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Background
Information:
“The dementias
are the most commonly found psychiatric syndrome in the
nursing homes with a prevalence of 67-78%. Alzheimer’s
disease accounts for about 75% of all progressive dementias
seen in the elderly, and multi-infarct dementia accounts for
15%. Together, the two conditions account for about 90% of
all dementias.”1
“Nursing home staffs consider 11% of residents to be
wanderers. (National Center Health Statistics, 1979) One in
five ambulatory cognitively impaired nursing home residents
are wanderers. (Algase, 1988)”2
“The
prevalence of Alzheimer’s disease doubles every 5 years after
age 65. Currently, an estimated 4 million Americans have
Alzheimer’s disease, but as the life expectancy increases and
the Baby Boomers start reaching age 65 by 2011, those with
Alzheimer’s will grow proportionately larger. Planners and
providers of long-term care services must seek new ways to
optimize medical management, delay cognitive and functional
decline, and reduce caregiver burden.”3
Wandering:
“Wanderers experience an average of 79 episodes of locomotion
per day and ambulate an average of 14 hours during the day. (Algase
and Cheng, 1991)”4
“Wandering is a common behavioral problem in Alzheimer’s
disease.”5
Resident Room
Privacy Gates prevent entrance into the cognitively intact
residents’ room; yet, do not obstruct the doorway view or
ventilation.
“Wanderers have poorer parietal lobe functioning (controls
general sensory experiences) than subjects with similar
degrees of cognitive impairment. (DeLeon and Associates,
1984)”6
“Wanderers showed significantly greater impairment in basic
skills (orientation, memory, and concentration) and in the
higher order skills of language, abstract thinking, judgment,
and spatial orientation than the non-wandering cognitively
impaired resident. (Algase, 1991)”7
Resident Room
Privacy Gates work because the cognitively impaired resident
cannot pull the gate toward them and then walk around it into
the room. (The cognitively impaired want to simply push
against it and if there is no give, they continue walking.)
“Wandering behavior can be both a psychosocial problem
(meddling in others’ belongings during wandering) and a
physical care problem. (Burnside, 1988)”8
“More
alert residents are annoyed by the intrusions of the
wanderers.”9
Resident Room
Privacy Gates allow cognitively intact residents to maintain
their privacy, self-respect and sense of security.
“The
abnormal behaviors most often complained about by nursing home
personnel include wandering and pacing. (Lucas, Steele and
Bognannis, 1986)”10
Resident Room
Privacy Gates eliminate the wasted man-hours spent by nursing
staff retrieving wanders from the cognitively intact
resident’s room.
“Open
doors are a signal to enter.”11
Resident Room
Privacy Gates are a signal not to enter.
Treatment
Approaches:
“Steps to decrease wandering include reality orientation and
redirection.”12
Resident Room
Privacy Gates orients wanderers to the hallway and redirects
them away from other residents’ rooms.
“The
abilities of Alzheimer’s residents can be enhanced by visual
barriers and nonverbal cues.”13
Resident Room
Privacy Gates are both a visual barrier and a nonverbal cue to
the cognitively impaired not to enter rooms where they do not
belong.
“Ongoing orientation on the unit is essential for the resident
with spatial orientation and training problems since their
ability to remember is also impaired. When spatial
orientation abilities are lost, the provision of activities to
engage and purposefully focus the attention of the older
person with cognitive impairment can be ability-compensation.”14
Resident Room
Privacy Gates are ability compensating because they assist in
orienting residents where not to wander.
“Wandering agendas can be classified as (1) purposeless,
including tactile or environmentally cued searching, or (2)
purposeful…Tactile wanderers are residents nearing the end of
the ambulatory dementia phase. Behavioral characteristics
include the use of their hands to explore the environment.
Nursing interventions include guiding residents away from
doors, supervising their walking, or redirecting them to other
tactile objects.”
Resident Room
Privacy Gates provide a tactile barrier, which assists nursing
staff in guiding residents away from the cognitively intact
resident’s doorway.
“Environmentally cued wanderers are usually in the mid to late
ambulatory dementia phase. They appear calm and tend to
follow cues within the environment. A chair may cue them to
sit, a window invites them to look out, hallways entice them
to keep walking, and a door may indicate an exit. Nursing
interventions include assessing the environment for cues to
wander. Doors may be fitted with special closures that
prohibit opening by impaired residents. (Hall, 1988)”16
Resident Room
Privacy Gates cue wanderers to “move on” away from the
cognitively intact resident’s room and continue walking.
FOOTNOTES AND
BIBLIOGRAPHY:
1.
Szwabo, Peggy A. and Grossberg,
George T., Problem Behaviors in Long-Term Care, Recognition,
Diagnosis and Treatment (New York, NY, Springer Publishing
Co., 1993) p. 35, 37
2.
Tangalos, Eric G., The
Environment of Care (The continuum of Dementia: Transforming
Long-Term Care for Alzheimer’s Disease Sept. 2003) p. 1&2
3.
Hogstel, Mildred O.,
Geropsychiatric Nursing (St. Louis, MO, The C.V. Mosby Co.,
1990) p. 262
4.
Szwabo, p. 164
5.
Ibid., p. 167
6.
Ibid., p. 167
7.
Ibid., p. 167
8.
Hogstel, p. 204
9.
Ebersole, Priscilla and Hess,
Patricia, Toward Healthy Aging-Human Needs and Nursing
Response (Baltimore, MD, The C.V. Mosby Co., 1990) p. 326
10.
Hogstel, p. 262
11.
Szwabo, p. 221
12.
Ebersole, p. 326
13.
Dawson, Pam, Wells, Donna L. and
Kline, Karen, Enhancing the Abilities of Persons with
Alzheimer’s and Related Dementias-A Nursing Perspective (New
York, NY, Springer Publishing Co., 1993) p. 33
14.
Dawson, p. 33
15.
Hogstel, p. 204
16.
Ibid. , p. 204
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