Mohammed T. Abou-Saleh

638 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYfluoxetine are examples. Perhaps a withdrawal syndrome, such asfrom alcohol or benzodiazepines, may be implicated. Pain as atrigger for wandering always needs to be considered.In the nursing home, proper staffing, appropriate staff trainingwith regard to causes and management of wandering behavior,coupled with supervised structured activities, such as musictherapy and simple crafts, are important. Use of planned activitiesand distraction techniques may be helpful.One of the key elements in managing wandering behaviors is toprovide an appropriate and safe environment where wanderingbehavior can be tolerated. This should ideally include speciallydesigned indoor and outdoor roaming areas that lack safetyhazards or distracting elements. Innovative ideas include a‘‘reduced stimulation unit’’ 11,16 and a ‘‘wanderer’s loungeprogram’’ 17 . It is vital that wandering behavior is not dealt withvia the use of physical restraints or the heavy use of sedatives ortranquilizers. Patients often fight such measures, resulting in moresignificant problem behaviors.A major concern for family or institutional caregivers is that thewandering patient may elope and come to physical harm, e.g. runinto automobile traffic. The use of ‘‘Wander-Guard’’-type deviceson doors and a special identification bracelet, labeled ‘‘cognitivelyimpaired—if lost, please call (phone number of facility)’’ mayhelp.CONCLUSIONSWandering exacts a heavy toll on family and professionalcaregivers. For the wanderer, issues of safety are of paramountconcern. To ease the burden on caregivers, it is important to try toascertain why the patient is wandering. This will usually give cluesto appropriate management. Unfortunately, wandering patientsusually cannot communicate why they are wandering because oftheir cognitive impairment. Consequently, caregivers need toplace themselves in the patient’s shoes to come up with theanswers.REFERENCES1. National Center for Health Statistics. The National Nursing HomeSurvey: 1977 Summary for the United States. Washington, DC: USDepartment of Health Education and Welfare.2. Warshaw G, Moore J, Friedman W et al. Functional disability in thehospitalized elderly. J Am Med Assoc 1982; 248(7): 847–50.3. Kramer JR. Education and consultation on mental health in LTCfacilities: problems, pitfalls, and solutions, a process approach to stafftraining and consultations. J Geriat Psychiat 1977; 10(2): 197–213.4. Goldfarb AI. Prevalence of psychiatric disorders in metropolitan oldage and nursing homes. J Am Geriat Soc 1984; 10: 77–84.5. Teeker RB, Garetz FK, Miller WR et al. Psychiatric disturbances ofaged patients in skilled nursing homes. Am J Psychiat 1976; 133(12):1430–4.6. Zimmer JG, Watson N, Trent A. Behavioral problems amongpatients in skilled nursing facilities. Am J Publ Health 1984; 76: 118.7. Rovner BW, Kafonek S, Flipp L et al. Prevalence of mental illness ina community nursing home. Am J Psychiat 1986; 143: 1446–9.8. Grossberg G. Forms of wandering. In Copeland JRM, Abou-SalehMT, Blazer DG, eds, Principles and Practice of Geriatric Psychiatry.Chichester: Wiley, 1994; 139–40.9. Snyder L, Rupprecht P, Pyrek J et al. Wandering. Gerontologist 1978;18(3): 272–80.10. Coons H. Wandering. Am J Alzheimer’s Care Rel Disord Res 1988:January/February: 31–42.11. Schwab M, Rader J, Doan J. Relieving the anxiety and fear indementia. J Gerontol Nurs 1985; 11: 8–12.12. Monsour N, Robb S. Wandering behavior in old age: a psychosocialstudy. Social Work 1982; 27: 411–16.13. Thomas D. Wandering: a proposed definition. J Gerontol Nurs 1995;September: 35–41.14. Algase DL. Wandering: Assessment and intervention. 1999: 163–75.15. Dawson P, Reid D. Behavioral dimensions of patients at risk ofwandering. Gerontologist 1987; 27(1): 104–7.16. Sawyer JC, Mendlovitz AA. A management program for ambulatoryinstitutionalized patients with Alzheimer’s disease and relateddisorders. Paper presented at the Annual Conference of theGerontological Society, Boston, 1982.17. McGrowder-Lin R. A wanderer’s lounge program for nursing homeresidents with Alzheimer’s disease. Gerontologist 1988; 28(5): 607–9.18. De Leon MJ, Potegal M, Gurland B. Wandering’s parietal signs insenile dementia of Alzheimer’s type. Neuropsychobiology 1984; 11:155–7.19. Algase DL. A century of progress: today’s strategies for responding towandering behavior. J Gerontol Nurs 1992; 18(11): 28–34.20. Rader J, Doan J, Schwab S. How to decrease wandering, a form ofagenda behavior. Geriat Nurs 1985; July/August: 196–9.