September Caregiver Connection: Wandering

As many as 60% of the 5.1 million Americans with Alzheimer’s disease will display wandering behaviors at some point in the disease process.  Sometimes wandering is little more than continual pacing within a small area, but it can often lead to the individual becoming separated from their caregiver.

People that display this behavior may wander around the room, from room to room, or even out of the house or facility.  They may wander away while on a trip to the grocery store or other location.  Wandering can occur on foot, in a car or on public transportation.

Critical wandering is when a person wanders away from supervised care, a controlled environment, or cannot be located.  Wandering can be random, where a person moves about aimlessly with no apparent goal, or goal-orientation.  This behavior can be attributed to trying to go home or searching for the restroom.  The key to controlling this behavior is understanding its triggers.

Most of the focus is placed on critical wandering due to the risk to the person with AD.  According to the Butler and Barnett study, the incidence of critical wandering is 1% among AD patients.  It is estimated that there are 125,000 critical wandering incidents in the United States each year.1 Confused and sometimes unable to ask for help, Alzheimer’s patients who wander are at risk from weather, traffic, and those who prey on the helpless.  Some have driven thousands of miles from home while others have died from exposure a short distance from their doorsteps. Getting them home can be a challenge as the person may forget their name and address, or give an old address. Additionally, Alzheimer’s patients often hide in hard to see places like bushes or ditches.  They may also not respond when their name is called.

Triggers

People with AD wander for a variety of reasons.  They may be searching for someone or something familiar, such as where they used to live or work.  They may need something, like food, water, a bathroom, or companionship, and can’t communicate about it, so they set out to find it.  When out in public it is very important to avoid stressful, intense energy situations that exacerbate the flight urge such as malls, airports, and grocery stores.  Because they are in large places it can also make locating the individual difficult.

Consider these possible triggers:

Agitation
Anxiety
Boredom/Restlessness
Medication side effects
Physical needs (urge to use the bathroom, hunger, fatigue)
Confusion related to time
Restlessness
Inability to recognize familiar people, places or objects

Remember there are some things that a caregiver should avoid doing when dealing with wandering behavior.  Don’t raise your voice.  It is important to keep a neutral and calm tone of voice.  Never restrain the person with AD or leave them alone in a locked room.  Only use sedatives as a last resort and under the medical supervision of a physician.

Prevention

It is important to take precautions to prevent the individual from wandering away from their home. Most important for Alzheimer’s/dementia families is to make certain that all environmental safeguards have been made inside the home.

Here are some suggestions to safeguard against a critical wandering incident from Coach Broyles Playbook and The Alzheimer’s Store:

□   Check doors to be sure they are locked.
□   Remind visitors to close doors securely behind them.
□   Make neighbors, repairmen, home health aids, or personal care providers aware of the issue.
□   Consider installing a keyed deadbolt.
□   Consider hanging bells on the doors, so you hear the door opening.
□   Place safety latches up high and down low on doors.
□   Make sure they receive enough exercise and sleep.
□   Place cloth of the same color over doorknobs, or paint the doorknobs and doors the same color as the walls.
□   Set-up door alarms on every door with a remote alarm that rings in another location of the house.
□   Set-up a motion detector in their bedroom that rings in the caregiver’s bedroom or wherever they choose.
□   Install chain-locks on every door – not at eye level.  This gives the caregiver a little more time to get to the person who is trying to leave.  There are chain-locks available with a key that allows the caregiver to get back inside the house, should the person ‘lock them out’.
□   Use visual cues such as a black mat in front of each exit door – which might represent a “black hole” to them.
□   Outside paths should not lead to the gates.  Put a chair in the middle of the path.  Put extra locks on the gates – don’t nail them shut, which allows for use in case of emergencies.
□   Enroll them in Medic Alert+ Safe Return www.medicalert.org/safereturn, Senior Safety Net www.seniorsafetynet.org or use some other identification tool.