Wandering is one of the frequently encountered behaviors of elders with dementia (EWDs). Managing behavior through operating environment is an imperative nursing strategy, yet, the impact of social and physical environment on behaviors of EWDs, has received little consistent conceptual development or empirical study in nursing. Guided by a model of Locomoting Responses to Environment in Elders with Dementia (LRE-EWD), this cross-sectional study explored relationship between environmental ambiance (indicator of the emotional valence) and locomotion behaviors of EWDs, endeavoring to add theoretical appreciation of how the environment affects wandering and other behaviors, and leading to tentative prediction and intervention. Study was done on a sample of 47 cognitively impaired older adults from nursing homes and assisted living facilities, through a random cluster sampling strategy. Subjects included were predominately female 85.1% (40), Caucasian 87.6 % (41), 72-103 years old with a mean age of 84.77 (S.D.=6.88). MMSE scores ranged from 0-21 with a mean of 9.26 (S.D.=5.56); 13 subjects had impairment too severe to be tested. Subjects were assigned to six 20 minutes observation periods, on 2 non-consecutive days each, according to 4 pre-established randomization schedules. All observation periods were randomly selected and occurred between 8am to 8pm. A multilevel model, HLM (Hierarchical Liner Modeling), was used to analyze data which focused on the observation as the unit of analysis, with repeated observations nested within subjects. Results indicated that environmental ambiance was a more robust predictor of locomotion than MMSE. High ambiance scores of the environment were found to be associated with lower frequency of walking episodes, shorter duration of walking, and longer duration of sitting, as predicted by the LRE-EWD model. Findings from this study highlight the importance of addressing the emotional valence of the social and physical environment in care of EWDs.
Session #1115 - Environmental Supports for Aging
The 29th Annual MNRS Research Conference (April 1-4, 2005)