Controlling Unsafe Wandering Behaviors in Alzheimer's Patients

People with Alzheimer’s disease gradually lose their memory and it can get to a point when they lose their sense of location. At this point, a common behavioral problem observed with Alzheimer’s disease patient is wandering. Wandering includes the act of pacing about a room, following the caregiver from room to room or simply leaving their environment for some other place.

Wandering affects all dementia patients but is more prevalent with people with Alzheimer’s disease¹. The patient may simply be wandering aimlessly or trying to achieve an objective such as finding a bathroom or home. This has led to the two classifications of wandering – Wandering aimlessly and goal-oriented wandering. In either case, the patient could wander into dangerous situations such as crime infested neighborhoods, high traffic areas and bad environmental conditions.

Another term that you may hear used with wandering is “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. When a dementia patient wanders from a home or facility, this is referred to as elopement. In many cases, the patient simply wanders from a home or facility at night, leaving their safe confines for conditions that could be hazardous to their health.

Understanding Wandering

Wandering causes worry and for both caregivers, loved ones and certainly for the patient. Often the patient is highly stressed, trying to reach the destination they are trying to get to. This is therefore a time when patience and the use of psychological skills can help in calming the patient and weaning them of the need for a particular trigger for wandering.

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 uninhibited 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.

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.

Managing Wandering Behavior

There are various techniques that can be use to control the incidence of wandering once the reason for the wandering is known. 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.

The environment can also be made safer for the Alzheimer’s patient. Patients can be lost in their own front yards, so it is important not to leave them unattended outside. In situations where there are several people present in the home, make sure that one per¬son is clearly responsible for knowing where the Alzheimer’s patient is. Some families have members take turns with this responsibility. Patients should wear Medic-Alert bracelets with their addresses on them in case they do get lost some¬where, and caregivers and/or families should keep recent photos of patients on hand in case the police must be called in to help search. To prevent someone from leaving at night when caregivers are not watching, install a deadbolt lock on the main door of the house, or add a lock to the door in a place a patient might not think to look, such as near the floor.

If wandering occurs at a specific time of day, it may be reduced by getting the patient involved in a strenuous activity such as a long walk, immediately before that time. If wandering coincides with a particular event each day, such as mealtime or the arrival of a particular person, caregivers should try to make that event less stressful in case the wandering represents an effort to escape the situation. If wandering occurs at night, more exercise during the day may help the person to sleep through the night. Since wandering may also represent a search for the bathroom, caregivers should ask patients if they need to use the bathroom and watch for signs that they need to use the bathroom.

What if a Patient is Lost

If you made a Medic-Alert bracelet for your loved one, that can help guide the police in returning him safely home. You need to have several photos of your loved one available for people who are helping for the search including the media. There may also be a need for some of his clothes for the dogs to pick up his scent from. Here are some other suggestions:

• 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.

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.

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.

References

1. Hewawasam L. Nursing Times. 1996 May 29-Jun 4; 92 (22):41-4.

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