Publication date: Aug 01, 2024

Wandering behavior in nursing home (NH) residents could increase risk of infection. The objective of this study was to assess the association of wandering behavior with SARS-CoV-2 infection in Veterans Affairs (VA) Community Living Center (CLC) residents. Retrospective cohort study. Veterans residing in 133 VA CLCs. We included residents with SARS-CoV-2 test from March 1, 2020 to December 31, 2020 from VA electronic medical records. We identified CLC residents with wandering on Minimum Data Set 3. 0 assessments and compared them with residents without wandering. The outcome was SARS-CoV-2 infection, as tested for surveillance testing, in those with and without wandering. Generalized linear model with Poisson link adjusted for relevant covariates was used. Residents (n = 9995) were included in the analytic cohort mean, (SD) age 73. 4 (10. 7); 388 (3. 9%) women. The mean (SD) activities of daily living score in the overall cohort was 13. 6 (8. 25). Wandering was noted in 379 (3. 8%) (n = 379) of the cohort. The exposure groups differed in prior dementia (92. 6% vs 62. 1%, standardized mean difference [SMD] = 0. 8) and psychoses (41. 4% vs 28. 1%, SMD = 0. 3). Overall, 12. 5% (n = 1248) tested positive for SARS-CoV-2 and more residents among the wandering group were SARS-CoV-2 positive as compared with those in the group without wandering (19% [n = 72] vs 12. 2% [n = 1176], SMD = 0. 19). Adjusting for covariates, residents with wandering had 34% higher relative risk for SARS-CoV-2 infection (adjusted relative risk, 1. 34; 95% CI, 1. 04-1. 69). CLC residents with wandering had a higher risk of SARS-CoV-2 infection. This may inform implementation of infection control and isolation policies as NHs attempt to balance ethical concepts of resident autonomy, proportionality, equity, and utilitarianism.

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