A comparison of two interventions for people with severe dementia who wander: Issues and Insights

Long term care (LTC) residents with dementia who engage in risky wandering experience adverse outcomes including weight loss, fatigue, injury from falls, resident to resident violence, becoming lost and death. Limited robust evidence currently informs best practice for managing risky wandering in LTC using non-pharmacological interventions. Two different behavioral interventions for these residents were separately trialed: 1) Supervised daily 30-minute outdoor walking sessions (n=7) and 2) Daily 20 minute indoor listening to preferred music sessions (n=10). Walking sessions were initiated and completed more frequently than music sessions (80% vs. 61%). The majority (90%) of commenced walking sessions lasted the full duration while only 60% of commenced music sessions lasted the full duration. Most music sessions were terminated because the participant removed the headphones (54%) or walked away from the speaker (32%). While staff were concerned that a tailored daily walk involving care staff would be difficult to manage with the care routines of the facilities, a similar concern about music sessions was not raised. Staff suggested a dedicated room was needed to implement the music intervention to avoid interruptions. Despite high intervention fidelity and staff and family commitment to the benefits of both interventions, neither intervention has immediate strong clinical applicability potential because of staff attitudes towards tailored programming, issues with the music delivery protocol, and questions about appropriate dose. Refinement of the interventions and implementation strategies will be discussed as methods to address clinical applicability and sustainability in the LTC setting.