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SUMMARY:The Institute of Clinical Research Conference
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/the-institute-of-clinical-research-conference/
LOCATION:The Birmingham Conference & Events Centre\, Hill Street\, Birmingham\, West Midlands\, B5 4EW\, United Kingdom
CATEGORIES:Conference
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DTSTART;TZID=Europe/London:20260413T170000
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SUMMARY:EV-Mediated Microglial Modulation in AD
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/ev-mediated-microglial-modulation-in-ad/
LOCATION:Online\, United Kingdom
CATEGORIES:Workshop
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END:VEVENT
BEGIN:VEVENT
DTSTART;VALUE=DATE:20260414
DTEND;VALUE=DATE:20260417
DTSTAMP:20260411T045238
CREATED:20251112T200037Z
LAST-MODIFIED:20251114T093825Z
UID:10001746-1776124800-1776383999@www.dementiaresearcher.nihr.ac.uk
SUMMARY:Alzheimer's Disease International Conference 2026
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/alzheimers-disease-international-conference-2026/
LOCATION:Palais des congrès de Lyon\, 50 Quai Charles de Gaulle\, Lyon\, 69006\, France
CATEGORIES:Conference
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DTSTART;TZID=Europe/London:20260414T093000
DTEND;TZID=Europe/London:20260414T160000
DTSTAMP:20260411T045238
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LAST-MODIFIED:20260305T221321Z
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SUMMARY:Innovation Forum: Place-based health and wellness
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/innovation-forum-place-based-health-and-wellness/
LOCATION:Somerdale Pavilion\, Somerdale Pavilion\, Keynsham\, BS31 2FW\, United Kingdom
CATEGORIES:Conference
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DTSTART;TZID=Europe/London:20260415T120000
DTEND;TZID=Europe/London:20260415T124500
DTSTAMP:20260411T045238
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LAST-MODIFIED:20260309T150636Z
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SUMMARY:Research Showcase - Dementia & Employment Research Priorities
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/research-showcase-dementia-employment-research-priorities/
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BEGIN:VEVENT
DTSTART;VALUE=DATE:20260422
DTEND;VALUE=DATE:20260423
DTSTAMP:20260411T045238
CREATED:20260327T113708Z
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UID:10002167-1776816000-1776902399@www.dementiaresearcher.nihr.ac.uk
SUMMARY:Replacing in vivo models with complex cellular systems
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/replacing-in-vivo-models-with-complex-cellular-systems/
LOCATION:Loughborough University\, Epinal Way\, Loughborough\, LE11 3TU\, United Kingdom
CATEGORIES:Training
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DTSTART;TZID=Europe/London:20260422T090000
DTEND;TZID=Europe/London:20260422T190000
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SUMMARY:UCL Advanced Therapies Symposium 2026
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/ucl-advanced-therapies-symposium-2026/
LOCATION:UCL – Kennedy Lecture Theatre\, Institute of Child Health - Main Building\, 30 Guildford Street\, London\, Greater London\, WC1N 1EH\, United Kingdom
CATEGORIES:Conference
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DTSTART;TZID=Europe/London:20260422T120000
DTEND;TZID=Europe/London:20260422T124500
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UID:10002151-1776859200-1776861900@www.dementiaresearcher.nihr.ac.uk
SUMMARY:Research Showcase - Blood Biomarkers for Alzheimer’s Across Diverse Communities
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/research-showcase-blood-biomarkers-for-alzheimers-across-diverse-communities/
LOCATION:Dementia Researcher Communities App
CATEGORIES:Webinar
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END:VEVENT
BEGIN:VEVENT
DTSTART;TZID=Europe/London:20260422T130000
DTEND;TZID=Europe/London:20260422T150000
DTSTAMP:20260411T045238
CREATED:20260323T110148Z
LAST-MODIFIED:20260323T110148Z
UID:10002155-1776862800-1776870000@www.dementiaresearcher.nihr.ac.uk
SUMMARY:Data Sharing in Dementia Research
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/data-sharing-in-dementia-research/
LOCATION:Online\, United Kingdom
CATEGORIES:Workshop
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END:VEVENT
BEGIN:VEVENT
DTSTART;TZID=Europe/London:20260422T140000
DTEND;TZID=Europe/London:20260422T151500
DTSTAMP:20260411T045238
CREATED:20260327T111108Z
LAST-MODIFIED:20260327T111108Z
UID:10002164-1776866400-1776870900@www.dementiaresearcher.nihr.ac.uk
SUMMARY:NAMs Technology Partn3Ring webinar
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/nams-technology-partn3ring-webinar/
LOCATION:Online\, United Kingdom
CATEGORIES:Online
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BEGIN:VEVENT
DTSTART;VALUE=DATE:20260423
DTEND;VALUE=DATE:20260424
DTSTAMP:20260411T045238
CREATED:20260203T162016Z
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UID:10002082-1776902400-1776988799@www.dementiaresearcher.nihr.ac.uk
SUMMARY:Vivensa Foundation Annual Symposium
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/vivensa-foundation-annual-symposium/
LOCATION:IET\, 2 Savoy Place\, London\, WC2R 0B\, United Kingdom
CATEGORIES:Symposium
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BEGIN:VEVENT
DTSTART;TZID=Europe/London:20260423T100000
DTEND;TZID=Europe/London:20260423T163000
DTSTAMP:20260411T045238
CREATED:20260220T150019Z
LAST-MODIFIED:20260218T115311Z
UID:10002115-1776938400-1776961800@www.dementiaresearcher.nihr.ac.uk
SUMMARY:Vivensa Foundation 2026 Annual Symposium
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/vivensa-foundation-2026-annual-symposium/
LOCATION:IET\, 2 Savoy Place\, London\, WC2R 0B\, United Kingdom
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DTSTART;TZID=Europe/London:20260423T140000
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SUMMARY:Dementia Hub @GIAM: Smell\, Care and Lived Experience
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/dementia-hub-giam-smell-care-and-lived-experience/
LOCATION:Westmont Enterprise Hub\, Westmont Enterprise Hub University of West London\, 9-10 The Park\, London\, W5 5NE\, United Kingdom
CATEGORIES:Public Discussion
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DTSTART;TZID=Europe/London:20260424T150000
DTEND;TZID=Europe/London:20260424T160000
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SUMMARY:Rethinking ARIA: Antibody Amplified CAA-ri?
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/rethinking-aria-antibody-amplified-caa-ri/
LOCATION:Online\, United Kingdom
CATEGORIES:Workshop
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END:VEVENT
BEGIN:VEVENT
DTSTART;TZID=Europe/London:20260427T160000
DTEND;TZID=Europe/London:20260427T170000
DTSTAMP:20260411T045238
CREATED:20260323T223943Z
LAST-MODIFIED:20260323T223943Z
UID:10002159-1777305600-1777309200@www.dementiaresearcher.nihr.ac.uk
SUMMARY:Capturing Inflammaging with Omics
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/capturing-inflammaging-with-omics/
LOCATION:Online\, United Kingdom
CATEGORIES:Workshop
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END:VEVENT
BEGIN:VEVENT
DTSTART;TZID=Europe/London:20260428T150000
DTEND;TZID=Europe/London:20260428T160000
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UID:10002174-1777388400-1777392000@www.dementiaresearcher.nihr.ac.uk
SUMMARY:ISTAART Technology PIA: Meet the Author
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/istaart-technology-pia-meet-the-author/
LOCATION:Online\, United Kingdom
CATEGORIES:Workshop
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END:VEVENT
BEGIN:VEVENT
DTSTART;TZID=Europe/London:20260428T190000
DTEND;TZID=Europe/London:20260428T200000
DTSTAMP:20260411T045238
CREATED:20260305T223143Z
LAST-MODIFIED:20260305T223143Z
UID:10002139-1777402800-1777406400@www.dementiaresearcher.nihr.ac.uk
SUMMARY:Sex and APOE4 Interaction in Alzheimer's Disease
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/sex-and-apoe4-interaction-in-alzheimers-disease/
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UID:10002181-1777464000-1777466700@www.dementiaresearcher.nihr.ac.uk
SUMMARY:Research Showcase - Amyloid & Tau Assembly in Alzheimer’s
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/research-showcase-amyloid-tau-assembly-in-alzheimers/
LOCATION:Dementia Researcher Communities App
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BEGIN:VEVENT
DTSTART;TZID=Europe/London:20260429T170000
DTEND;TZID=Europe/London:20260429T180000
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LAST-MODIFIED:20260215T095856Z
UID:10002109-1777482000-1777485600@www.dementiaresearcher.nihr.ac.uk
SUMMARY:LBD PIA: ISTAART Journal Club - Meet the Author
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/lbd-pia-istaart-journal-club-meet-the-author/
LOCATION:Online\, United Kingdom
CATEGORIES:Workshop
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END:VEVENT
BEGIN:VEVENT
DTSTART;VALUE=DATE:20260430
DTEND;VALUE=DATE:20260501
DTSTAMP:20260411T045238
CREATED:20260215T095524Z
LAST-MODIFIED:20260215T095524Z
UID:10002108-1777507200-1777593599@www.dementiaresearcher.nihr.ac.uk
SUMMARY:Families for the Treatment of Hereditary MND (FaTHoM)
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/families-for-the-treatment-of-hereditary-mnd-fathom/
LOCATION:Milton Hill House Hotel\, Мilton Hill\, Steventon\, Milton\, OX13 6AF\, United Kingdom
CATEGORIES:Public Discussion
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DTSTART;VALUE=DATE:20260430
DTEND;VALUE=DATE:20260502
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SUMMARY:AFTD 2026 Education Conference
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/aftd-2026-education-conference/
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DTSTART;TZID=Europe/London:20260430T110000
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SUMMARY:Nominations are open for The UK Dementia Awards 2026!
DESCRIPTION:In this episode of the Dementia Researcher Podcast Dr Anna Volkmer hosts a discussion exploring the complexities of wandering in dementia care. \nDr Bryony Waters-Harvey and Dr Emma Hock from The University of Sheffield and Conny McGowan from The Orders of St John Care Trust discuss their research and outcomes of the NIHR funded "FREEDEM study" - Reframing 'wandering' as a meaningful activity using realist synthesis and qualitative exploration. \nThis episode explores how “wandering” in dementia care is often misunderstood. Rather than being a behaviour to control\, walking is reframed as meaningful\, purposeful\, and deeply human. Drawing on NIHR funded research\, the discussion highlights practical strategies that help care homes support movement safely while protecting dignity and independence. With insights from research\, evidence synthesis\, and frontline care\, the conversation challenges assumptions and offers a more compassionate\, realistic approach to supporting people living with dementia. \nTakeaways \n\nWandering is often a meaningful activity for residents.\nIndividualised care plans are crucial for supporting residents.\nLanguage matters in how we perceive wandering.\nPositive risk-taking can enhance residents' quality of life.\nHydration and nutrition are important for wandering residents.\nResearch should focus on the positive aspects of wandering.\nCare staff need training to support safe wandering.\nEnvironmental factors significantly impact wandering behavior.\nResidents should have access to outdoor spaces.\nFuture research should involve residents and their families\n\n\n\nClick here to read a full transcript of this podcast \nVoice Over: \nThe Dementia Researcher Podcast\, talking careers\, research\, conference highlights\, and so much more. \nDr Anna Volkmer: \nHello\, and welcome to the Dementia Researcher Podcast. Today we're talking about wandering in care homes\, drawing on a National Institute for Health Research-funded study\, reframing wandering as a meaningful activity. \nWandering is a term that is used widely in care homes and in dementia care. It is often associated with risk\, safeguarding concerns\, and anxiety for staff and families. At the same time\, many people walk for meaningful reasons\, whether that is habit\, comfort\, restlessness\, or a need that is difficult to express in other ways. This episode looks at how research is challenging the idea that wandering is simply a problem to manage and instead asks how care homes can support walking in ways that protect safety while also respecting autonomy and quality of life. \nNow I'm joined by three guests who bring together research\, evidence synthesis\, and frontline care experience. First\, Dr. Bryony Waters-Harvey\, who is a researcher involved in National Institute for Health Research through NIHR-funded work\, exploring how care homes understand and respond to wandering\, including the research for social care study that sits behind today's discussion. \nWe're also joined by Emma Hock\, who is also from the University of Sheffield\, whose work focuses on evidence synthesis and understanding how complex interventions work in real-world settings. \nAnd finally\, we're joined by Conny McGowan\, head of care at Hartsholme House and Orders of St. John's Care Trust care home. Conny began her career as a carer and now leads care practise within a home rated outstanding by the Care Quality Commission. She brings invaluable insights from day-to-day dementia care. \nNow\, before I welcome our guests\, I should also mention who I am. My name is Dr. Anna Volkmer. I am a speech and language therapist with 25 years of clinical experience\, often working in care homes and meeting people who are wandering and talking to staff who are having difficulties managing this. \nSo\, I'm really excited to host this podcast today. Thank you all for joining me. Hi\, Bryony. Hi\, Emma. Hi\, Conny. \nDr Bryony Waters-Harvey: \nHi. \nConny McGowan: \nHello. \nDr Anna Volkmer: \nSo\, to start us off\, could I ask each of you to introduce yourselves\, please? How about Bryony? Do you want to go first? \nDr Bryony Waters-Harvey: \nYeah. So hi\, I am a postdoctoral researcher at the University of Sheffield\, and I've got several years of working on care home research. And a lot of my research came out of what I learned while I was a wellbeing therapist at a care home. \nDr Anna Volkmer: \nFantastic. I think that often happens\, doesn't it? A lot of my research came out of my clinical experience\, which I think is why I love these kinds of podcasts because we talk about clinical experience and how that influences research. And perhaps we could come to Conny next. Could you introduce yourself\, Conny? \nConny McGowan: \nYes. So\, I've worked with the Orders of St. John Care Trust for about 20 years now. I've been at Hartsholme House for about 13 years as head of care. We are a 43-bedded care home. We have residents living with dementia and also residents who are residential. \nDr Anna Volkmer: \nWowza\, that's huge. And Emma\, an introduction from you. \nDr Emma Hock: \nYes. Hi\, I'm Dr. Emma Hock. I'm a senior lecturer in public health at the University of Sheffield\, and my research work focuses pretty much entirely on evidence synthesis methods\, and I also teach on the Master of Public Health Course. \nDr Anna Volkmer: \nWonderful. Welcome. So why wandering is such a difficult issue\, that's what we're here to discuss. As we've already touched on during the introduction\, wandering\, it's often an issue for people who reside in care homes\, but can also be an issue for people living at home still. I should make that really clear. So perhaps\, Bryony\, we can start with you. Could you tell us what is wandering in care homes and what made it feel like an important issue to focus on? \nDr Bryony Waters-Harvey: \nYeah. So\, I guess the official terminology of what wandering is\, is that it's a meaningless act of movement for people with dementia. But for us\, actually\, we see wandering just as any form of walking in the home. And as you've mentioned\, that's not always aimless. There's also a lot of positive reasons for that. So\, for us it was just about\, actually\, people that like to walk frequently. \nAnd this research really came from actual care staff. So\, we have our principal investigator\, Alys Griffiths\, was a researcher in a care home. So\, she was working in one specific care home. And the staff said that they really wanted to support people to walk safely\, but actually\, they didn't really know how to do that. So\, they would normally go to the strategies of telling people to sit down and try moving people away from unsafe areas. So\, they wanted us to create some sort of guideline to actually help people be able to allow people to walk and stop saying\, "Sit down." \nDr Anna Volkmer: \nFascinating. Thank you. It's such a challenge. I know as a clinician\, I've experienced people being at the door of a care home and even struggling to get into a care home. And then when people are trying to leave\, it can be difficult if people are just right there\, wandering out to the door. So\, I can see there's lots of challenges. So\, Emma\, is there already a lot of research on this topic out there? \nDr Emma Hock: \nYes\, there is quite a bit of research. As we found\, it focuses more on certain areas than others. And there were some aspects that we were actually focusing on where we found very little research. For example\, there isn't much research on helping to support residents with hydration and nutrition while they're walking. However\, there was a lot of research on strategies to\, as Bryony mentioned\, prevent people from wandering or limit their wandering. And there is quite a bit of research on strategies that could potentially support wandering\, but it could also be used to limit wandering\, depending on how they're implemented. \nDr Anna Volkmer: \nYeah. That makes total sense to me. I have a vivid memory of working with a family\, because as a speech therapist\, we do a lot of swallowing work\, and we had a lady who was very\, very thin and nobody could work out how to maintain her weight. And she was wandering. She was burning so many calories and wouldn't sit down. It's a real challenge. I can see that. And we've already started talking about practise\, but Conny\, could you tell us\, bringing this into practise\, what does wandering tend to represent in a day-to-day setting within a care home? Tell us about that. \nConny McGowan: \nSo\, when you come into the care home\, you'll always find a couple of lounges\, and you'll see that majority of the residents are sat down and engaging in conversations amongst themselves\, doing activities\, but you will always have a small number of individuals that just like to walk around. They're either along the corridors\, they'll either be at the front door\, they'll either be at the garden door\, they might follow staff members into the kitchen or the laundry\, or they'll go into other people's bedrooms. So\, it's really these individuals that we\, as a team\, have to keep an eye on. And really\, the main thing is always keeping everyone safe. So\, a lot of residents as well that do like to walk around a lot are actually high risk of falls. So\, you have that constantly on your mind. Are they going to be falling? Are they safe just walking around? So it is that kind of pressure that you feel. \nDr Anna Volkmer: \nWe haven't really talked about the risks yet\, but yeah\, the risk of falling. What about the risk of absconding? I guess we used to call it\, but it's perhaps a bit ... Sounds very harsh. But them getting out and wandering off. \nConny McGowan: \nAbsolutely. I mean\, I do always feel that we are very high security here. All our doors have got codes\, so residents can't just leave\, but that doesn't stop them from asking to leave. And we now have a very quick response. Rather than saying\, "No\, no\, you can't\," someone will put a coat on\, take their mobile phone\, and we will just go for a walk with them. And usually\, by the time you get to the end of the drive\, they realise that they haven't really thought this through very well. And usually\, I go for a little walk with them\, and I always suggest\, "Shall we not go back and maybe plan a bit about where we're actually going? And seeing you haven't got a bus pass; you haven't got any money." And then they say\, "All right." Then we'll go back. And sometimes it's that feeling of ... They want to really get out. And now that's out of their system\, they do become a bit more settled. \nDr Anna Volkmer: \nSo interesting. I can imagine that working well in certain environments and not others. So\, wards where you perhaps are embedded in a bigger building\, it's such a tricky thing\, isn't it\, managing that. But also\, do you find that people get distressed if you can't deal with ... If they're wanting to get out? \nConny McGowan: \nAbsolutely. Absolutely. They do get very distressed. And sometimes\, that's the whole point\, that we invest those 10\, 15 minutes\, even 20 minutes. Take that resident out\, and then the rest of the shift will be a lot more smoothly. So\, it's always thinking about\, "How can I use my time wisely?" And usually\, it works. It doesn't always work\, but it's worth just investing that bit of time for that resident because in the long run\, it'll pay off. \nDr Anna Volkmer: \nIt's interesting how we talk about it with our medical hats on. It's all about risk and the negative consequences and the challenges\, but I can see\, actually\, that wandering can also ... If we can reinterpret it in a different light\, then we could maybe think about it differently. Thank you for that\, Conny. \nNow that we understand what wandering is\, I'd like to get into thinking a little bit about our understanding of this. Bryony\, your work challenges the idea that wandering is meaningless. Why does language matter so much in this space? \nDr Bryony Waters-Harvey: \nSo again\, we were very much guided by the care homes over the last two years\, and even before that\, since this project's been developed. We've had a lot of debates with academics\, with care staff\, with just the general public about this term\, wandering. It seems to be ... If you're a younger person and you're using this term about\, I don't know\, going for a wander on a Sunday afternoon\, it's seen as that leisurely activity where you haven't really got any direction or purpose\, but that's okay\, you're doing it for the enjoyment of walking. \nBut when it comes to dementia and care homes\, it automatically has this negative connotation that is a symptom of the dementia or it needs to be stopped\, where for us\, actually\, when we are walking with these people that we've been working with\, a lot of the time it's not part of their dementia. It's just their life\, that they're potentially bored or they always walked. They've grown up. We've had people that have grown up as postmen or as nurses who are used to walking\, and now we're putting them into a care home where they have a lot of their independence taken away because of needing supportive care and also trying to take away their walking. \nSo\, for us\, it was very much making sure that every staff member in every care home was happy with the terminology. So actually\, as the project has developed\, we do still use wandering\, but we've actually moved away from wandering at the same time\, to use other words. And so\, a lot of the time on all of our documents now\, we just use walking because that is what\, at the end of the day\, these people are doing. But we've also had care homes that like walking with purpose or exploring or venturing. So\, for us\, it was really important to make sure that language mattered because it was what people felt comfortable with. \nDr Anna Volkmer: \nYeah\, absolutely. I think that I've had that experience. I used to work on a ward in South London\, and I vividly remember this guy. And they kept saying\, "He's absconding\, he's absconding. He needs to get out of the ward." And he'd run. He wasn't wandering. He wasn't walking. He was running. And it took a couple of weeks\, but everyone was really stressed about it. And then suddenly\, his daughter arrived and said\, "Yeah\, no\, he was an award-winning boxer\," and he'd had this lifelong exercise routine. And then she put all these pictures up on his wall. And suddenly\, that narrative then became much easier to talk about. And actually\, the ward managed to get some funding for an exercise physiologist to go for a run with him because there weren't enough runners on the team to go running with him. But it's so important\, isn't it? Thank you\, Bryony. That was a really great\, useful description. \nEmma\, let's think about the evidence. So\, I believe you reviewed the evidence on this topic. Did you find much about the kinds of assumptions? Or maybe I should rephrase that. What kinds of assumptions did you notice in how wandering was framed in the research studies? \nDr Emma Hock: \nYeah. So as Bryony mentioned\, the overwhelming majority of research framed it as negative. And we actually didn't focus on that research so much because we were interested in research that looked at how wandering could be supported. But even so\, in a lot of that evidence\, wandering was often framed as a negative thing. And we did manage to draw out some evidence relating to approaches that can help people to wander safely\, such as\, for example\, controlling entrances and exits to enable people to wander freely within a space without entering a space that might be dangerous. However\, a lot of the language within the studies would still be talking about limiting people's wandering behaviour and so on. \nAnd it's very interesting\, talking about the example of the boxer that you just mentioned\, because a lot of the literature\, actually\, we looked at was what we call qualitative evidence\, so very rich descriptions of people's experiences and accounts. And there were loads of stories like that in the evidence\, such as people whose everyday lives involve wandering. So\, it was framed as fairly normatively in terms of that\, and how staff can help this by doing that very process of understanding exactly what walking means in that person's life\, or any kind of movement\, really. \nIt's funny. We did look at mostly academic literature\, journal articles\, and so on\, but we also included what we call grey literature\, which is stuff that the everyday person might access on the internet. So\, we had a few blog posts which were posted by care agencies\, and the language in those was a lot more positive around wandering. \nDr Anna Volkmer: \nThat's fascinating. So that's really interesting\, isn't it\, that just a different type of literature described it quite differently. How interesting. Thank you. Conny\, if you have staff members\, particularly newer staff members\, do staff make assumptions about people's walking that are negative? Or do they tend to make positive assumptions? Tell us a bit more about that. \nConny McGowan: \nI think if you have new carers\, there is definitely that assumption as to ... Are they safe to walk around? Should I tell them to sit down? But I would say that we are in a quite fortunate position\, that we have got a very experienced team here at the care home. So as a team\, as a whole\, housekeepers\, they may see someone and then ask them if they want a cloth and wipe down the handrails\, give them something to do because\, like Bryony said as well\, it is often that they want to be helpful. They want to be doing something. A lot of people have had very busy lives. So\, for them to just suddenly stop and just unwind\, it's difficult. So\, it's involving residents. Even the carers\, I see them asking the resident to push the trolley around\, to collecting cups\, and things like that. So\, I think we are very fortunate here\, that we see residents walking about that ... What can we do with them? \nDr Anna Volkmer: \nYeah. Be purposeful\, yeah. Do you think the number of staff matter? Do you think if you have a day when you're a bit understaffed\, does that make it all harder? \nConny McGowan: \nIt does. It does. And again\, as I mentioned before\, sometimes you have to just think about the situation. If you have a resident that ... He is very unsettled. He's very high at risk of falls. So personally\, if I was leading the shift\, I would allocate one carer to keep an eye on that resident because he might be the one triggering everyone else to be unsettled. So\, I would say\, "Can you take this gentleman down to the lounge?" And that way\, I think everyone's time is spent better\, if that makes sense. \nDr Anna Volkmer: \nYeah\, really useful. Okay\, thank you. Well\, next\, let's move on to talk more about your research. So\, this study was funded through the NIHR Research for Social Care programme. Bryony\, obviously\, we know this study is not about wandering\, but could you talk us through that in more detail? What the study set out to explore\, and why this focus felt important? \nDr Bryony Waters-Harvey: \nYeah. So\, our main goal was to develop some form of guidance to support care staff\, to be able to support people to walk safely in the care home without having to restrict them. And we felt it was really\, really important because at the end of the day\, our research team is very much about wanting to improve the lives of people with dementia and allowing them to continue to be able to be independent and have a fulfilled life while they're in their care homes. And we felt that this was one topic that really needed to be focused on. And as Emma has mentioned\, a lot of the research that was out there was more towards that negative\, trying to restrict people than support them. \nSo\, we had three phases of the overall project. So\, we had the realist review that I'll leave for Emma to explain us. I am definitely not an expert on that methodology\, but then we had our observation studies. So\, we got to go into six care homes and just spend ... I think it was about two months across about 14 hours with each resident\, and just getting to walk around with them\, seeing where they went\, if they shared why they were walking\, see how staff supported them\, and looking at how different care homes are able to support people or maybe those areas where staff struggles. All staff don't want to restrict residents. As Conny was saying\, that fear of the falling or leaving the care home or the other risks that are associated\, they don't know how they can manage that with giving people independence. \nAnd then our final phase was actually co-developing that guidance booklet. So\, we worked with staff and managers in care homes to create some form of booklet that took all of the work from the review and the observation studies to be able to provide people with those strategies and a bit more understanding of how they could support people safely. \nDr Anna Volkmer: \nIt's really interesting. Bryony\, you're right. People don't want to restrict people\, do they? And I think sometimes when I've been in clinical settings and people have ... It does happen very occasionally. People get out of a ward unsupervised. And in settings I've worked in\, we once or twice have had to call the police. And the way the staff treat it is often ... We need another study. Let's do another study. The conversations I've had\, people are like\, "Oh\, this is an awful thing." But also\, it's not only awful. I remember this gentleman\, he ended up ... He was found\, but he'd been fishing\, and he'd been fishing in a suit. It was a very amazing story\, but he'd obviously had a wonderful time. There'd obviously been heaps of risks\, but then the narrative in the staff\, we didn't want to restrict him\, but it was a conflict. I feel like there's a whole other study there\, as you're talking. \nAnd speaking of studies\, Emma\, your study used a realist approach. I've heard a lot about realist approaches. I've not used it. I'd love to use it. For me and the listeners who are unfamiliar with this methodology\, could you tell us what does a realist study help us understand that other methodologies might miss? \nDr Emma Hock: \nOkay. So\, it is quite complex\, but in a nutshell\, a realist approach helps you to work out what's actually going on. It focuses on the mechanisms behind what's happening. So\, in this case\, how and why are the strategies that have been described in the literature to help people to wander safely were actually improving people's wellbeing and enabling them to walk and also remain safe. And also\, there's a better focus on the context. So\, what is it about the environment or the person or the situation\, the staff\, the culture of the care home\, the physical environment in the care home\, that would then activate the mechanisms\, which is the underlying ... What's going on\, how is this working\, in order to be able to lead to\, say\, a resident being happy\, satisfied\, not agitated\, the staff being not anxious about their wellbeing\, and the resident being kept safe. \nSo essentially\, it's in synthesis\, which is what we did for the first part of the study. In synthesis\, this looks like gathering lots of evidence\, but you are not just looking at what's happening\, which you might do in\, say\, a systematic review. You're not looking at\, say\, which strategies are effective for helping people to wander safely. You're looking at how\, why\, for whom\, and in which circumstances. \nDr Anna Volkmer: \nDoes it go to the granular level or can it capture some of the granular stuff that ... I'm thinking about a conversation analytics study that I'm quite familiar with\, where they did look at wandering or people walking around and how the staff assigned to that person verbally interacted\, and what was said that perhaps made the situation more difficult and what was said that perhaps made that situation easier. Can it capture that kind of granular level as well? Or is it perhaps a bit more umbrella-y? I'm just pondering. \nDr Emma Hock: \nYeah. So\, this was a challenge that we had\, actually\, because we ended up looking at quite a few different strategies and the mechanisms behind them. And we did this with perhaps ... Maybe we looked at too many for the scope the project\, but we did cover a lot of evidence. So\, we began to look at everything in detail. So\, I\, Bryony\, and a few others\, we pulled out the rich data from the papers. As I mentioned\, actually all of the evidence was qualitative in the end. That wasn't by design. It was the way it worked out. But actually\, as you said\, qualitative evidence\, evidence where the data is people's descriptions\, experiences\, accounts\, and so on\, does give a lot of detail\, which helps to explain some of the how’s and whys. And so\, we spent a lot of time\, didn't we\, Bryony\, getting all this data out of the papers and into a format that we could then use. \nAnd then all of this data was looked through in detail and how it related to the context and mechanism was pulled out of it. So we did begin with a lot of detail\, but we realised that to produce something that would fit the work out of a journal\, we had to reduce some of that detail and try and obviously make some recommendations as well that could be implemented in care homes\, and it could carry forward to the next stage of the research\, the actual getting into the care homes and watching what was going on\, speaking to people. So\, we did have to remove quite a bit of the detail from the actual writeup in the end\, but it all went in there. \nSo yes\, to answer your question\, we did go into the granularity of it\, although some of that may eventually have been unfortunately lost in the writeup. But in realist approaches\, you could look at\, say\, a small number of questions and then explore those in greater detail. So\, it's not a function of the method\, it's just the size of the evidence that we were looking at. \nDr Anna Volkmer: \nI hear what you're saying. So did the second stage\, the observational stage that you described\, Bryony\, also use realist methods? And did you use realist methods to join that together\, or how did that work? \nDr Bryony Waters-Harvey: \nYeah. So\, the realist review informed our second part of the study. So as Emma mentioned\, we reduced all that information down and came up with five main areas that we focused on\, which was personal care\, monitoring\, access to spaces\, food and drink\, and safety and comfortability\, if I remember rightly. What we took for that\, that was our basis. So\, we looked at\, okay\, are these things really being translated into practise? And yeah\, still following that ... When do these strategies work and for who? We did ethnography methods for this\, but very much was informed by the realist approach. \nIn another part of the study\, we completed an environmental mapping. We had an occupational therapist that joined our research team at the start of the project\, and she was really interested in how the environment of the care homes could impact on the behaviour of wandering. So as part of her role within the project\, she developed the wayfinding tool\, which is an 80-item tool that describes the environment relating to the act of orientation and wayfinding. And this looked across 11 different areas of the care home\, such as exits\, corridors\, fire safety\, and the various different rooms that you might find in a care home\, such as bedrooms. And this tool used quantitative and qualitative methods to look at how that environment was set up. So\, we looked at the layout of the care home\, where the corridors were\, visual access\, looking at ... Was there visual access from the bedroom to the toilet\, to help with wayfinding. \nShe also used measurements. So\, she measured the width of the corridors to see if they were suitable for how people could pass in the corridors or people in wheelchairs. We used a tape measure to measure the length\, to find out what the longest route was in each care home\, from the bedroom to the communal areas. There was also measurement of chairs and tables to see if they're suitable for residents to be able to independently sit and stand themselves. \nAnd in each care home\, we went round and completed this 80-item tool to get an overview of what that care home's environment looked like. And from what we found in that part of the study\, actually\, this was really important because each care home was so different that it really helped to contextualise the observation results in the context of each care home. So\, we're really hoping that by developing this tool\, we're going to make it available to other researchers that are interested in using it. And we hope that in future studies\, people may consider creating a conceptual environmental mapping of care homes when looking at a behaviour\, to see how the environment interacts with that behaviour that's being studied. \nAnd we also hope that this tool could be used by care homes to audit their care homes\, to see what areas of the environment could be changed to improve wandering and wayfinding. \nAnd we found that this wasn't about saying what was wrong or what wasn't. It was to really just look at that conceptual idea and how that interacted with the behaviour. \nDr Anna Volkmer: \nOkay. And then out of those packages came a set of recommendations. Is that what- \nDr Bryony Waters-Harvey: \nYes. Yeah. So\, we took all of the findings from the first phase\, all of the findings from the second phase\, and we took them to the staff and managers that signed up to the co-production workshops\, and said\, "This is what we've found. These seem to be strategies that are possible." So obviously\, we had very different care homes. So\, some care homes were like\, "Nope\, those strategies would never work in our care homes." We had others that were very much more accessible. We had some places where the whole care home was accessible to everyone and people were allowed a lot more freedom because of the format of where it was in the buildings. Obviously\, a lot of these are not purpose-built buildings\, so are very restricted. So\, we took everything we had and said\, "Look\, what do you think out of these are doable\, are safe\, and are most possible?" And as a group of 30 staff\, we were able to actually come up with three or four strategies for each of those elements that could be practically inputted into care homes. \nI should probably talk about the strategies that have come out of this research that have been included in the booklets. So\, we found seven areas of residents' needs that we wanted to look at. And within each of those areas\, we asked care staff to pick their top two to three most important strategies. \nSo\, some that were quite important to us in area one is knowing each resident as an individual. So\, we feel it's really important to understand each resident and what strategies they need for that individual\, based on their life history\, their abilities\, their needs\, and anything that the staff learn about residents during that time. So\, two strategies that were quite important in this area was creating individualised care plans. And as part of that\, we've developed care plan prompts to make sure that staff are covering all areas when it comes to supporting people to wander. So this is looking at life history and understanding how that could influence how people decide to walk\, why they walk\, looking at walking preferences\, looking at if there's any triggers to understand when a resident is wanting to walk for enjoyment rather than when maybe they're walking due to an unmet need or due to anxiety\, and looking at what support they need. So\, whether they need tailored walking aids\, if they need someone to walk with them. \nAnd as part of that as well\, it's looking at reporting incidences and near misses to make sure that you can support residents to continue to walk safely. So\, if there's residents in certain areas that don't get on\, how that can be supported to make sure that all residents can walk in the same space. \nAnother really important strategy for us is residents taking part in meaningful activities. So\, we found that a lot of residents walk because they want to find something meaningful to do. So being able to offer even meaningful activities\, such as music\, exercise\, dance\, baking\, can be really helpful. Also\, allowing residents to take part in household tasks that they enjoy is a really great way to allow people to walk meaningfully and allow them to have that purpose. So\, some of these household tasks can be such as setting and cleaning tables\, dusting\, folding laundry\, things that are very regular for people to do while walking. \nAnother area that was important to us was safe and comfortable movement. And so\, the main strategy for this is providing physical and emotional support. So\, while some residents may be able to walk independently without any assistance\, it is important to offer physical support for residents that maybe need that additional help to be able to move around the care home\, but also handholding and guiding. Hands on backs can also be a reassurance for residents\, especially for those that maybe have a fear of falling. \nAnd similarly with the emotional support\, offering verbal directions on bending your knees or turning this way\, you can provide that reassurance to residents that they're safe and supported. \nAnother strategy is using tailored walking aids. So\, with the support of healthcare professionals\, working out when mobility changes\, whether tailored walking aids can allow residents to continue to have that independence. And then those that do have walking aids\, it's about making sure that residents are using them and providing calm and positive communication to support them to use those aids. And we found in many care homes that personalization was really important to make sure that residents are using the correct walking aids. So\, this could be having their name put on the front\, having a picture that's associated with that resident or having different colours to help them identify them easily. \nNot only were we interested in wandering\, but we were also interested in wayfinding or navigating the care homes. And there was a number of strategies for this\, such as using appropriate lighting to making sure that areas are well lit\, and that it's natural light rather than harsh lighting that can cause glare or discomfort\, making sure that there is an elimination of dark shadows or confusing glares off of different materials that could cause trips and falls\, and looking at whether lighting needs to be changed\, depending on the time of day. So gently dimming the lights as the night goes on to stimulate the difference between day and night. \nManaging access was a big\, big area for us. So this was about keeping spaces clean\, arranging furniture that gives wide\, clear walking paths\, and making sure that those walking paths are kept clear of any equipment or furniture\, making sure that flooring is even and dry\, with no loose mats or cables\, and making sure that staff report to management and maintenance when there is potential hazards within the space. \nThere was also looking at restricting access to unsafe areas. So\, by locking areas to unsafe areas\, this actually can support more wandering in the areas that are safe. So\, this was about running risk assessments on the residents that are in the care home; to look at what areas can safely be left unlocked and what areas need locking. And this could be through pin codes or gates on stairwells. And this really looked at the needs of the residents at that time\, and reassessing when residents need to change to make sure that it is always the least restrictive environment. \nAnd when you do have areas that are locked\, looking at redirecting residents. So\, trying to acknowledge their feelings\, but then use that information that you know about the residents to guide them to a safe alternative activity or area. \nThe final area that I want to discuss is food and drink. So\, residents that walk frequently can experience a large amount of weight loss due to not getting enough nutrition and hydration. So\, we found it was really important that snacks are available all day and night and making sure that staff are regularly encouraging residents to drink and eat. And we found one way that this could be done is through hydration stations. So\, placing visually appealing hydration stations in key communal areas can help residents to access that drink on their own. \nAnd in terms of snack\, offering finger foods and grazing menus that residents can take on the go can be really helpful\, as it means that they can walk and eat at the same time. So\, some of these foods could be sandwiches\, cheese sticks\, or sliced fruit. And we found it was really about being creative. So\, choosing ways to serve food that's easy to eat on the go\, such as soup in takeaway cups or using snack belts that staff wear to easily distribute those snacks. \nSo\, we're hoping to have our final output ready in the next couple of weeks. It is currently just with our graphic designer\, making it look nice. So\, we've ended up with two booklets. We've got one for care staff and one for managers that explains those strategies. So\, each page is a separate one of those themes\, and then they've got several strategies that explains what could be implemented. \nAnd then alongside those booklets\, we've got a resource pack that's going to have a number of practical support tools for staff. So\, we've got a checklist\, we've got training prompts\, we've got little stories of different characters that we've created that can allow care homes to discuss these strategies and just wandering in a wider concept. \nWe've got care plan prompts to help make sure that\, actually\, staff know these strategies and know what works for each resident. And then we've also got a poster to advertise it. We've also been really lucky as well\, that we got some extra funding to work with another one of our projects to create a comic book. And one of the stories within our comic book is exploring how to give people the independence to wander and focusing on some of those strategies. \nDr Anna Volkmer: \nConny\, from your perspective\, you were involved in all of this. What did it mean to be involved in research like this? \nConny McGowan: \nI thought it was a fantastic opportunity\, especially because we have quite a few residents that do like to walk around. And for us as a home\, we just needed to know\, really\, whether we're doing things right\, how we can do things better. We're always looking to improve ourselves\, and how this research can benefit our residents. Whichever research we do\, we always think\, "How will the residents benefit from this?" So yes\, it was a great opportunity. \nDr Anna Volkmer: \nWell\, I'm going to move on to talk about ... I mean\, we've already jumped ahead and talked about the outputs from the findings\, but I want to focus on that in a bit more detail. \nI expect a strong message from this study is going to be that walking is often meaningful. So\, Emma and Bryony\, I wonder\, how do you envisage that your research will change how wandering is understood in care homes? \nDr Bryony Waters-Harvey: \nI guess for us\, it's just raising that awareness. We had six amazing care homes that were all very much wanting to support wandering\, but unfortunately there are many care homes out there that aren't aware of the positives of walking. And unfortunately\, in a care home I used to work in\, it was a lot more restrictive. So\, we're really hoping to push these outcomes out as far as possible to try and reach as many people as possible\, to get the message out and just show that people can continue to walk. And there is a number of strategies. \nI think it's amazing as well\, something that I think none of us in the team really thought about\, was actually wandering doesn't need to be someone walking around on their feet. We had many residents that actually are in wheelchairs and still continue to wander. And staff have found ways to allow those residents to independently take themselves around the care home in their wheelchair\, and I think that was something we never envisioned would come out of this research. \nDr Anna Volkmer: \nAmazing. Conny\, do you feel that the research itself and the findings match up with what you see in your own care home? \nConny McGowan: \nYes\, I'd like to think so. When we went through the booklets\, or the booklet at the time\, it was confirming that what we are doing is pretty close to what is in the booklet\, just the sessions we had as well\, with meeting other care home managers and carers. I certainly learned a few things just talking to others and finding out how they manage this behaviour. So yes\, it was confirming that we are doing things right\, but like I said\, always room for improvement. \nDr Anna Volkmer: \nIt's interesting you talk about confirmatory. I think with my behaviour change hat on\, we know that\, actually\, if you name a behaviour or a strategy\, then you know what it is and you can do more of it. So actually\, I can see that even that is valuable for some of the homes perhaps where things are happening well. But supporting walking\, it does raise ethical issues. I think it's interesting you talk about wheelchair access because that's kind of an ethical issue. And I've been talking about this idea of people getting out. It's tricky in care homes to balance safety with dignity and autonomy\, often when there are really limited resources\, aren't there? Conny\, how do you tackle this? And can research like this help others and be translated into supporting autonomy and being ethical? \nConny McGowan: \nSo\, over the last few years\, I think we've really changed our approach to something called positive risk-taking. So\, residents are living with dementia\, but that doesn't mean we need to restrict things. And we have to\, rather than just keep thinking about things that can go wrong\, think about the person and think about ... If they didn't have dementia\, would they still be able to drink a bottle of wine or something like that? \nDr Anna Volkmer: \nExactly. \nConny McGowan: \nSo it is about just changing our approach and really thinking about that person because sometimes residents do come to us that have previously been in a care home where the care home couldn't manage\, and yet we find them a pleasure to be around and\, really\, they're lovely to have in the home and part of our community. So other homes can definitely take a lot from this research. \nDr Anna Volkmer: \nThank you. I like the phrase positive risk-taking. It's a great way of describing things because we all take risks all the time. Why should a diagnosis stop you? I think you're absolutely right. It's really a brilliant summary\, but there's lots more research that needs to be done. So\, Emma\, what needs to happen next in terms of evidence and guidance? \nDr Emma Hock: \nWell\, so I'll invite Bryony to jump in afterwards because she was much more involved in the ethnography study and the care home side of things. But in terms of evidence gaps that we've identified\, certainly there needs to be more research on how relatives of residency care homes\, how they're involved in supporting their resident in the care home to wander safely. And also\, there didn't seem to be much research on how strategies work to enable residents to wander safely when there are several different residents in the care home all at the same time\, with different needs\, walking around. \nThere also needs to be some more longitudinal research\, which is a research that's taken over a long time period\, looking at how everything works over the longer term\, how residents and staff and relatives negotiate some of these issues of safety and care preferences and preferences for walking. \nAnd also\, there could be some more research on staffing and shift patterns in terms of how that affects the support that residents are able to receive\, which I know was mentioned quite early on in this podcast. And there could also be ... I know there's a lot of qualitative evidence and it's extremely useful for understanding exactly what's going on. There could be also some more quantitative evidence looking at the effectiveness of some of these strategies\, which we didn't find an awful lot of\, just to complement the qualitative evidence. \nBryony\, it'd be really useful to have your insights from the ethnography\, as to what research needs to be taking place. \nDr Bryony Waters-Harvey: \nYeah. I think I completely agree with Emma. Relatives would be really interesting. So\, we did plan on recruiting relatives\, but this was the only participant type that we really struggled to recruit. So\, it would be really interesting to see more about relatives and how they can support\, but also their beliefs on allowing people to wander. We had many people say that sometimes there is this challenge between what the care home wants to implement because they know it's what's best for the resident\, but then that relative having that fear of not wanting their relative to fool or escape or be harmed. So\, I think that would be something that's really interesting. \nAnd I think the quantitative is definitely something that needs ... So\, we were fully qualitative as well. So\, we were able to suggest these strategies\, but actually how much they relate to reducing anxiety and distress and how much does giving that independence stop people from leaving would be really interesting. \nI think my final point would be about access to gardens. So\, we had some care homes that very much did give free access to residents\, and they could go into that garden at any time of the day without any supervision. But then we have other care homes that were very restricted and either let no one into the garden at all or it had to be supervised. And there's other research out on this that\, actually\, a lot of care homes do go more towards that restriction of access. And I think it'd be really interesting to explore that further. And actually\, if some of the strategies that we've seen in these care homes that are freely open\, can they be implemented everywhere and allow that freedom to everyone? Because I think that was something that really struck me during the research\, that actually some of these residents\, they might never get to go outside again. I guess we take it for granted that we can feel rain\, or we can feel the sun\, but actually some of these residents never get to experience that again once they go into a care home. \nDr Anna Volkmer: \nSo\, we're almost out of time\, but to finish\, I would like to ask each of you one final question. So\, the question is\, what is one common myth about wandering that you would like people to stop repeating? Bryony\, do you want to go first? Should we go alphabetically? \nDr Bryony Waters-Harvey: \nI guess the biggest thing for me is that it isn't a meaningless activity. For these people\, they have a purpose while they're walking\, and it is beneficial for them. And we shouldn't just be saying\, "Sit down\, sit down. It's not safe." We should be supporting them to walk safely. \nDr Anna Volkmer: \nConny? \nConny McGowan: \nYes. Very similar to Bryony's answer. And she mentioned something in the beginning as well. I think that wandering in a care home has got that negative connotation\, but I think we should see this wandering\, walking around\, as an opportunity to have that moment with the resident\, to engage them in a conversation\, to interact with them on a one-to-one basis. So really\, it can be something very positive as well. \nDr Emma Hock: \nJust from looking at the evidence\, allowing people to wander takes up more staff time and convenience because the evidence suggested that actually allowing people to wander safely can actually take up a bit less time than constantly having to\, say\, redirect somebody or something like that. But I don't if that's your experience\, Conny. \nDr Anna Volkmer: \nWell\, this has been such a wonderful discussion. Thank you. Just to summarise\, I think what I'm hearing is that we're talking about wandering or walking being a meaningful activity that makes people human and that actually could\, if we had the right strategies in place\, could reduce resource use\, improve quality of care\, and allow people positive risk-taking\, which is something human we all do. \nThank you so much to Dr. Bryony Waters-Harvey\, Dr. Emma Hock\, and Conny McGowan for sharing their experience and perspectives today. And listening to some of mine. I'm sorry. I've been inserting mine in there too. Links to the NIHR Research for Social Care study and related resources will be included in the show notes. Thank you all for listening. I'm Anna Volkmer\, and you've been listening to the Dementia Researcher Podcast. Bye\, everybody. \nDr Emma Hock: \nBye. \nDr Bryony Waters-Harvey: \nBye. \nVoice Over: \nThe Dementia Researcher Podcast was brought to you by University College London with generous funding from the UK National Institute for Health Research\, Alzheimer's Research UK\, Alzheimer's Society\, Alzheimer's Association\, and Race Against Dementia. Please subscribe\, leave us a review\, and register on our website for full access to all our great resources\, dementiaresearcher.nihr.ac.uk. \n\n\n\n\n\n\n\nIf you would like to share your own experiences or discuss your research in a blog or on a podcast\, drop us a line to dementiaresearcher@ucl.ac.uk \nDid you know... you can find our podcast in your favourite podcast app on mobile devices\, and our narrated blogs are also available as a podcast. \n\nThe views and opinions expressed by the host and guests in this podcast represent those of the guests and do not necessarily reflect those of UCL\, Dementia Researcher or its funders. \n\nShare your thoughts on this topic in the comments below. \n\n\n\n\n    Meet the contributors\n    \n\n        \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Dr Anna Volkmer\, University College London\n        \n            \n        \n             18/04/2018  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Bryony Waters-Harvey\, The University of Sheffield\n        \n            \n        \n             02/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Dr Emma Hock\, The University of Sheffield\n        \n            \n        \n             04/02/2026  Dementia Researcher         \n            \n      \n \n            \n\n        \n    \n         \n    \n        \n        \n        \n    \n     \n        \n        \n            Profile – Conny McGowan\, The Orders of St John Care Trust\n        \n            \n        \n             09/02/2026  Dementia Researcher         \n            \n      \n \n           \n\n\n	\nEssential links / resources mentioned in the show:\n\nFreedem Toolkit \nRealist Review Research Publication \nThe Orders of St John Care Trust \n\n			\n			Related content		\n			\n		\n							\n				\n	\n		 \n		 \n		\n			Podcast – Exploring Psychotherapy for People with Dementia		\n			\n\n\n	\n		 \n		 \n		\n			Blog – Why Care Home Communities Deserve a Place in Research		\n			\n\n\n	\n		 \n		 \n		\n			Podcast – Thirst for Knowledge: Hydration & Dementia
URL:https://www.dementiaresearcher.nihr.ac.uk/event/nominations-are-open-for-the-uk-dementia-awards-2026/
LOCATION:Coombe Abbey Hotel\, Brinklow Rd\, Binley\, Coventry\, CV3 2AB\, United Kingdom
CATEGORIES:Public Discussion
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