Caring for persons with dementia requires provider organizations to create tailored care delivery environments that enhance a person’s remaining capabilities while also supporting the special needs of a person diagnosed with Alzheimer’s disease or related dementias. Some symptoms and behaviors associated with dementia also bring along clinical risks, which can lead to serious harm or even death. Hazardous wandering and elopement are two of those behaviors.
As described in ECRI’s white paper, Mismatched Needs and Services Can Lead to Harm: A Systems REThinking Approach, organizations should systematically evaluate the scope of services they offer to meet resident needs and determine their staffing, infrastructure, and technology needs to fulfill these obligations.
Identified Care Risks: Hazardous Wandering and Elopement
Wandering is a behavior often exhibited by older adults with dementia, a group of symptoms most frequently caused by Alzheimer’s disease. Wandering is estimated to occur in 6 of 10 people with dementia. Elopement is, generally, when individuals leave an area they are meant to remain within, for their safety. Approximately 80% of elopements occur among older adults who wander "persistently." About 45% occur within 48 hours of admission to a new residence; however, as many as half occur among residents who have been at a facility for at least 12 months. People who wander unsafely or in unsafe environments face a higher risk of injury and may elope, get lost, become trapped in unsafe areas, or die.
People with dementia who elope are at risk for bad outcomes such as injuries, dehydration, exposure, medical complications, drowning, or being hit by a car. The longer a person is missing, the greater the risk. One study determined that residents who were not found within the first 24 hours experienced a 25% fatality rate, jumping to 40% for those not found within 72 hours and 54% for those not found within 96 hours; rates were even higher in hot or cold, rainy climates.
Additionally, incidents involving unsafe wandering or elopement pose risks for providers, potentially leading to regulatory sanctions, litigation, or both. Regulatory sanctions can be severe and depend on the type of organization and the agencies that regulate it. Closed claims based on elopement allegations are associated with high payouts. The insurer CNA's Aging Services Claim Report: 11th Edition (2022) highlights elopement as the highest severity allegation, with an average cost per closed claim of $360,000.
Technology: Using GPS Tracking to Mitigate Hazardous Wandering and Elopement Risks
While many interventions to reduce hazardous wandering and elopement are likely to be environmental, promoting safe wandering in a controlled space, and involve training staff to support and encourage safe behaviors, technology solutions are increasingly available to help not only limit the risk of elopement but to help recover those who do elope.
Older technology solutions focused on things like door-exit alarms, warning staff that a resident may be eloping but not aiding in finding them and ensuring their safe return. However, across medicine and healthcare, emerging technologies continue to redefine what we see as a heath device. In regard to hazardous wandering and elopement, wearable GPS tracking devices are being used to help mitigate certain related risks. ECRI recently evaluated several GPS tracking solutions.
ECRI’s testing reviewed four GPS tracking systems for both facility-based and home use, considering abilities such as:
- Finding someone who is outdoors and hidden out of view
- Sending an audible alert to the wearable device or tag
- Creating an audible alert on the phone application
- Establishing a geofence
- Forwarding location from the phone application to others outside the care group who may aid a search
Learn more about ECRI’s evaluation; full details are available to members of ECRI’s Device Evaluation and Aging Services Risk Management memberships.
Other ECRI recommendations to help prevent harm associated with hazardous wandering and elopement include:
- Make certain that the physical environment supports both rest and activity, including safe wandering.
- Educate and train all staff on wandering, elopement, and organizational policies and procedures.
- Conduct individualized assessments of risk factors and wandering behavior.
- Ensure that all residents, family members, and visitors understand the risks of wandering and elopement.
- Select interventions targeted at the individual and monitor their effectiveness.
- Consider ethical issues when evaluating technology use and ensure that technology is not used to substitute for supervision.
- Move beyond simple reporting of wandering and elopement events by creating a severity-based classification system.
- Establish plans for responding to missing person incidents and conduct routine drills.
Learn more about ECRI’s Device Evaluations and Aging Services Risk Management membership which provides actionable guidance, resources, and tools for hazardous wandering and elopement and many other care challenges to help enhance care and service delivery to reduce preventable harm.