P77: Barriers and facilitators to reframing ‘wandering’ as a meaningful activity for residents with dementia in care homes

Abstract

Up to 60% of people with dementia living in care homes will ‘wander’ (i.e. walk without a clear purpose) at some point, which may occur due to cognitive changes, issues with orientation or lifelong habits. Nonpharmacological interventions are considered the best approach to supporting wandering as they aim to address underlying causes while posing minimal risk to the individual. However, there are many benefits to wandering safely in care homes, including physical benefits of exercise, retaining autonomy over location, and maintaining self-identity. This study aimed to develop evidence to understand the perspectives of care home staff around wandering as a meaningful activity. Specifically, we sought to identify: i) attitudes towards wandering; ii) the barriers and facilitators to supporting wandering in the care home; and iii) support needs to implement strategies across different care home contexts.

We conducted 20 semi-structured interviews with staff members including direct care staff, registered nurses, managers, and activities coordinators. Participants were recruited from a range of care homes across North England who provide care for older adults living with dementia, using purposive sampling to recruit participants with a range of experiences. Data were analyzed using framework analysis, a form of thematic analysis.

Four main themes were identified and refined by the wider research team. The impact of the environment on how residents moved around the care home, the importance of life history and personhood for staff to understand the motivations residents had for wandering, individual factors that contributed to each resident’s unique experiences and the importance of the care home culture to whether residents were supported. Participants also highlighted a range of strategies that they engage with to support residents to wander safely.

Although this was a small-scale study, conducted in one region of England, it has implications for the ways that wandering as a behavior is conceptualized and supported in care homes. The importance of language and vocabulary was highlighted and requires further consideration. The results of this study will be used to develop further work to test strategies in care homes and produce guidelines for supporting residents to wander safely.