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Caring for early‐onset dementia with excessive wandering of over 30 kilometres per day: a case report
Author(s) -
Yamakawa Miyae,
Yoshida Yukiko,
Higami Yoko,
Shigenobu Kazue,
Makimoto Kiyoko
Publication year - 2014
Publication title -
psychogeriatrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.647
H-Index - 32
eISSN - 1479-8301
pISSN - 1346-3500
DOI - 10.1111/psyg.12075
Subject(s) - irritability , medicine , dementia , olanzapine , severe dementia , psychomotor agitation , carelessness , actigraphy , psychological intervention , disease , pediatrics , insomnia , psychiatry , schizophrenia (object oriented programming) , cognition
Excessive wandering in people in dementia is associated with a severe care burden. However, the quantification of excessive wandering has not been described, and its cause and treatment have not been evaluated with objective measurements to date. The purpose of this study was to evaluate pharmacological treatments and non‐pharmacological interventions to reduce excessive wandering in an early‐onset A lzheimer disease patient with objective indicators. Wandering was quantified using an integrated circuit monitoring system that measured the distance moved and the location of the patient. Monitoring was conducted in the dementia ward of a general hospital in 2012. Sleep quality was measured by non‐wear actigraphy. The study was approved by the ethics committees of the O saka U niversity S chool of A llied H ealth S cience, and of the study hospital. The case involved a 62‐year‐old woman diagnosed with early‐onset A lzheimer disease and hospitalized in 2012 because of irritability and agitation; her M ini‐ M ental S tate E xamination score was 5/30 and her C linical D ementia R ating score was 3. When olanzapine (2.5 mg) was prescribed, she developed insomnia, and her wandering movements increased from 10 to 20 km/day. On some days, it exceeded 30 km/day, and she walked most of the night. She did not experience weight loss or physical exhaustion, but she sustained a minor injury in her left sole. Olanzapine was increased to 7.5 mg, but these problems persisted. Nursing staff discovered triggers for wandering and insomnia, including high sensitivity to odour and noise in the living room or her room. When the environment was changed to meet her needs, the distance moved per day decreased to <15 km and the sleep disturbances disappeared. This case demonstrated the difficulty in assessing the degree of ambulation and sleep disorder. Objective indicators are essential in evaluating the effectiveness of pharmacological and non‐pharmacological interventions.