Locomoting responses to environment in elders with dementia: A model construction and preliminary testing.

다국어 초록 (Multilingual Abstract)

Wandering is one of the frequently encountered behaviors of elders with dementia. Managing behavior through environmental manipulations is an important nursing strategy, yet, the impact of social and physical environment on behaviors of elders with dementia has received little consistent conceptual development or empirical study in nursing. To develop effective environmental interventions, understanding of the dementia-environment dynamic is a critical first step. Guided by a middle-ranged theory, the Need-driven Dementia-compromised Behavior (NDB) model, a model of Locomoting Responses to Environment in Elders with Dementia (LRE-EWD) is constructed through a theory synthesis approach. This leads to insights concerning how the environment affects wandering and other behaviors, and tentative prediction and intervention. The LRE-EWD model focuses on locomotion as the behavior central to the model, recognizing that wandering is subsumed. It proposes that the initial emotional reactions of cognitively impaired elders shape their subsequent cognitive events, rather than the conventional thought that behavior and emotional responses are modeled by cognition. Ambulatory behaviors were assumed to be emotional reactions by EWDs to their environment. In a similar vein, wandering, or certain type of wandering behavior, could be elicited by the pleasant/unpleasant valence of the environment as an implicit emotional reaction. Testing of the model provides support for this proposition. Model testing was accomplished with 47 cognitively impaired older adults from nursing homes and assisted living facilities, using a random cluster sampling approach. Hierarchical Liner Modeling regression results indicated that environmental ambiance (indicator of the emotional valence) was a more robust predictor of locomotion than Mini Mental State Examination (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. The findings also support and expand the NDB model which conceptualizes wandering, problematic vocalization, and physical aggression as means of communication and reaction to EWD's environment and unmet needs. Findings from this study highlight the importance of addressing the emotional valence of the social and physical environment in care of EWDs.