It’s estimated that more than half of people living with dementia in residential aged care will experience dementia-related wandering, and with the risks even greater for those living in the community, Anglicare Southern Queensland is part of the team working to reduce negative outcomes.
Anglicare Southern Queensland is involved in a research project called the 3Ps to Getting Home Safely with Dementia, which is led by lecturer and Registered Nurse Associate Professor Margaret MacAndrew.
Assoc Prof McAndrew shares insights into the project during a webinar, highlighting how the three Ps – prepare, prevent and prompt response – can be embedded into aged care processes.
“Dementia-related wandering is one of the more misunderstood behaviours of dementia, but it’s also one of the more common dementia-related behaviours. It’s estimated to affect over 50% of people living in residential aged care,” she explained.
“We see it more in the younger population of people living with dementia and more men than women. It is more prevalent in the more severe stage of dementia but it can be apparent from the very early stages. Getting lost can be one of the first signs that someone has a problem which then triggers people to go and investigate why this is occurring.”
She explained that people with Alzheimer’s disease are more likely to wander than others as the part of the brain used for navigation, the hippocampus, is directly impacted by Alzheimer’s disease.
Wandering is a major risk, not only for the fact someone can become lost, but if they wander enough they will become fatigued, experience pain, lose weight or suffer a devastating fall.
She said awareness of dementia-related wandering has improved over time but the risks are still too high, sharing that “one life lost is too many.”
“The greatest predictor of who will get lost is a previous getting lost event, particularly if nothing is put in place to reduce that risk. It is the three Ps that are most likely to prevent a person with dementia from getting lost and then finding them more successfully if they do go missing,” she added.
So how do the three Ps work?
Prepare: Raising awareness early on is essential. Staff, family and friends who understand that someone is at risk of getting lost means they can look out for behavioural changes.
Prevent: By doing early work in the form of a risk assessment, and following it up with ongoing risk assessments, aged care staff can put preventative measures in place to ensure a resident or client does not wander in unsafe circumstances.
Prompt response: In a worst-case scenario, having the tools and processes in place to promptly respond will help reduce the long-term risks of someone becoming lost or injured.
The research, which has been funded by the Dementia Australia Research Foundation and supported by Dementia Training Australia, aims to provide real-world tools for aged care providers. This includes a Safe Walking Assessment and Planning tool to help identify risk profiles and determine which evidence-based strategies will help reduce that risk.
Anglicare Southern Queensland has been involved in the co-design of the tool for residential aged care purposes, while police have also been involved in co-designing a six-step missing person procedure that can be relied upon in any emergency situation.
“The SWAP tool incorporates all of the evidence around the characteristics of walking exhibited by a person with dementia associated with risk. It’s a simple’ do they do it’ or ‘Don’t they do it,” Assoc Prof MacAndrew said.
“If they do it, they exhibit a walking habit associated with risk, we then have associated evidence-based strategies for you to consider implementing to try and reduce that risk. The list of strategies is very extensive.”
Critically, Assoc Prof MacAndrew added that time is of the essence if someone does go missing at home or in the community. She said police should always be notified right away if a person with dementia goes missing.
Anglicare Southern Queensland will be implementing the SWAP tool as part of the next research phase for ten aged care residents to determine its feasibility.
Vicki Cain, the Clinical Lead for Anglicare’s Specialist Dementia Care Program (SDCP), also provided a glimpse into one of the most impactful dementia supports available.
The SDCP funds specialist dementia care units (SDCU) in residential care settings designed to support people with severe dementia symptoms. However, SDCUs are not long-term homes as the goal is to see residents return to less intensive settings within 12 months.
Anglicare Southern Queensland has one unit at their St Martin’s home with three more on the way. Less than 12 dozen SDCP units are in operation or under development across Australia.
“Between 2019 and 2022, 62% of people transition from SDCP to less intensive environments with reduced behaviours of concern and psychological distress,” Ms Cain explained.
“These residents historically bounce back into the hospitals and they end up on high levels of psychotropic medication. We know that that’s not the answer. So what it demonstrated is that we have a far reduced use of psychotropic medication which is quite phenomenal.
We have incredible positive feedback from relatives. In our particular facility, we have very few SIRS reports. It is because of the setup, the staff ratios and the services we offer through external health services.”
SDCUs typically operate under small home models of care with just up to nine residents living together and one carer for every four residents, plus a dedicated Registered Nurse to oversee clinical operations.
Ms Cain said their success comes down to recruiting staff who are passionate about dementia care and want to work in the environment. This has resulted in no staffing changes to their clinical team since 2020.
Understanding triggers has also been critical to alleviating unwanted behaviours or helping improve mental health and wellbeing. Being responsive and flexible also helps.
“We use the richness of our lifestyle team to cross-pollinate vital care plans. It’s a moving document. When we see a lifestyle care plan completed within the first seven days of admission I feel horrified because it stays like that,” Ms Cain added.
While a specialist dementia care unit will never be in place at all residential care homes, Ms Cain said by tapping into individual needs and triggers, aged care staff can always find a way to better support residents with dementia.
“When we look at best practice I challenge you to stop thinking in best practice clinical, medical terms. Best practice is what’s right for me,” she said.
