Newcastle University

Project:

WANdering in DementiA (WANDA)

From April 2004 to March 2005
Project Leader(s): Louise Robinson
Contact: Dr Louise Robinson
Sponsors: NHS HTA grant

Wandering is a common problem in dementia occurring in up to 40% of people. The term ‘wandering’ refers to a complex collection of different behavioural abnormalities which occur for a multitude of reasons. Traditional responses to wandering include physical barriers (alarms, locks), human and physical restraints (Buxton chairs, tethers), and medication (neuroleptic). More recent interventions include electronic devices that increase freedom and autonomy while minimising risk (electronic tagging and tracking), behavioural approaches (such as cognitive behavioural therapy), and distraction therapies (such as physical activity and planned walks, music therapy, occupational therapy). Subjective barriers (visual modifications that the person with dementia may interpret as a barrier even if it is not physically so e.g. painted bars on windows), were the subject of a recent Cochrane review which found no suitable trials from which to comment on their effectiveness. A systematic review therefore required to synthesise the evidence for the other non-pharmacological interventions listed above.

This project aimed to determine the clinical and cost effectiveness of non-drug related interventions to prevent/reduce wandering in people with dementia, and to assess their acceptability to relevant stakeholders, through a systematic review. The available evidence on cost effectiveness was too limited and unsatisfactory in quality, so the economic evaluation included a simulation modelling exercise. Outcomes included the number of successful/attempted exits, number and nature of accidents, acceptability measures for both patients and carers, quality of life measures and assessment of costs of care. The project also considered in greater depth the acceptability and ethical implications of such interventions through a qualitative study of relevant stakeholders, such as people with dementia, their informal and formal carers and health and social care professionals via focus groups and one to one interviews.

Objectives

1.To perform a systematic review of all relevant studies involving non pharmaceutical interventions to prevent wandering in dementia and determine their clinical and cost effectiveness in comparison to usual care from the perspectives of patients, carers and service providers;

2.To evaluate the acceptability to stakeholders of such interventions and identify ethical issues associated with their use, and the extent to which issues of acceptability and ethics are assessed in relation to such interventions; and,

3.To explore objective 2) in greater depth through a qualitative study involving relevant stakeholders.