Jun-Ah Song

Validation of the Algase Wandering Scale (Version 2) in a cross cultural sample.

This study examined the psychometric properties of an expanded version of the Algase Wandering Scale (Version 2) (AWS-V2) in a cross-cultural sample. A cross-sectional survey design was used. Study subjects were 172 English-speaking persons with dementia (PWD) from long-term care facilities in the USA, Canada, and Australia. Two or more facility staff rated each subject on the AWS-V2. Demographic and cognitive data (MMSE) were also obtained. Staff provided information on their own knowledge of the subject and of dementia. Separate factor analyses on data from two samples of raters each explained greater than 66% of the variance in AWS-V2 scores and validated four (persistent walking, navigational deficit, eloping behavior, and shadowing) of five factors in the original scale. Items added to create the AWS-V2 strengthened the shadowing subscale, failed to improve the routinized walking subscale, and added a factor, attention shifting as compared to the original AWS. Evidence for validity was found in significant correlations and ANOVAs between the AWS-V2 and most subscales with a single item indicator of wandering and with the MMSE. Evidence of reliability was shown by internal consistency of the AWS-V2 (0.87, 0.88) and its subscales (range 0.88 to 0.66), with Kappa for individual items (17 of 27 greater than 0.4), and ANOVAs comparing ratings across rater groups (nurses, nurse aids, and other staff). Analyses support validity and reliability of the AWS-V2 overall and for persistent walking, spatial disorientation, and eloping behavior subscales. The AWS-V2 and its subscales are an appropriate way to measure wandering as conceptualized within the Need-driven Dementia-compromised Behavior Model in studies of English-speaking subjects. Suggestions for further strengthening the scale and for extending its use to clinical applications are described.This study examined the psychometric properties of an expanded version of the Algase Wandering Scale (Version 2) (AWS-V2) in a cross-cultural sample. A cross-sectional survey design was used. Study subjects were 172 English-speaking persons with dementia (PWD) from long-term care facilities in the USA, Canada, and Australia. Two or more facility staff rated each subject on the AWS-V2. Demographic and cognitive data (MMSE) were also obtained. Staff provided information on their own knowledge of the subject and of dementia. Separate factor analyses on data from two samples of raters each explained greater than 66% of the variance in AWS-V2 scores and validated four (persistent walking, navigational deficit, eloping behavior, and shadowing) of five factors in the original scale. Items added to create the AWS-V2 strengthened the shadowing subscale, failed to improve the routinized walking subscale, and added a factor, attention shifting as compared to the original AWS. Evidence for validity was found in significant correlations and ANOVAs between the AWS-V2 and most subscales with a single item indicator of wandering and with the MMSE. Evidence of reliability was shown by internal consistency of the AWS-V2 (0.87, 0.88) and its subscales (range 0.88 to 0.66), with Kappa for individual items (17 of 27 greater than 0.4), and ANOVAs comparing ratings across rater groups (nurses, nurse aids, and other staff). Analyses support validity and reliability of the AWS-V2 overall and for persistent walking, spatial disorientation, and eloping behavior subscales. The AWS-V2 and its subscales are an appropriate way to measure wandering as conceptualized within the Need-driven Dementia-compromised Behavior Model in studies of English-speaking subjects. Suggestions for further strengthening the scale and for extending its use to clinical applications are described.

Factors Affecting Burden of Family Caregivers of Community-Dwelling Ambulatory Elders with Dementia in Korea

The purpose of the study was to test a staged causal model as a theoretical base to explain the burden of family caregivers of community-dwelling self-ambulatory persons with dementia (PWDs) in Korea. The model contained three stages including antecedents (Stage 1), behavior (Stage 2), and outcome (Stage 3). The antecedents were variables of the PWDs (e.g., cognitive impairment and activities of daily living [ADL] dependency of the PWDs) and caregiver variables (e.g., age, gender of caregiver, and the relationship of caregiver to PWD). Stage 2 focused on wandering behavior. In Stage 3, the outcome variable was caregiver burden. A total of 83 noninstitutionalized, community-dwelling elders with dementia and their family caregivers participated. The instruments used in this study were the Korean version of Mini Mental State Examination, K-PADL (Korean-Physical Activities of Daily Living), Korean-Revised Algase Wandering Scale-Community Version, and K-CWOB (Caregiver Worry, Overload, and Role Captivity Scale-Korean) Korean versions of standardized Western instruments. Results indicate that cognitive impairment and ADL dependency had an indirect influence on caregiver burden through wandering behavior. In addition, caregiver age had a direct impact on caregiver burden. The findings of this study suggest that further refinement of the underlying model is warranted.

The Interrelatedness of Wandering and Wayfinding in a Community Sample of Persons with Dementia

The aim of this study was to evaluate the relationship of wandering and wayfinding and validate the Revised Algase Wandering Scale – Community Version (RAWS-CV) using a community sample of persons with dementia. Adult caregivers (n = 266) completed the RAWS-CV and the Wayfinding Effectiveness Scale (WES). Four aspects of wandering were confirmed (persistent walking, repetitive walking, spatial disorientation, eloping behavior), and two new aspects were also validated (negative outcomes, mealtime impulsivity). The spatial disorientation subscale of the RAWS-CV had significant (p < 0.01) negative correlations with all WES subscales. The global strategies and simple wayfinding goals subscales of the WES correlated significantly with all RAWS-CV subscales except repetitive walking and mealtime impulsivity. ANOVAs comparing wayfinding at 4 levels of wandering revealed differences only for the simple wayfinding goals subscale. Studies examining the relationship of wandering and wayfinding at various levels of cognitive impairment are suggested to further understand these phenomena.

Keeping wandering nursing home residents at the table: improving food intake using a behavioral communication intervention

The purpose of this multiple case design study (n = 3) with an embedded experiment was to determine the effect of the systematic use of a behavioral nursing intervention on the mealtime behavior of nursing home residents with probable Alzheimers disease. It was hypothesized that the systematic behavioral intervention would increase time spent seated during the meal and proportion of food consumed while decreasing the frequency of table-leaving events during mealtime. The intervention was designed to impact the proximal factors of physiological need and social interaction from the Need-Driven Behavior Model. Results demonstrate that all cases were able to sit at the table longer and eat more food during the intervention, while body weight for all cases remained stable throughout the study. Two of the three cases left the table fewer times during the intervention. There were no statistically significant changes in proportion of fluids consumed in any case.

A comparison of wandering behavior in nursing homes and assisted living facilities.

Wandering, a challenging behavior associated with dementia, affects many residents of long-term care facilities and can result in elopement, injury, and death. Most studies of wandering have taken place in nursing homes (NH). Expansion of the long-term care sector over the last 2 decades has resulted in a surge in options such as assisted living facilities (ALF). This study compared wandering behavior of residents (N = 108) in 21 long-term care facilities (15 NH, 6 ALF). Staff used the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH) to quantify wandering. While there were some differences in demographic variables (i.e., race, motor ability) between NH and ALF participants, no significant differences were found in either RAWS-NH overall or any of the 6 subscale scores. This suggests that the expression of wandering is similar in long-term care residents across all dimensions of the RAWS-NH regardless of facility type. Findings are of concern for those involved in the safe management and protection of residents at risk for wandering, particularly in long-term care facilities with underregulated staffing and training requirements.

Premorbid Characteristics and Wandering Behavior in Persons with Dementia

This study aimed to explore relationships of premorbid personality and behavioral responses to stress with wandering behavior of persons with dementia in long-term care facilities. Ambulatory residents (N = 108) with dementia were selected from 21 long-term care facilities. The Mini-Mental State Examination, the NEO Five-Factor Personality Inventory, the Behavioral Responses to Stress Scale, and the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH) were used as data collection tools. When the MMSE and age were controlled, regression analyses revealed that premorbid extroversion and premorbid negative verbalization stress response were significant negative predictors for the overall RAWS-NH and some subscales.

Relationship between familiar environment and wandering behaviour among Korean elders with dementia

AIM To explore the relationship between wandering behaviour and familiar environment in community-residing persons with dementia in Korea. BACKGROUND Numerous non-pharmacological interventions have been developed to decrease behavioural symptoms and to increase the quality of life among persons with dementia. Although the concept of familiarity is very important and environmental interventions using the concept should have been developed for persons with dementia, no study examining even the direct relationship between familiar environment and wandering has yet been published. DESIGN A descriptive, cross-sectional survey design. METHODS A convenience sample was gathered of 77 non-institutionalised, community-dwelling persons with dementia and their family caregivers in Seoul and Wonju, South Korea. Descriptive statics, Pearsons correlations, t-tests, and multiple regressions were used in the data analysis. RESULTS The mean age of persons with dementia was 76.9 years (SD 8.0) and their mean cognitive level score using the Mini-Mental State Examination was 13.51 (SD 6.10). Most persons with dementia (71.4%) had been diagnosed with known types of dementia such as Alzheimers disease, multiple infarct dementia, mixed type or Parkinsons disease with dementia. A familiar feeling with the environment was associated with cognitive impairment (r = 0.32, p < 0.01) and physical dependency in activities of daily living (r = -0.38, p <0.01). In addition, a familiar feeling with the environment (r = -0.56, p < 0.001) and physical dependency in activities of daily living (r = 0.56, p < 0.001) were strongly related to wandering behaviour. Familiarity and physical dependency in activities of daily living were the significant predictors for overall wandering and they explained 45% of the total variance. Cognitive impairment was the only significant predictor on the subscale of spatial disorientation. CONCLUSIONS It was found that a familiar feeling with the environment was an important factor affecting persons with dementias cognitive and functional abilities as well as specific features of wandering. However, future research using a more reliable method is necessary to confirm the findings obtained in this study. RELEVANCE TO CLINICAL PRACTICE This study suggested that providing persons with dementia with a familiar feeling in daily clinical practice through establishment of familiar physical as well as psychosocial environment may have benefit to decrease wandering behaviour.

Translation and validation of the Revised-Algase Wandering Scale (community version) among Korean elders with dementia

The purpose of this study was to examine the psychometric properties of a Korean translated version of the Revised Algase Wandering Scale, community version (K-RAWS-CV) among persons with dementia in Korea. A cross-sectional survey design was used. After established equivalence of the instrument using back-translation and a field test, 69 community dwelling family caregivers described the wandering behavior of their family members with dementia. The overall mean of the K-RAWS-CV was 1.73 (SD = 0.61, range = 1–3.87). Means of each subscale ranged from 1.44 (meal-time impulsivity, MI) to 2.04 (escape behavior, EB). The reliability alpha for the overall scale was 0.96 with reliabilities for subscales ranging from 0.82 (negative outcome, NO) to 0.93 (persistent walking, PW). The correlation between the overall K-RAWS-CV and each subscale ranged from 0.52 (overall and NO) to 0.82 (overall and PW) with a mean value of 0.66. Pearsons correlations between the level of cognitive impairment and each subscale of the K-RAWS-CV demonstrated significant, moderate relationships ranging from −0.24 (MI, RW, and MMSE) to −0.39 (PW, EB and MMSE). Mean differences between wanderers and non-wanderers were statistically significant for the K-RAWS-CV overall and all subscale except for MI. Results support the validity and reliability of the K-RAWS-CV overall and the six subscales.

The Association Between the Burden on Formal Caregivers and Behavioral and Psychological Symptoms of Dementia (BPSD) in Korean Elderly in Nursing Homes

Behavioral and psychological symptoms of dementia (BPSD) are sources of psychological distress for caregivers who take care of people with dementia. The purpose of this study was to examine the association between BPSD and the burden on formal caregivers of nursing homes in South Korea. Results showed that the total severity score of BPSD had a statistically significant positive correlation with the total distress score. Agitation/Aggression was the most distressing symptom for registered nurses and care workers. These findings suggest that there is a need for improved treatments for BPSD, to help mitigate its burden on formal caregivers.

Wandering behaviour of persons with dementia in Korea: investigation of related factors.

Objectives: Despite being identified as a significant clinical phenomenon, wandering of persons with dementia (PWDs) has not been studied in Korea. As an initial trial, various factors chosen from the literature for their predictive relationships to wandering of Korean PWDs were evaluated in this study. Method: A total of 160 PWDs residing in 14 long-term care facilities participated in this study. The Mini-Mental State Exam (MMSE), Physical Activities of Daily Living (PADL) and Korean-translated Revised Algase Wandering Scale (Nursing Home version) (KRAWS-NH) were used to assess participants’ degree of cognitive impairment, functional ability and wandering behaviour on six dimensions: persistent walking (PW), specific patterns (SP), spatial disorientation (SD), escape behaviour (EB), attention shift (AS) and negative outcomes (NO). Demographic, personal and environmental data were also collected. Results: The MMSE score was a significant negative predictor for KRAWS-NH overall and subscales except for EB; while age, PADL and history of falls were positive predictors for SD and NO. Total number of residents in a room was a significant negative predictor for EB and AS. Conclusion: Different factors found in PWDs may contribute to different aspects of wandering behaviour. Further studies on factors influencing multiple facets of wandering in various cultural settings are warranted.