Management of wandering in dementia : the effectiveness of non-pharmacological interventions

Abstract

Background: Wandering is one of the most difficult Behavioural and Psychological Symptoms of Dementia (BPSD) to manage. It places a heavy burden on caregivers and often results in individuals with dementia having to be institutionalised. Aim: The purpose of this review was to evaluate the effectiveness of nonpharmacological management of wandering behaviour in individuals with dementia. The sample population consisted of individuals with dementia, the interventions include nonpharmacological management and there was no direct comparison. The outcome was the effective management of wandering. Design: An electronic search involving multiple databases and a hand search of references of individual articles was undertaken. The searches yielded a total of 15 studies related to the effectiveness of non-pharmacological interventions. Critical Appraisal Skills Programme (CASP) tools were used to appraise the main literature. The studies chosen could have been carried out in any environment and involved participants with dementia and acquired cognitive impairment. The studies excluded had a primarily pham1acological focus, focused on end-of-life care or were editorials. Results: The results indicated that there is no robust evidence to supp01i the use of non-pharmacological interventions. Consideration should be given to the use to environmental modifications, walking/exercise and individualised behaviour management. However, due to methodological limitations, caution has to be exerted when interpreting these findings. Conclusions: High quality research is needed to determine the effectiveness of nonpharmacological interventions that allow safe wandering which are ethically acceptable. Educating caregivers of individuals with dementia will result in the implementation of nonpharmacological interventions that may prove to be successful. Managerial staff in healthcare settings should be made aware of the current non-pharmacological interventions that could be effective in managing wandering so that pharmacological management would not be the first line treatment implemented in such individuals. A dementia strategy and guidelines for practice need to be published locally to guide clinical practice.