Little evidence that wandering prevention works in dementia

Everything from multicolored lights to garden walks has been suggested as ways to keep people with dementia from wandering, but there is little evidence to show that any of these interventions work, according to a new analysis.

Wandering is a catch-all term for a variety of behaviors, usually walking or pacing, but sometimes any type of excessive activity that occurs in 15 percent to 60 percent of people with dementia. Although wandering may provide good exercise and calm some people with dementia, the behavior can also put them in harm's way, particularly if they wander away from care or become agitated while moving about.

Although tranquilizer and antipsychotic drugs have been used to control wandering in people with dementia, the drugs are only modestly successful and may have serious long-term side effects. Instead, health care workers have turned increasingly to drug-free ways to prevent wandering, such as music therapy, aromatherapy, exercise programs and even electronic tracking devices.

However, "there is no robust evidence so far" to recommend any of these alternatives, according to Dr. Louise Robinson of the University of Newcastle upon Tyne in the United Kingdom and colleagues.

The review is published in the latest issue of Health Technology Assessment, the international journal series of the Health Technology Assessment Programme, part of the National Institute for Health Research in the United Kingdom.

Robinson and colleagues reviewed 10 studies of wandering prevention strategies and 27 studies on the acceptability and ethics of the techniques. There were no studies on the cost-effectiveness of the strategies.

The researchers found some evidence that exercise programs and "multisensory environments" in the form of light and sound relaxation sessions can reduce wandering and restlessness, but the single studies supporting these techniques are of poor quality, the analysis concludes.

The average age of participants was 79 years, from the seven studies that reported age.

Robinson and colleagues also discussed the ethics of physical restraints and electronic tracking to prevent wandering with professional and family caregivers and a few dementia patients.

"None of the participants felt that physical restraints were an acceptable approach to manage wandering," Robinson said.

Opinions were mixed on electronic tracking strategies, such as giving patients mobile phones that could be located with satellite tracking technology. In both studies and focus groups, caregivers felt the devices could keep patients safer and reduce healthcare worker and family stress. But they worried that the devices might be impinging on patients' privacy and freedom.

Dr. Francis Miskelly, a researcher at Imperial College in the United Kingdom who studied mobile phone tracking among 50 dementia patients for several years, says, "the patients and relatives welcomed the technology as a solution to a difficult problem, no ethical issues at all."

"We took the view that it was the least restrictive method of restraint," Miskelly said, adding that the program eventually "fizzled out from lack of funding."

People with dementia who were interviewed for the focus group were concerned that mobile phone tracking might be embarrassing or hard to use, the researchers found, reporting that patients preferred more traditional ways of tracking.

"For example, participants felt they would be happy to carry identity cards, because they were used to carrying them during the Second World War," Robinson said.

Future studies should include more information on what kinds of monitoring and help people with dementia would prefer when wandering, Robinson and colleagues say.

Patients and caregivers seem open to the idea that wandering is not always a problem, and that safe walking should be promoted rather than discouraged in people with dementia, the researchers say.

By Becky Ham