Wandering is a common phenomenon in the early and
middle stages of dementia occurring in 15-60% of dementia sufferers. This
behavioral disturbance is a major cause of hospital admission, physical harm,
institutionalization and even death. It is considered one of the least
manageable behavioral problems of dementia by caregivers. Less than 4% of
people with dementia who wander away from home are able to return on their own.
Alzheimer’s patients have difficulty determining whether they, or the objects
around them, are actually moving in the environment. This problem with “optic
flow” can lead to disorientation, wandering and getting lost.
Generally if an individual is found within 24 hours
they are returned safely, however after 24 hours the survival rate drops down
to 46%.
Chances are that your loved one will become
separated from you at least once during the course of the disease – either at a
crowded shopping center or while you are busy with chores. Though wandering
remains a risk while a loved one is mobile there are things you can do to help
prevent wandering and to ensure that your loved one is returned safely if they
do become separated.
Who is at Risk of Wandering?
Anyone who has memory problems and is able to walk
is at risk for wandering. Even in the early stages of dementia, a person can
become disoriented or confused for a period of time. Note that wandering and
getting lost is common among people with dementia and can happen during any
stage of the disease. It's important to plan ahead for this type of situation.
Be on the lookout for the following warning signs:
- Returns
from a regular walk or drive later than usual
- Tries to
fulfill former obligations, such as going to work
- Tries or
wants to "go home," even when at home
- Is
restless, paces or makes repetitive movements
- Has
difficulty locating familiar places like the bathroom, bedroom or dining
room
- Asks the
whereabouts of current or past friends and family
- Acts as if
doing a hobby or chore, but nothing gets done (e.g., moves around pots and
dirt without actually planting anything)
- Appears
lost in a new or changed environment
Why
Wandering is an Issue for Alzheimer’s?
Wandering is a definite hallmark of Alzheimer’s
disease yet the association between wandering and Alzheimer’s is not thoroughly
understood, and can be unsettling and frightening both for the person suffering
from Alzheimer’s and their loved ones. Although seemingly aimless, the activity
of wandering can actually be a desperate attempt to communicate after critical
language skills have slipped away.
Those persons with Alzheimer’s may be trying to tell
you they are feeling lost, or feel as though they have lost something through
their wandering, however it can also be signaling something as simple as
hunger, thirst, or a need for rest or exercise. Think about how it would be if
you were absolutely unable to communicate your most basic needs to your
caretakers after all, even the tiniest babies communicate their specific needs
through their varying types of crying, and most mothers become extremely adept
at deciphering those cries. Too much external stimulation can also link to wandering
and Alzheimer’s disease as the brain which has slowed down significantly can be
overwhelmed by loud sounds, or even multiple conversations in the background.
The combination of wandering and Alzheimer’s can also be attributed to certain medication side effects, frustrated attempts to express fear, isolation or loneliness, simple curiosity, boredom, visual stimuli which triggers past memories or routines, or even being thrust into a new environment. For instance, a person with Alzheimer’s may see a briefcase, and be thrust back into a time when they picked up their briefcase and went to work each day. This kind of visual stimulus could prompt them to wander about in an effort to find their office.
Prevent Wandering
If you're caring for a loved one who has
Alzheimer's, use simple strategies to curb wandering:
- Address
potential triggers. Offer your loved one a snack,
a glass of water or use of the bathroom. Encourage physical activity to curb
restlessness and promote better sleep. If you think your loved one is
looking for something familiar, provide a family photo album or share
favorite memories.
- Provide
visual cues. People who have Alzheimer's often
forget where they are, even inside their own homes. It might help to post
descriptive photos on the doors to various rooms, such as the bathroom,
bedroom and kitchen. Encourage your loved one to explore his or her
immediate environment as often as necessary.
- Plan
activities and other distractions. If your loved one
tends to wander at the same time every day, a planned activity at that
hour could stem the wandering. It might be as simple as asking the person
to fold a basket of towels or put place mats on the table for dinner. If
wandering outdoors is an issue, you may want to store coats, boots and
keys out of sight.
- Reassure
the person if he or he feels lost, abandoned or disoriented.
If the person with dementia wants to leave to "go home" or
"go to work," use communication focused on exploration and
validation. Refrain from correcting the person. For example, "We are
staying here tonight. We are safe and I'll be with you. We can go home in
the morning after a good night's rest."
- Avoid
busy places that are confusing and can cause disorientation.
This could be shopping malls, grocery stores or other busy venues.
- Consult
with doctor. Consult with a physician to see if
medications can help. Individuals who wander as a result of delusions or
hallucinations may require psychotropic medications.
Keep your Loved One Safe
Despite your best efforts, it may be impossible to
completely prevent wandering. Consider these techniques to minimize problems
related to wandering:
- Reduce
hazards. Remove tripping hazards, such as
throw rugs and extension cords. Install night lights to aid nighttime
wanderers. Put gates at stairwells to prevent falls.
- Provide
a place to wander safely. If wandering
isn't associated with distress or a physical need, you may want to focus
simply on providing a safe place for walking or exploration — such as a
path through the rooms of your house or a circular trail through a fenced
backyard.
- Install locks on
the doors. The doors are the first place to
stop a loved one from wandering. Early in the disease when they are most
likely to wander off, they may still remember how to unlock the current
locks. Placing hook and eye latches on the outside screen door is very
effective. They are best if they are placed either very low on the door or
high on the door. You can place a double key lock on the inside door, but
be aware that your loved one may get panicked if they cannot open the
inside door.
- Install locks on
the windows. The windows are something most
forget about but sooner or later many loved ones remember. Even windows on
the upper levels of home or a facility should be safeguarded from an
individual who may open it and crawl out. If you have windows (and doors)
that slide open from side to side, often a piece of wood cut so the window
can only be opened part way is helpful. Windows that slide up and down can
be safeguarded by putting a nail or screw in the track so the window can
only be partially opened. If the window opens with a crank, you can take
the handle off when you have adjusted the window to the desired position.
- Keep all keys up
and out of sight and reach. An individual
with Alzheimer’s Disease may still be able to recognize a key and
understand its use. A loved one that gets hold of a car key and slips off
can be gone miles by the time it is noticed. This does happen and it
happens more often than you would think.
- Keep outdoor
clothes under control. Put away essential items,
such as the person's coat, shoes, pocketbook or glasses, since some
individuals will not go out without certain articles.
- Install
alarms. There are many types of alarms
systems that can be used to let you know when a loved one is entering or
leaving an area. You can equip the doors that lead outside or to dangerous
areas like garages and stairs with a simple door alarm available at most
electronic shops. In general, they sound an alarm when a pin is pulled or
a connection lost when a door is opened. You can also get pressure
sensitive mats that will set off an alarm when a loved one steps on it.
This can give you the benefit of a little extra time by alerting you where
they are before they open the door to go out. You can also get motion
detecting alarms that can be set to let you know when your loved one gets
out of bed or exits their room.
- Camouflage
doors. To short-circuit a compulsion to
wander into off-limits rooms, you might place curtains over doors or
camouflage doors with paint or wallpaper that matches the surrounding
walls. A mirror on the door might help, too. You may also place large
signs on exits that say "Stop" or "Do Not Enter". Place
a black mat or paint a black space by an exit, which may appear to be an
impassable hole to those with dementia. Likewise, a large line, strip of
tape or Velcro may act as a barrier.
- Erect fences and
gates. Trying to keep a loved one
restricted to the indoors all the time, especially in good weather, is
usually not reasonable. Everyone enjoys being able to go outside on their
own, including individuals with Alzheimer’s Disease. A fence can often
provide them a place to go in relative safety. Chain link fences are not a
good idea as most loved ones can climb those rather quickly. A privacy
fence can be good but you want to make sure the side without the brace
beams are not facing in or it is a double sided privacy fence. The side
braces often provide a foothold for climbing over the fence. In general, a
farm fence with squares, which are too small for a foothold, works very
well. It should be at least six feet tall to provide extra assurance that
your loved one cannot pull themselves over the fence.
- Avoid leaving a
loved one home alone. Determining when an
individual with Alzheimer’s Disease is no longer to be left at home alone
for short periods can be difficult. Alerting a neighbor to keep an eye out
when you go out is a good idea or even recruiting a friend or neighbor to
"visit" with your loved one while you go to the store is even
better. You can approach for help at local area churches, High Schools,
Scouts, Community Centers, Senior Citizen's Centers, local Alzheimer’s
Association chapter and any other group you can uncover. When someone
offers to help don't refuse it! Accept it right then and count it as a
blessing.
Ensuring a Safe Return
Wanderers who get lost can be difficult to find
because they often behave unpredictably. For example, they may not call for
help or respond to searchers' calls. Once found, wanderers may not remember
their names or where they live. Consider these tips to improve your chances
that your loved one will get back home safely:
- Inform
your neighbors. To trigger the neighborhood unofficial
watch, inform your neighbors and other close contacts about your loved
one's condition. Keep a list of emergency phone numbers handy in case you
can't find your loved one.
- Keep a list
of places where the person may wander. This could
include past jobs, former homes, Adult Day Care or Senior Centers, places
of worship or a restaurant. While considering a search plan, keep in mind
if the person is right-handed or left-handed. Wandering generally follows
the direction of the dominant hand.
- Consider
enrolling in a safe-return program. A Safe Return
bracelet, necklace or emergency ID card will help your loved one to be
identified if you get separated. A Safe Return bracelet from the
Alzheimer’s Association (http://www.alz.org) is a good way of assuring
that if your loved one identity is known to authorities. It is best to put
the bracelet on the dominant wrist so that your loved one is not able to
take it off. Sometimes it is impossible to get a loved one to wear the
bracelet or necklace. In those cases you can make sure that a label with
your loved one’s name and phone number is on all their clothing. You can
never depend on your loved one to carry their ID when they are separated
from you and you want to be sure that if your loved one wanders they can
be ID and returned quickly.
- Dress
in brightly colored clothing. Bright and
distinct clothing can be spotted from a distance. Dressing in clothing
that can be easily spotted especially in a crowd is helpful when taking a
loved one out shopping or on an outing. It is very easy for an individual
with Alzheimer’s Disease to become separated especially when there is a
crowd. It can happen within seconds. Don’t panic if it happens.
- Use a GPS
device. You might consider having your
loved one wear a GPS or other tracking device that can send electronic
alerts about his or her location. If your loved one wanders, the GPS
device can help you find him or her quickly. Modern smart phones are
capable to get installed free or commercial GPS tracking applications
which will help you to know where your loved one at any moment.
- Search
Immediately. If the person does wander, search the immediate area for no more
than 15 minutes. Call "911" and report to the police that
a person with Alzheimer's disease — a "vulnerable adult" — is
missing. A Missing Report should be filed and the police will begin to
search for the individual. In addition, a report should be filed with MedicAlert+
Alzheimer's Association Safe Return at 1.800.625.3780. First
responders are trained to check with MedicAlert+ Alzheimer's Association
Safe Return when they locate a missing person with dementia. You do not
need to be enrolled in MedicAlert+ Alzheimer's Association Safe Return in
order to file a missing report. A search should start immediately,
typically beginning in a five-mile radius of where the person was last
seen.
Please remember wandering is a big risk factor for
individuals with Alzheimer’s Disease. We can take precautions to keep our loved
ones safe. Even the best caregiver or facility will have experiences with
wandering. If your loved one wanders of, don’t beat yourself up for being
neglectful. Take reasonable precautions, don’t panic and enlist others to help
you find him/her.
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