Wandering

What is Wandering?

Wandering is a common and potentially life-threatening behavior that may accompany Alzheimer’s disease. Individuals with this disease may become disoriented and lost, in their own neighborhoods or far from home. Nearly 60 percent of the five million Americans with Alzheimer’s disease may wander off and get lost sometime during the course of the disease, and many do so repeatedly. All patients who are ambulatory are at risk.

There are many reasons why an Alzheimer’s patient wanders or walks away from home or a well-known path or area. As a first step, try to determine the reasons behind wandering by asking these questions:

Medication

Some medications have side effects that result in confusion and restlessness. Is the patient on such medications? If so, consult your physician.

Stress

Is the person trying to handle stress, noise, unpleasant people, crowding, or isolation? If so, consider changing the situation.

Time Confusion

Does the person become confused at certain parts of the day, such as the middle of the night or early evening? Does the person claim that people have been gone for days or weeks and then searches for them?

Basic Needs

Is the person looking for something specific such as food, drink, the bathroom, or companionship?

Restlessness

Does the person have enough movement and activity during the day? Is it possible that the person wanders in order to get up and move around?

Lack of Recognition

Is the person in a new or changed physical environment that makes him want to search for familiar objects, surroundings, or people?

Fear

Is the person trying to escape from something frightening? Is the person experiencing a delusion or hallucination, or has the person simply misinterpreted sights and sounds?

Past Behavior

Is the person trying to meet former obligations involving a former job, home, friend, or family member?

Other factors that may contribute to wandering include medical conditions such as stroke, or other issues such as consumption of alcohol, changes in the weather, or feeling abandoned, useless, or helpless. Wandering may be frustrating and irritating for caregivers, but it becomes a problem only when the person moves into an unsafe or unhealthy area or climate, puts others at risk, or invades others’ property.

For this reason, many people who care for Alzheimer’s patients decide to overlook wandering behavior until it becomes dangerous to the patient and to others. Or they permit the person to wander within safe boundaries or follow the individual on special outings.

Action Steps

Be prepared

Be aware that wandering may or may not happen. There’s no way to predict who will wander or when and how it might happen. Some people never get lost, and others get lost frequently. The best advice is to be prepared. If the person has a daily exercise routine and hasn’t yet wandered, you needn’t be overly concerned. However, once the person begins to wander or gets lost, you should watch him more closely.

Encourage movement and exercise

Allow the person to move within safe areas or make a shared exercise such as walking part of your daily routine. Although walking a circle might seem unusual, keep in mind that physical activity — from walking and sweeping, to rolling yarn or folding clothes — is a positive experience for the person with Alzheimer’s.

Be objective

Don’t take the person’s wandering behavior personally. The individual is probably trying to make sense of a world that no longer seems predictable.

Be aware of hazards

Remember that places that look safe might be dangerous for the person with Alzheimer’s. For this reason, you should review the environment around your home for possible hazards, such as fences and gates, bodies of water, swimming pools, dense foliage, tunnels, bus stops, steep stairways, high balconies, and roadways where traffic tends to be heavy.

Secure your living area

Do whatever you can to keep your home safe and secure. Place locks out of the normal line of vision — either very high or very low on doors. In addition, use a double-bolt door lock, keeping the key handy for emergencies. Also use a childproof door knob that prevents the person with Alzheimer’s from opening the door. Other effective safety actions include the following:

• Put hedges or fences around your patio or yard.

• Place locks on gates.

• Consider electronic buzzers, infrared electronic eye alarms, or chimes on your doors.

• Place a pressure-sensitive mat at the door or person’s bedside.

• Camouflage some doors with a screen or curtain, or put a two-foot square of a dark color in front of the door knob.

• Use a recliner or rocking chair; the person may need assistance to get up.

• Use nightlights, signs, and familiar objects to help the person move around in a safe area.

• Put gates at dangerous stairwells.

Communicate with the person

Remind the person that you know how to find him and that he’s in the right place. If possible, take the person for rides in cars or buses in addition to providing regular activity and exercise. And continually reassure the person, who may feel lost or abandoned.

Identify the patient

Investigate the Alzheimer Association’s Safe Return program. You may want to invest in a discrete identification bracelet or locket that includes the person’s name, telephone number, memory problem, and medical condition. Some experts have even recommended putting identification on the person’s dentures or attaching a sensor to the patient’s ankle or wrist. In addition, choose bright-colored clothing and mark it with a sew-on or iron-on label, permanent marker, or reflective material. Also place identification on the person’s shoes, eyeglasses, and keys.

Involve your neighbors

Inform your neighbors of the person’s condition and keep a list of their names and telephone numbers handy. Although neighbors can be
helpful in guiding the person home, you’ll probably want to teach them how to approach the person with Alzheimer’s disease by using these steps:

• Approach the person from the front.

• Introduce yourself and call or ask a name.

• Gently look for or ask to see identification.

• Offer help and reestablish the day, date, and time.

• Avoid pulling or pushing the person.

• Report the patient found.

Involve the police

Some police departments keep a photo and fingerprints of people with Alzheimer’s on file. Many local Alzheimer’s Association chapters sponsor some kind of identification program to help with wandering patients. If a person with Alzheimer’s becomes lost, take a photo and an article of unwashed, worn clothing in a plastic bag to the police. Also have data on the following items:

• Age

• Hair color

• Blood type

• Eye color

• Identifying marks

• Medical condition

• Medication

• Dental work

• Jewelry

• Allergies

• Complexion

Offer suggestions about where the police might find the patient, such as old neighborhoods, former workplaces, or favorite places.

Be prepared for other modes of wandering

Although most wandering takes place by foot, some individuals with Alzheimer’s disease have been known to drive 300 miles — sometimes

in an automobile that belongs to someone else. You can prevent these problems by keeping car keys out of sight or by temporarily disabling the car by removing its distributor cap.

Resources

For additional help, the Alzheimer’s Association has a nationwide program, Safe Return, to help locate and return missing people with Alzheimer’s disease and other memory impairments.

Safe Return program includes:

• identification products, including wallet cards, jewelry, and clothing tags

• national photo/information database

• 24-hour, toll-free emergency crisis line

• Alzheimer’s Association local chapter support

• wandering behavior education and training for caregivers and families

How does Safe Return work?

To register, a person with dementia or their caregiver fills out a simple form, supplies a photograph, and chooses the type of identification product that the registrant will wear and/or carry. This information is then entered into a national database.

If that individual wanders and is found, the person who finds him/her can call the Safe Return toll-free number located on the wanderer’s identification wallet card, jewelry, or clothing tag. The Safe Return telephone operator immediately alerts the family members or caregiver listed in the database, so they can be reunited with their loved one.

If a person is reported missing by a family member or caregiver, Safe Return immediately alerts local law enforcement agencies. Photo flyers can be created and faxed to hospitals and law enforcement agencies to aid in the search. Local Alzheimer’s Association chapters provide family support and assistance, while police conduct the search and rescue.

For further information on Safe Return, call your local Alzheimer’s Association chapter. For the chapter nearest you call 1-800-272-3900.

Special thanks to the Alzheimer’s Association for their contribution to this chapter on wandering.