Validation of the Algase Wandering Scale (Version 2) in a cross cultural sample.

This study examined the psychometric properties of an expanded version of the Algase Wandering Scale (Version 2) (AWS-V2) in a cross-cultural sample. A cross-sectional survey design was used. Study subjects were 172 English-speaking persons with dementia (PWD) from long-term care facilities in the USA, Canada, and Australia. Two or more facility staff rated each subject on the AWS-V2. Demographic and cognitive data (MMSE) were also obtained. Staff provided information on their own knowledge of the subject and of dementia. Separate factor analyses on data from two samples of raters each explained greater than 66% of the variance in AWS-V2 scores and validated four (persistent walking, navigational deficit, eloping behavior, and shadowing) of five factors in the original scale. Items added to create the AWS-V2 strengthened the shadowing subscale, failed to improve the routinized walking subscale, and added a factor, attention shifting as compared to the original AWS. Evidence for validity was found in significant correlations and ANOVAs between the AWS-V2 and most subscales with a single item indicator of wandering and with the MMSE. Evidence of reliability was shown by internal consistency of the AWS-V2 (0.87, 0.88) and its subscales (range 0.88 to 0.66), with Kappa for individual items (17 of 27 greater than 0.4), and ANOVAs comparing ratings across rater groups (nurses, nurse aids, and other staff). Analyses support validity and reliability of the AWS-V2 overall and for persistent walking, spatial disorientation, and eloping behavior subscales. The AWS-V2 and its subscales are an appropriate way to measure wandering as conceptualized within the Need-driven Dementia-compromised Behavior Model in studies of English-speaking subjects. Suggestions for further strengthening the scale and for extending its use to clinical applications are described.

[1]  L. Hewawasam.  Floor patterns limit wandering of people with Alzheimer's. , 1996, Nursing times.

[2]  M. Folstein,et al.  Psychopathology of dementia: implications for neuropathology. , 1979, Research publications - Association for Research in Nervous and Mental Disease.

[3]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[4]  The use of two-dimensional grid patterns to limit hazardous ambulation in elderly patients with Alzheimer's disease , 1996 .

[5]  M. Matteson,et al.  Wandering behaviors in institutionalized persons with dementia. , 1996, Journal of gerontological nursing.

[6]  K. H. Namazi,et al.  Psychological well-being of elderly board and care home residents. , 1989, The gerontologist.

[7]  P. Dawson,et al.  Behavioral dimensions of patients at risk of wandering. , 1987, The Gerontologist.

[8]  D. Mungas,et al.  Assessment of Disruptive Behavior Associated With Dementia: The Disruptive Behavior Rating Scales , 1989, Journal of geriatric psychiatry and neurology.

[9]  S. Kanowski,et al.  Measuring the efficacy of psychopharmacological treatment of psychomotoric restlessness in dementia: clinical evaluation of tiapride. , 1997, Pharmacopsychiatry.

[10]  E. Cumming,et al.  The episodic nature of behavioural disturbances among residents of facilities for the aged. , 1982, Canadian journal of public health = Revue canadienne de sante publique.

[11]  J. Cohen-Mansfield,et al.  Two studies of pacing in the nursing home. , 1991, Journal of gerontology.

[12]  J. Cohen-Mansfield,et al.  Assessment of ambulatory behavior in nursing home residents who pace or wander: a comparison of four commercially available devices. , 1997, Dementia and geriatric cognitive disorders.

[13]  T. Cornbleth.  Effects of a protected hospital ward area on wandering and nonwandering geriatric patients. , 1977, Journal of gerontology.

[14]  E L Bogue,et al.  The Algase wandering scale: Initial psychometrics of a new caregiver reporting tool , 2001, American journal of Alzheimer's disease and other dementias.

[15]  R. N. Mohan,et al.  Wandering in dementia sufferers , 1991 .

[16]  P. Chafetz.  Two-dimensional grid is ineffective against demented patients' exiting through glass doors. , 1990, Psychology and aging.

[17]  E. Beattie,et al.  Estimates of stability of daily wandering behavior among cognitively impaired long-term care residents. , 1997, Nursing research.

[18]  Jae-On Kim,et al.  Factor Analysis: Statistical Methods and Practical Issues , 1978 .

[19]  B. Hoeffer,et al.  Problematic wandering behavior in the cognitively impaired elderly. A single-subject case study. , 1995, Journal of psychosocial nursing and mental health services.

[20]  S. Tsai,et al.  Behavioural disturbances in psychiatric inpatients with dementia of the Alzheimer's type in Taiwan , 1997, International journal of geriatric psychiatry.

[21]  S. Gauthier,et al.  Validity and Reliability of the Dementia Behavior Disturbance Scale , 1990, Journal of the American Geriatrics Society.

[22]  D. Thomas.  Understanding the wandering patient. A continuity of personality perspective. , 1997, Journal of gerontological nursing.

[23]  J. Madson.  The study of wandering in persons with senile dementia , 1991 .

[24]  J. Gurwitz,et al.  The Epidemiology of Adverse and Unexpected Events in the Long‐Term Care Setting , 1994, Journal of the American Geriatrics Society.

[25]  Martin H. Teicher,et al.  Circadian locomotor activity rhythms in Alzheimer's disease. , 1991, Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology.

[26]  M. Tsuang,et al.  The Mini-Mental State Test and computerized tomography. , 1979, The American journal of psychiatry.

[27]  T Hope,et al.  The Present Behavioural Examination (PBE): the development of an interview to measure current behavioural abnormalities , 1992, Psychological Medicine.

[28]  D. C. Brown,et al.  Use of two-dimensional grid patterns to limit hazardous ambulation in demented patients. , 1987, Journal of gerontology.

[29]  D. Algase.  Cognitive Discriminants Of Wandering Among Nursing Home Residents , 1992, Nursing research.

[30]  E. Stopa,et al.  Circadian locomotor activity and core-body temperature rhythms in Alzheimer's disease , 1995, Neurobiology of Aging.

[31]  H. S. Wilson,et al.  Wandering in Alzheimer's Dementia Patients , 1993, Clinical nursing research.

[32]  V. Henderson,et al.  Spatial disorientation in Alzheimer's disease. , 1989, Archives of Neurology.

[33]  L. McNeal,et al.  Travel behavior of nursing home residents perceived as wanderers and nonwanderers. , 1991, The Gerontologist.

[34]  B. Fries,et al.  Predictors of the placement of cognitively impaired residents on special care units. , 1992, The Gerontologist.

[35]  K. H. Namazi,et al.  Visual barriers to prevent ambulatory Alzheimer's patients from exiting through an emergency door. , 1989, The Gerontologist.

[36]  D. Bennett,et al.  Predictors of behavioral disturbance in Alzheimer's disease. , 1991, Journal of gerontology.

[37]  S. Robb,et al.  Wandering behavior in old age: a psychosocial study. , 1982, Social work.

[38]  S. Gauthier,et al.  Spatial disorientation in persons with early senile dementia of the Alzheimer type. , 1991, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.