Alzheimer's Disease: Understanding Wandering Behavior

Most families who care for a loved one with advanced Alzheimer’s disease ultimately opt for institutionalized patient care as the disease progresses. While many patients can remain in their homes for years, some of the behaviors associated with advanced Alzheimer’s disease are extremely difficult to control, causing families to seek care outside of the home. In this article, I will discuss one of those behaviors—wandering—and what can be done to help understand it and ensure that your loved one is safe.

Understanding Wandering Behavior Triggers

When I use the term “wandering,” I am referring to a type of behavior seen in Alzheimer’s disease and dementia patients that can seem aimless to the casual observer. But Alzheimer’s disease and dementia experts say there is usually a logical reason for wandering behavior, which may include boredom, curiosity or restlessness.¹ Determining the reasons for the Alzheimer’s wandering behavior can help caregivers understand what the patient’s motivation is—for example, pain, physical discomfort or simply a need to move.

Beneficial Wandering vs. Unsafe Wandering Behavior

Behavioral management is central to providing quality of life and a safe environment for the Alzheimer’s disease patient. Managing Alzheimer’s wandering behavior, however, should not be about controlling the situation but rather about understanding the motivation for the behavior. When a patient is placed in a new environment, such as a nursing home, wandering may simply be due to confusion over the new surroundings. Oftentimes, staff and other patients find this activity bothersome or intrusive, and the family or staff may try to stop the behavior. But wandering in certain circumstances may actually be beneficial—especially if restlessness or socialization is the reason for the behavior—as it offers movement and stimulation for the patient. Indeed, movement can help preserve strength, slow skin breakdown, manage constipation and enhance patient mood.²

The biggest problem with wandering behavior is when it is unsafe, such as when the Alzheimer’s disease patient leaves the facility. Sometimes wandering may be triggered by an urge to return to a safe, familiar and secure environment (such as the person’s home) or former place of work, and it is not an attempt to actually “escape.” Once outside of a controlled setting, however, injuries, fatigue and even death can occur. And because patients with advanced Alzheimer’s disease usually are frail, and because of neurological impairment, they are predisposed to falls. Falls in the elderly are always problematic; with Alzheimer’s disease or any advanced dementia, they accelerate the decline of the disease process.