Wandering and Elopement in Nursing Homes
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Lester PE, Garite A, Kohen I. Wandering and elopement in nursing homes. Annals of Long-Term Care: Clinical Care and Aging. 2012;20(3):32-36.
Paula E. Lester, MD, FACP • Adrianna Garite, DO • Izchak Kohen, MD
Dr. Lester is an assistant professor of clinical medicine, Stony Brook University Medical Center, and associate fellowship program director, Division of Geriatric Medicine, Winthrop University Hospital, Mineola, NY. Dr. Garite is a hospice medical director and faculty member in geriatric and palliative medicine, Division of Geriatric Medicine, Winthrop University Hospital, Mineola, NY. Dr. Kohen is an attending faculty geriatric psychiatrist, Zucker Hillside Hospital/NS-LIJ Health System, Glen Oaks, NY, and an assistant professor of psychiatry, Hofstra Medical School, Uniondale, NY.
Facilities’ Response to Elopement
Elopement is a serious concern for nursing homes,22 and facilities should establish a plan to manage the crisis of resident elopement. This plan should include a formal search procedure that clearly defines staff roles and responsibilities. Photographs and other identifying information should be on file for all residents so that this information is readily available for searchers and police in the event of an elopement.
Urgency should be heightened for residents who wander outdoors due to the significantly increased dangers associated with this. In a retrospective analysis of elopement incidents in Virginia involving community-dwelling adults and LTC residents with dementia, Koester23 said, “There is a 25% fatality rate if the subject is not found within the first 24 hours.” The likelihood of survival decreases as the amount of time the patient is missing increases. Only 60% of patients are found alive 72 or more hours after last being seen, which drops to 46% for those missing 96 hours or longer.24 Most deaths are attributable to hyperthermia, dehydration, and drowning; very few involve trauma.24
Koester24 reported that 89% of missing persons with dementia were found within 1 mile of their residence, with the distance traveled averaging 0.5 miles. They tended to travel along a path of least resistance (ie, downhill). Searchers should not expect missing patients to assist in their own rescue. Koester24 found that only 1% of patients responded to shouts or calls from rescuers and fewer than 1% of them called out to rescuers.
Increasingly, residents and their families are suing LTC facilities for elopement incidents in which a resident allegedly suffered injury or death due to the facility’s negligent care. Nearly 70% of elopement claims filed against nursing homes involve a resident’s death,7 underscoring the urgency of finding missing residents quickly. Residents who are injured while wandering have a fair degree of success when claims are filed that they were injured because the nursing home failed to provide the proper standard of care.25
Wandering and elopement frequently occur in nursing homes and pose serious risks for residents with cognitive impairment and for the facility, which can be held liable if a resident leaves without permission and is injured. In implementing measures to deter wandering and elopement, nursing homes must balance safety with autonomy. Although instruments are available to help assess wandering risk, it is important that facilities never underestimate their residents’ propensity to wander or elope. Physical handicaps and a lack of prior wandering or elopement attempts are no guarantee against elopement. As our case illustrates, even nonambulatory residents with cognitive impairment may be at high risk of wandering, especially if they are able to self-propel in wheelchairs.
The authors report no relevant financial relationships.
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