People who wander unsafely or in unsafe environments may face a higher risk of injury and may elope, become lost, or become trapped in unsafe areas (e.g., a freezer, a toolshed). People with dementia who elope are at risk for outcomes such as injuries, dehydration, exposure, medical complications, drowning, being hit by a car, or death (CMS). The longer a person is missing, the greater the risk.
Further, incidents involving unsafe wandering or elopement can lead to regulatory sanctions, litigation, or both. Regulatory sanctions depend on the type of organization and which agencies regulate it but can be severe. Closed claims based on elopement allegations are associated with high payouts.
However, an individual's wandering may represent "a behavioral expression of a basic human need" (Alzheimer's Association). Wandering may have health benefits (e.g., maintenance of mobility) and may support the individual's independence and sense of control. Often, it is preferable to support an individual's safe wandering than to try to stop it.
This self-assessment questionnaire (SAQ) focuses on managing wandering and preventing elopement in older adults with dementia in long-term care settings and offers considerations for other settings as well. Because strategies to manage wandering and prevent elopement vary based on organizational factors and the individual needs of people with dementia, this SAQ presents key suggestions; it is not exhaustive.
Organizations may wish to complete this SAQ at least annually. Potential participants include the risk manager, the director of nursing, the medical director, nursing supervisors, facilities and building management personnel, the patient or resident safety officer, and security personnel. To assess care provided to people with dementia, users may wish to review records for a sample of individuals at risk for unsafe wandering or elopement. For more information, see the guidance article
Wandering and Elopement.
The following sources were used to develop the questions in this SAQ. This list is not comprehensive.
The following ECRI resources may be useful:
Self-assessment questionnaires (SAQs) can be used to identify compliance with best practices and opportunities for improvement. They include questions based on laws, regulations, standards, professional society guidelines and statements, and best practices identified by the clinical literature. Each SAQ also includes an Action Plan to help document next steps and responsible parties.
SAQs are available both as PDFs, for use as-is, or as Microsoft Word documents, which can be edited to suit your organization's custom needs, such as by adding questions regarding local or state requirements that may not be represented.