A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use.

Full Abstract

OBJECTIVES:
To determine the effectiveness and cost-effectiveness of non-pharmacological interventions (excluding subjective barriers) in the prevention of wandering in people with dementia, in comparison with usual care, and to evaluate through the review and a qualitative study the acceptability to stakeholders of such interventions and identify ethical issues associated with their use.

DATA SOURCES:
Major electronic databases were searched up until 31 March 2005. Specialists in the field.

REVIEW METHODS:
Selected studies were assessed and analysed. The results of two of the efficacy studies that used similar interventions, designs and outcome measures were pooled in a meta-analysis; results for other studies which reported standard deviations were presented in a forest plot. Owing to a lack of cost-effectiveness data, a modelling exercise could not be performed. Four focus groups were carried out with relevant stakeholders (n = 19) including people with dementia and formal and lay carers to explore ethical and acceptability issues in greater depth. Transcripts were coded independently by two reviewers to develop a coding frame. Analysis was via a thematic framework approach.

RESULTS:
Ten studies met the inclusion criteria (multi-sensory environment, three; music therapy, one; exercise, one; special care units, two; aromatherapy, two; behavioural intervention, one). There was no robust evidence to recommend any non-pharmacological intervention to reduce wandering in dementia. There was some evidence, albeit of poor quality, for the effectiveness of exercise and multi-sensory environment. There were no relevant studies to determine the cost-effectiveness of the interventions. Findings from the narrative review and focus groups on acceptability and ethical issues were comparable. Exercise and distraction therapies were the most acceptable interventions and raised no ethical concerns. All other interventions were considered acceptable except for physical restraints, which were considered unacceptable. Considerable ethical concerns exist with the use of electronic tagging and tracking devices and physical barriers. Existing literature ignores the perspectives of people with dementia. The small number of participants with dementia expressed caution regarding the use of unfamiliar technology. Balancing risk and risk assessment was an important theme for all carers in the management of wandering.

CONCLUSIONS:
There is no robust evidence so far to recommend the use of any non-pharmacological intervention to reduce or prevent wandering in people with dementia. High-quality studies, preferably randomised controlled trials, are needed to determine the clinical and cost-effectiveness of non-pharmacological interventions that allow safe wandering and are considered practically and ethically acceptable by carers and people with dementia. Large-scale, long-term cohort studies are needed to evaluate the morbidity and mortality associated with wandering in dementia for people both in the community and in residential care. Such data would inform future long-term cost-effectiveness studies.

Learn Faster Today Improve your study skills

Author information

Author/s: Robinson, L (L); Hutchings, D (D); Corner, L (L); Beyer, F (F); Dickinson, H (H); Vanoli, A (A); Finch, T (T); Hughes, J (J); Ballard, C (C); May, C (C); Bond, J (J);

Affiliation: Centre for Health Services Research, University of Newcastle upon Tyne, UK.

Journal and publication information

Publication Type: Journal Article; Review

Journal: Health technology assessment (Winchester, England) (Health Technol Assess), published in England. (Language: eng)

Reference: 2006-Aug; vol 10 (issue 26) : pp iii, ix-108

Dates: Created 2006/07/19; Completed 2006/12/22; Revised 2007/01/26;

PMID: 16849002, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Evid Based Nurs. 2007 Jan;10(1):15. (PMID: 17218289)

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Confusion - prevention & control
Dementia - therapy
Great Britain
Humans

These are the highest related articles currently in the database:

Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review. 30 Dec 2006
Use of restraints on dementia patients: an ethical dilemma of a nursing staff in Israel. 29 Nov 2003
All outcomes should be disclosed. 29 Sep 2003
Unanticipated harm to patients: deciding when to disclose outcomes. 29 Sep 2003
Managing infectious or untested autologous blood components: the ethical dilemma of private rights versus public safety. 29 Sep 2005
Medico-legal and ethical aspects in the management of wandering patients following brain injury: questionnaire survey. 28 Nov 2006
A business case for patient safety. 30 Aug 2003
The patient safety movement. 29 Apr 2005
Safety: when infants and parents are research subjects. 30 Dec 2004
The end of the beginning: lessons learned from the patient safety movement. 27 Feb 2003

See 100+ related articles.