Wandering

INDICATORS OF RISK

• Cannot remember how to get to well-known places, such as a store or friend’s home
• Returns home later than expected when out for a walk
• Talks about going to work or going home even when at home
• Cannot find rooms in the home without guidance, such as the kitchen or bathroom
• Is confused in a new or different setting
• Becomes anxious or nervous in crowded areas, even familiar spaces such as a grocery store or place of worship
• Is restless and/or makes repetitive movements or paces
• Acts as if doing a hobby or chore, but nothing gets done (e.g., moves around pots and dirt without actually planting anything)

STRATEGIES

Early dementia 

• Each morning, talk about the schedule for the day.
• Consider GPS tracking apps on the cellular devices of family members that are linked to a person’s phone or other devices such as shoe inserts and watches.
• Be sure the person has personal identification on them.

As dementia progresses, include all of the above, PLUS:

• Provide a reliable routine in a familiar setting.
• Keep a current photo or video recording of the person available in case they get lost.
• Consider a medical identification bracelet or medallion with name, date of birth, primary caregiver name, and phone number.
• Limit fluids after 7pm to reduce nighttime awakenings and subsequent wandering.
• Purchase a pressure-sensitive mat with an alarm at the side of the bed to alert others of nighttime movement.
• Use nightlights to prevent falls when out of bed at night.
• Put hedges or fencing around outdoor spaces to create a natural barrier.
• If the person is no longer driving, remove car keys from sight.
• Place signs on the doors of the rooms (bathroom, bedroom, etc.).
• Do not leave the person alone at home or when out doing errands.
• Keep a list of familiar areas the person may wander to, which can assist others if the person gets lost.

Late dementia, include all of the above, PLUS:

• Remember that if the person is convinced that they need to leave, whether to go to work or for any other reason, they cannot be talked out of it — it is a fixed idea (delusion). Use strategies like:
  • Distraction
  • Coming closer
  • Using the delusion to change the focus from having to leave to reminiscing about the past.
  • Conversations such as career highlights or the childhood home may lessen the desire to leave.
• Read the website document Delusions and Hallucinations for more information.
• The confusion between where the person is and where they think they should be is upsetting. Use a calm, soothing reassuring tone when speaking.
• Physical concerns such as hunger or toileting may prompt the person to try and leave. Investigate these as possible sources when restlessness begins.
• Avoid busy places such as shopping malls, grocery stores, and airports that are confusing and can cause disorientation.
• Involve the person in home activities such as folding laundry or helping to make a meal.
• Use safety gates, tape on the floor, or brightly colored nets to designate areas that are not to be entered.
• Place slide locks out of the line of sight, either at the top or bottom of exterior doors.
• Paint doors the same color as adjacent walls. Cover doorknobs in a fabric of the same color or use plastic childproof knob covers.
• Place signs such as “STOP,” “DO NOT ENTER,” or “CLOSED” on doors.
• Place scenic pictures on doors.
• Keep coats and hats out of sight.
• Use a home alarm system for doors and windows.
• Never leave the person home alone and never lock them indoors unattended.
• Let neighbors know the diagnosis of dementia and the risk for wandering. Ask them to notify the caregiver if the person is outside alone.
• Consider adult day care.

If the person is lost:

• Immediately start searching. Consider familiar areas and start in the direction of the person’s dominant hand.
• Most people are found within 1.5 miles of home. Look everywhere, including in brush and treed areas.
• If the person is not found within 15 minutes, activate Silver Alert by calling 9-1-1. Provide police with a verbal description, recent photo or video recording, and clothes recently worn, and let them know the person has dementia.