Wandering: A Preventable Danger
By Miranda Pacchiana, MSW
Wandering is one of the most common and potentially dangerous behaviors among patients with Alzheimer’s and other forms of dementia. For families and caregivers of seniors living with AD (Alzheimer’s/Dementia), it is imperative that we understand the many causes of wandering. Fortunately, armed with a variety of solutions and a thorough knowledge of possible dangers, we can take steps to reduce the chances that a patient or loved one will wander.
Any person who suffers from AD is at risk for wandering; in fact, it is believed that approximately 60% of people in this category will wander. The wanderer is likely to travel one to three miles away if on foot, and will rarely respond to his or her own name when called, making the search for the person’s whereabouts considerably more difficult. Once they have wandered off, people with AD are at risk for falls, hypothermia, drowning and exploitation (such as being convinced to withdraw money from a bank account and hand it over to a stranger).The grim statistics state that if not located within 24 hours, the possibility of the person being found alive decreases to about 54%. That leaves 46% of wanderers having lost their lives or unaccounted for after a full day away, without the cognitive ability to take proper care of themselves.
There are many reasons why wandering occurs. Often, the person will feel an urgent need to get somewhere; to fulfill an obligation from an earlier part of life such as going to work, picking up the kids or getting home for supper. Sometimes the desire to wander arises simply out of boredom or a desire to get out of the house. The wanderer’s curiosity may be peaked by something outside.
Because people with AD are not able to process their environment in the same way, they may become agitated or frightened by misinterpretations of the goings on around them. The bustling atmosphere of a shift change in a nursing home, for example, may bring about stress in a patient, and she reacts by trying to flee or get away. Also, wanderers frequently do not recognize where they are, even in a familiar environment. Because their memories of certain places were stored long ago, they are thrown off by slight changes like a new couch, or a different color of paint on a home in their neighborhood. Again, the reaction may be panic, fear and a desire to get back to someplace they know. Caregivers often hear their patients say they “want to go home” even when they are already home.
The urgent desire to be somewhere else has another possible cause that is easily misunderstood: much of the time, the patient is simply uncomfortable. He or she may be in pain, feel hungry, tired or need to go to the bathroom. Because patients are not always able to understand the source of their discomfort, they look for a way out. Think about how it feels to have a full bladder when you’re stuck in traffic. Physical agitation – a “squirmy” feeling, is a natural result just as it is for our potential wanderers. The difference is that we have the cognitive capacity to understand what’s occurring. In fact, when patients expressing a desire to get somewhere are asked whether they are in pain or uncomfortable, they will respond in the affirmative most of the time.
It is important to remember that patients with AD usually have poor impulse control. They are not wandering deliberately or out of defiance, although the results are undoubtedly frustrating and frightening for those looking after them.
Let’s look at effective ways to prevent wandering from occurring:
- Install locks and alarms on access doors and windows. Placing the locks in unusual spots like the bottom of a door will make it more difficult for the patient to get past them. Inexpensive alarms can be purchased from hardware or home stores.
- Use motion detectors to let you know when the person is roaming around the house, especially at night.
- Inform area neighbors and businesses of the person’s condition.
- Keep copies of an updated photo (both full-length and close-up) to help police and local residents and business identify the wanderer.
- Keep track of what the person is wearing daily, also important to aid in identification.
- Make sure the person is wearing identification, and consider dressing in bright clothes for easier spotting.
- Place dark-colored mats in front of entryways. Depth perception problems, quite common in AD patients, cause the person to see this as a hole and they will avoid stepping on it.
- Keep car keys inaccessible
- Consider signing up for the Safe Return Program through the Alzheimer’s Association. For a sign-up fee of $55 including shipping (and an annual fee of $25), the AA creates a file with the patient’s photo, medical status and contact numbers. The patient receives an ID bracelet or pendant. This program coordinates with local law enforcement when a member goes missing, much like the Amber Alert system for missing children. Its reported results make it a very valuable resource: enrollees in the Safe Return Program are located within the first 24 hours 99% of the time. You can sign up online at www.alz.org or call 1-888-572-8566.
- SafetyNet by LoJack is a program that tracks wanderers with a bracelet or anklet using radio signals, and also enlists law enforcement to bring them home. The website is www.lojack.com.
- Finally, to prevent wandering at night:
- Keep the person awake for most of the day to facilitate better sleep at night.
- Use shades to block out the early morning sun.
- Keep the bedroom temperature comfortable.
- Avoid providing liquids and heavy or large meals in the evening before bed.
Wandering is a prevalent and potentially life-threatening problem, but we have more control over this danger to our loved ones and patients than we might realize. Simple tips and smart programs can go a long way in keeping them safe at home.