How do you know a resident is at risk for elopement?

Over 60% of people with Alzheimer's disease are prone to elopement, making it a critical safety concern for caregivers. Knowing how you know a resident is at risk for elopement is the first step in implementing preventative measures and ensuring the well-being of those under your care.

Quick Summary

Assessing elopement risk involves observing a resident's behaviors, such as agitation, restlessness, and attempts to exit, alongside evaluating their medical history for cognitive impairment, prior wandering incidents, and medication changes. Factors like new environments and unmet needs also contribute to heightened risk.

Key Points

• Behavioral Changes: Watch for increased restlessness, agitation, and repeated attempts to exit the facility, which are common signs of a resident at risk.

• Cognitive Assessment: Identify cognitive impairments like dementia or Alzheimer's, as they are the leading risk factor, causing confusion and disorientation.

• History of Wandering: Documenting any prior incidents of wandering or elopement is crucial, as past behavior is the strongest predictor of future attempts.

• Environmental Awareness: Be mindful of how a new or stressful environment, as well as high-risk times like shift changes, can increase a resident's desire to leave.

• Unmet Needs and Triggers: Recognize that unmet physical or emotional needs, or certain medications, can trigger wandering and elopement behaviors.

• Verbal Cues: Take note of statements like "I need to go home" or "I have to go to work," which signal a resident's intent to leave.

Understanding the Core Risk Factors

Elopement, the act of a resident leaving a supervised care environment unnoticed and unsupervised, is a serious risk, particularly for those with cognitive impairments like dementia. The first and most crucial step in prevention is to identify the signs that indicate a resident may be a flight risk. Several key factors, ranging from cognitive and behavioral issues to environmental influences, can increase this risk.

Cognitive Impairment and Medical Conditions

Cognitive impairment is the most significant risk factor for elopement. Dementia, Alzheimer's disease, and traumatic brain injury can impair a resident's judgment and memory, leading them to wander or attempt to leave for what they perceive as a logical reason, such as 'going home'.

• Dementia and Alzheimer's: Confusion and disorientation are common symptoms that can lead to aimless or purposeful wandering.
• Delirium or Acute Confusion: Temporary states of confusion, often caused by urinary tract infections (UTIs), medication changes, or other acute illnesses, can trigger out-of-character elopement attempts.
• Psychiatric Conditions: Mental health issues like anxiety, agitation, or paranoia can motivate a resident to attempt to leave a facility during a distressed episode.

Behavioral Indicators and Warning Signs

Observing a resident's behavior is often the clearest way to spot an elopement risk. Caregivers should be vigilant for a range of behaviors that deviate from the resident's norm.

Checklist of Behavioral Red Flags

• Restlessness and Agitation: Frequent pacing, inability to settle down, or a general state of unease can indicate a desire to leave.
• Verbal Cues: Listen for repetitive statements such as "I need to go home," "I have to go to work," or "I'm looking for my mother".
• Pacing or Purposeful Walking: A resident who walks with a clear and determined destination in mind, even if the destination is illogical, poses a higher risk than one who wanders aimlessly.
• Attempts to Exit: Any observed attempts to open exterior doors or windows, or testing door handles, are major red flags.
• Packing Belongings: The act of gathering personal items as if preparing for a trip is a strong indicator of a planned exit.
• 'Sundowning' Syndrome: Increased confusion, agitation, and restlessness during the late afternoon and evening hours is a common trigger for wandering and elopement.

History and Environmental Triggers

A resident's past and current environment can significantly influence their risk of eloping. A new or stressful environment can increase disorientation and anxiety.

• Previous Incidents: A history of wandering or elopement is the single strongest predictor of future incidents.
• New Admission: The first 48 to 72 hours in a new care setting are a high-risk period, as the resident is unfamiliar with their surroundings.
• Environmental Stressors: Loud, chaotic environments, understaffing, or perceived abuse can cause residents to flee for safety.
• Unmet Needs: Basic unmet needs like hunger, thirst, or the need to use the bathroom can cause a resident to wander in search of assistance.

Comparing Wandering vs. Elopement Risk

Understanding the distinction between wandering and elopement is key to proper risk assessment and intervention. While both are related, the level of risk and required response differ significantly.

Feature	Wandering	Elopement
Definition	Unsupervised, aimless movement within a safe, designated area.	Leaving a supervised, designated safe area unnoticed and without authorization.
Location	Confined to the indoor facility or a secure outdoor space.	Involves exiting the facility premises and venturing into potentially hazardous external environments.
Intent	Often unintentional, driven by confusion, boredom, or restlessness.	Can be intentional or unintentional; often driven by a perceived purpose like going 'home'.
Danger Level	Lower, though still poses risk of falls or getting lost indoors.	High, with risks including traffic accidents, exposure, and injury.
Immediate Action	Requires redirecting the resident and addressing the underlying cause.	Triggers an immediate facility-wide emergency response protocol.

Systematic Evaluation and Prevention

An effective elopement prevention strategy relies on consistent, thorough evaluation and proactive intervention. Best practices involve an individualized approach combined with facility-wide safety measures.

Individualized Care Plans

1. Comprehensive Assessment: Upon admission and regularly thereafter, staff should use formal assessment tools like the Algase Wandering Scale (AWS) to evaluate risk factors.
2. Tailored Interventions: Develop a personalized care plan that addresses the specific triggers for that resident. This could include structured activity times, supervised outdoor walks, or addressing unmet needs.
3. Ongoing Monitoring: A resident's risk level can change. Staff must be vigilant, especially during high-risk times like shift changes, and re-evaluate the care plan periodically.

Environmental and Technological Safeguards

• Secure Exits: Install alarms on all exit doors, use keypad locks, and ensure staff are trained to never ignore an alarm.
• Disguise Exits: Placing visual barriers, such as wall murals, over exit doors can make them less obvious to a confused resident.
• Personal Tracking: Wearable devices like bracelets with GPS or radio-frequency technology can alert staff when a resident attempts to exit a designated area.
• Structured Environment: A secure, enclosed outdoor courtyard or garden can provide a safe place for exploration and physical activity.

Conclusion: Proactive Care for Enhanced Safety

Recognizing the signs and risk factors for elopement is a continuous and collaborative process involving staff, family, and technology. By staying attuned to behavioral changes, understanding medical vulnerabilities, and maintaining a secure yet engaging environment, caregivers can significantly reduce the risk of a resident eloping. The key is moving beyond a reactive stance to a proactive one, where safety measures are integrated into a resident's daily life, ensuring their freedom and dignity are maintained within secure boundaries. Prioritizing resident well-being through thoughtful, preventative action is paramount in senior care.

For more information on preventing elopement, consult the best practices outlined by healthcare experts at ECRI, available at https://home.ecri.org/blogs/ecri-blog/10-steps-to-preventing-patient-elopement.

Frequently Asked Questions

What is the main risk factor for a resident to elope?

The most significant risk factor for resident elopement is cognitive impairment, such as dementia or Alzheimer's disease. Memory loss, confusion, and impaired judgment increase the likelihood of a resident attempting to leave a supervised area.

How is elopement different from wandering?

Wandering typically refers to a resident moving around aimlessly within a safe, designated area. Elopement, on the other hand, is the more dangerous act of leaving the facility premises unnoticed and without authorization, exposing the resident to external hazards.

Are new residents at a higher risk of elopement?

Yes, new residents are at a significantly higher risk of eloping, particularly within the first 48 to 72 hours of admission. This is because the unfamiliar environment can cause increased stress, confusion, and a desire to return home.

Can medication changes affect elopement risk?

Yes, a change in medication dosage or a new medication can cause confusion, restlessness, or agitation, which can increase a resident's risk of elopement. Healthcare staff should closely monitor residents after any medication adjustments.

What role does a resident's mobility play in elopement risk?

Residents with cognitive decline but strong physical mobility are at a higher risk of successful elopement. Their ability to move freely, combined with poor judgment, increases the potential danger.

What is 'sundowning,' and how does it relate to elopement?

Sundowning is a phenomenon where confusion and agitation increase during the late afternoon and evening hours. This can be a trigger for wandering and elopement attempts in residents with cognitive impairments.

How can staff detect early elopement signs?

Staff can detect early signs by observing behavioral changes like restlessness, pacing, and agitation. They should also listen for verbal cues expressing a desire to leave and remain vigilant during high-risk times, such as shift changes.