Longitudinal investigation of wandering behavior in Department of Veterans Affairs nursing home care units.

OBJECTIVES To explore the extent of and factors associated with male residents who change wandering status post nursing home admission. DESIGN Longitudinal design with secondary data analyses. Admissions over a 4-year period were examined using repeat assessments with the Minimum Data Set (MDS) to formulate a model understanding the development of wandering behavior. SETTING One hundred thirty-four Veterans Administration (VA) nursing homes throughout the United States. PARTICIPANTS Included 6673 residents admitted to VA nursing homes between October 2000 and October 2004. MEASUREMENTS MDS variables (cognitive impairment, mood, behavior problems, activities of daily living and wandering) included ratings recorded at residents' admission to the nursing home and a minimum of two other time points at quarterly intervals. RESULTS The majority (86%) of the sample were classified as non-wanderers at admission and most of these (94%) remained non-wanderers until discharge or the end of the study. Fifty-one per cent of the wanderers changed status to non-wanderers with 6% of these residents fluctuating in status more than two times. Admission variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behavior, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status. CONCLUSION A resident's change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but spares mobility.