Alzheimer's disease is the most common cause of dementia among seniors 65 and older. According to the Alzheimer's Association, researchers estimate that approximately 5 million Americans have Alzheimer's disease, and project that the number may reach up to 16 million by 2050 if current populations continue and no preventative treatment is found.
Alzheimer's prompts many behavioral changes, but perhaps one of the most dangerous behaviors is wandering. People with Alzheimer's are more likely to wander than those with vascular or any other type of dementia. It is estimated that more than 60% of people with Alzheimer's will wander at some point during the course of the disease. Wandering can be dangerous, and even deadly, to a person with Alzheimer's disease, especially in areas with unsafe conditions such as heavy traffic, crime, and extreme climates. Why does dementia-related wandering occur, and how can it be managed?
What is Dementia-Related Wandering?
There is no standardized classification system to identify the different categories of wandering, but it generally falls into two categories: goal-directed and non-goal-directed wandering, which is also known as random wandering. In goal-directed wandering, the patient may be searching for something familiar, such as an object or place. Random wandering is simply wandering aimlessly.
No matter what type of wandering behavior the patient exhibits, without monitoring, it causes potential for harm. This may include getting lost, leaving a safe environment or putting oneself in a dangerous situation. The medical community sometimes uses the term critical wandering. Both wandering and critical wandering mean the same thing, referring to any person with dementia who wanders away from their caregiver or controlled environment such as a facility or home. Wandering may occur by walking, driving or other means, and it can also happen within a controlled environment. For example, a person with Alzheimer's who is prone to wandering may put water on for tea, become distracted or confused, and leave the kitchen without turning off the stove. This, too, is considered wandering, and the dangerous situation it creates emphasizes the need for monitoring unsafe wandering behaviors.
Critical wandering that involves the senior leaving the home or facility where he or she lives is sometimes called elopement. Often occurring in conjunction with sundowning, elopement typically involves the person wandering outside the home or facility at night. This may involve the person being dressed inappropriately, either for the weather of the environment (e.g., wearing pajamas outside at night).
Common Causes of Wandering in Alzheimer's Patients
Wandering behavior can be curbed even though total prevention may not be possible. Understanding the causes of wandering can help you minimize the incidences of wandering and the risk to the person with Alzheimer's.
Many factors can contribute to wandering in Alzheimer's patients. Perhaps the most significant is the severity of the patient's dementia. Unfortunately, the more severe the dementia, the more difficult it becomes to identify the causes, since communication continues to decline. Following are some common causes of dementia-related wandering in people with Alzheimer's.
Memory loss. Patients who cannot remember their destination may wander as a result. Wandering may also occur when the person attempts to reach a destination that is part of his or her past routine, such as going to work or meeting a friend.
Physical needs. Toileting and other basic physical needs may prompt wandering.
Social needs. A decline in language skills may prompt wandering in a person who simply needs social interaction.
Insomnia. Increased mental fatigue due to lack of sleep can contribute to confusion and disorientation, resulting in wandering.
Side effects from medication. Many drugs used to treat common conditions in the elderly may have side effects such as disinhibited behavior and restlessness, which can result in wandering.
Disorientation. Confusion regarding time, place and identity is common in Alzheimer's patients. Combined with memory loss and an inability to recognize familiar people and environments, the patient may wander out of fear, in an effort to reach a more familiar, comforting place.
Understanding Wandering Behavior in Alzheimer's Patients
Wandering causes worry and stress for caregivers and loved ones. Not only is there the potential for getting lost, but a person with Alzheimer's is also unable to distinguish safe situations from dangerous ones. Establishing behavior patterns will help you understand what is driving the patient's need to wander. Look for patterns such as:
- Places the patient wanders to repeatedly
- Time of day wandering usually occurs
- Activity patient was engaged in prior to wandering incidents
Studies have shown that men tend to wander more than women, and wandering often increases as Alzheimer's progresses. Delusions, hallucinations and depression all appear more frequently in wanderers with Alzheimer's versus other dementias. Wanderers do not usually respond to rescuers shouting their name and almost never call for help when they are lost. Former homes or favorite places are frequent wandering destinations, so include these in your places to look if the person is missing. The overwhelming majority of wanderers are found within two miles of their place of residence, so be sure to search the building and surrounding area, repeating the search every hour or so.
How to Prevent Wandering at a Senior Care Facility
Institutional facilities are better equipped to deal with wanderers than home settings, as some of the most effective means of preventing wandering include a combination of locks, alarm systems, 24-hour surveillance and wandering monitoring devices like Wanderguard.
Staff also plays a crucial role in curbing unsafe wandering behaviors. If you are placing your loved one in a nursing home or Alzheimer's facility:
- Tell the staff that he or she has a history of wandering.
- Ask how the facility identifies wanderers and what measures they use to keep them safe.
- Share details about your loved one's patterns of wandering.
Alzheimer's causes disorientation, confusing the person's sense of time and place. Living in a facility can exacerbate this disorientation. To offset this, destinations should be clearly marked. Bathrooms may be marked with a picture of a toilet, for example. It may be useful to mark the resident's door with a sign bearing his or her name in large print as well as a photo of the person as a young adult. Wanderers who live in facilities often try to leave. This can be deterred by concealing or camouflaging exits, but facilities that care for wanderers should also be secure. Using black insulation tapes in two different grid configurations, one study found that "the use of a horizontal grid reduced exit door contact by up to 97% for four of [ten] patients with a diagnosis of Alzheimer's disease.1"
Efforts to control wandering should use the gentlest methods possible. People with dementia can read body language and facial expressions, so remaining calm will help reduce the wanderer's stress as well. Approach slowly and speak softly. Establish what the wanderer is doing. Ask specific, answerable questions. For goal-directed wandering, some strategies include:
Validation. What does the wanderer's emotional state appear to be? Establish a rapport by validating his or her feelings with positive, open statements such as, "You look worried." Offer to help.
Distraction. Focus the wanderer's attention on something more positive. Try establishing a common goal, such as searching for something together, steering the person toward that goal.
Redirection. Once you have the wanderer's attention, redirect it in a reassuring manner. For example: "I'm sorry you're upset. Let's sit down for a cup of coffee."
After the situation has been controlled, it may be possible to redirect the wanderer's attention once again to a calming activity such as listening to music, looking at photos or working on a puzzle. Many Alzheimer's facilities and nursing homes have gardens, courtyards or pathways that are specifically designed for wanderers; this may be a good time to suggest going for a walk.
How to Prevent Wandering at Home
Caring for an individual with Alzheimer's at home can be extremely difficult, especially if the patient is a wanderer. The tactics outlined below will help you curb dangerous wandering behaviors and prepare you in the event that your loved one wanders off and becomes lost.
Make your home Alzheimer's friendly so your loved one can wander safely indoors.
Encourage safe wandering. Accompany your loved one on walks around the neighborhood. Fenced yards allow for safe walking as well.
Camouflage exit doors by painting them the same color as the walls, including doorknobs. Create a further deterrent by using black electrical tape to depict a grid.
Label internal doors with large-print signs or pictures that denote the room's purpose. For example, put a picture of a toilet outside the bathroom door and a picture of a bed outside the bedroom door.
Buy a bedside commode if nighttime wandering is triggered by the need to use the bathroom.
Install an alarm system that is activated by the opening of external doors.
If your loved one becomes lost:
- Search and re-search your home (including closets and cupboards) and immediate neighborhood. Ask friends and neighbors to help.
- Have several recent photos of your loved one on hand to distribute to all parties assisting in your search.
- Have bedclothes or clothing ready to assist police in their search if they become involved.
Alzheimer's Safe Return Program
Despite the many precautions taken by nursing homes, caregivers and families, people with Alzheimer's are still at risk when they wander. The Alzheimer's Association Safe Return Program is a government-funded program that works with local law enforcement and emergency response agencies to help mitigate the risks when an individual wanders and becomes lost. The program's national database includes photos and information on each registered individual. In the event that the person is lost, Safe Return faxes that person's photo to local law enforcement to help in the search and rescue effort. If medical attention is required, Safe Return will supply immediate access to the patient's medical records, also stored in their database.
Combined with these efforts, Safe Return also provides jewelry, wallet cards and clothing labels to help identify the wanderer. All products are labeled with Safe Return's toll-free number. It costs $50 to register for the program, with a $25 annual renewal fee.
1 Hewawasam L. Nursing Times. 1996 May 29-Jun 4; 92 (22):41-4.