Donna L. Algase, PhD, RN, FAAN, FGSA, School of Nursing, University of Michigan, Ann Arbor, MI, USA.

Wandering is among the most challenging behaviours associated with dementia. While research is progressing toward a fuller understanding of this phenomenon, the basis for deriving effective and tested interventions has not been fully developed. In this paper, wandering is defined from multiple perspectives, and its various outcomes and risks are discussed. Putative causes of wandering are summarized. Finally, an approach to aid clinicians in discovering effective strategies for managing an individual’s wandering is presented.
Key words: wandering, dementia, assessment, intervention, primary care.

David B. Hogan, MD, FACP, FRCPC, Professor and Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary, Calgary, AB.

Dementia is a common condition that places its victims at risk for injury. This article provides an overview of home safety for those with dementia. A conceptual approach to this management challenge is the Home Safety / Injury Model described by Hurley and colleagues. I focus on two common safety concerns: wandering and falls. Unfortunately, most recommendations are based on “common sense” (i.e., what seems reasonable). Whether these approaches actually decrease the likelihood of harm is largely unknown. It is anticipated that future research will lead to evidence-based recommendations.

Key words: dementia, home safety, wandering, falls.

Nina M. Silverstein, PhD, Associate Professor, Gerontology, University of Massachusetts Boston, College of Public & Community Service, Boston, MA.
Gerald Flaherty, Director of Special Projects & Safe Return Alzheimer's Association, Massachusetts Chapter, Boston, MA.

Nearly half of all residents in long-term care settings suffer from some type of dementing illness, with Alzheimer disease by far the most common type. People with dementia should be presumed at high risk for wandering due to their cognitive deficits and unpredictable behaviour. Recommendations are shared to minimize attempts to wander and actual wandering episodes by promoting a more therapeutic environment both through the physical structure and through staff training. In addition, effective strategies to follow in situations when a resident is, in fact, missing are presented.
Key words: dementia, wandering, long-term care, environment.

Bob Chaudhuri, MD
Resident in Psychiatry,
Department of Psychiatry,
University of Toronto.

In 1990, three million members of the US population were 85 years of age or older. By the year 2050, it is expected that the numbers of these very elderly people will reach 20 million. However, the percentage of older people in the US is less than that in most European nations. If one considers developing nations, 250 million Chinese will be over the age of 60 by the year 2020, and the number of people in developing nations over the age of 60 will be greater than that number in all the countries in Europe. Importantly, the number of people over the age of 80 continues to grow in proportion to the nation's population.¹ Given these demographic numbers,² the sequella of aging is relevant to psychiatry in general and geriatric psychiatry specifically. There is no specific Canadian data on this subpopulation.

Dementia is primarily a disease of later life, affecting approximately 5% of people over the age of 65, and in some populations studied, almost 50% of those over the age of 85. The essential features of dementia include the development of multiple cognitive deficits including, memory impairment, disturbance in executive functioning, and at least one of aphasia, apraxia or agnosia.