data Set (MDS) to formulate a model understanding the development of wandering behavior. ---------- Setting: One hundred thirty-four Veterans Administration (VA) nursing homes throughout the United States. Participants: Included 6673 residents admitted to VA nursing homes between October 2000 and October 2004. ----------
Measurements:MDS variables (cognitive impairment, mood, behavior problems, activities of daily living
and wandering) included ratings recorded at residents’ admission to the nursing home and a minimum
of two other time points at quarterly intervals.----------
Results: The majority (86%) of the sample were classified as non-wanderers at admission and most of
these (94%) remained non-wanderers until discharge or the end of the study. Fifty-one per cent of the
wanderers changed status to non-wanderers with 6% of these residents fluctuating in status more than
two times. Admission variables associated with an increased risk of changing status from non-wandering
to wandering included older age, greater cognitive impairment, more socially inappropriate behavior,
resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with
locomotion and having three or more medical comorbidities were associated with a decreased chance of
changing from non-wandering to wandering status.----------
Conclusion: A resident’s change from non-wandering to wandering status may reflect an undetected
medical event that affects cognition, but spares mobility.