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There is no hard and fast answer to addressing a problem behaviour.
The following information is provided as a tool to help the Caregiver find the solution that works for situation they are faced with.
Alzheimer's causes disorientation, leading to wandering. Three out of four people with Alzheimer's will wander at some point Alzheimer's disease can erase a person's memory of once-familiar surroundings and make adaptation to new surroundings extremely difficult.
As a result, people with Alzheimer's sometimes wander away from their homes or care centers and turn up — lost, frightened and disoriented — far from where they started, often long after they disappeared.
If Caregivers are aware of the causes of wandering they can minimize the risks associated through coping strategies.
Physiological or Medical Causes
- Direct result of changes in the brain Inability to identify or express hunger
- Reaction to sedatives, tranquilizers, or the interaction of medications
- Physical discomfort due to pain, infection, constipation and bruising
- Seizures resulting in aimless, confused wandering
- Need to use bathroom
- Desire to exercise
- Dehydration contributing to confusion, wandering
- Temperature changes - too cold or hot
- Cant make sense of environment .
- Sensory overload too many people or activities, excessive noise
- Sensory deprivation to quiet, boredom
- Poor lighting, resulting in shadows which are misinterpreted or frightening
- Sometimes people are looking for light because they are frightened
- Feels closed in or trapped
- Friend or family members out of sight
- Acting out a once regular routine Such as leaving a workplace
- Lost ... Sometimes people with dementia suddenly begin losing their way to familiar places and become lost
- Inability to recognise environment or surroundings
- Feels tension in environment
- Task to difficult
- Perceives activity as too childlike
- Feels useless, helpless while watching other do a task
- Inability to follow through on task
- Bored with activity or lack of activity
- Clothing to tight or uncomfortable
- Caregivers anger, tension, impatience sensed by person
- Caregivers actions perceived as insulting or too fast
- Touching by caregiver frightening or misinterpreted
- Caregivers directions not simply stated or understood
- Searching for home or people from past
- Nighttime Wandering
- Inability to separate dreams from reality
- Inactivity - too much sleep during daytime
- Adverse reactions to tranquilizers
- Inability to differentiate day and night
- Disorientation to time when person wakes up, he/she thinks it is time to get up (see 'Problems with Sleeping')
- Have a thorough medical evaluation ... particularly if wandering begins suddenly.
- Consider possible physical causes such as illness, fever, hunger, pain, swelling, etc
- Allow person to wander if environment is safe and secure.
- Place familiar objects, furniture, and pictures in surroundings.
- Help direct person with clearly labeled rooms. For example, door decorations or name plaques may be useful for finding bedroom; a picture of a toilet or a brightly coloured door may help person locate the bathroom.
- Decrease noise levels and number of people interacting with wanderer at one time.
- Go for a walk around neighborhood, in a shopping centre, around home. Walking or other exercise often reduces agitation that leads to wandering, and also helps person to sleep better.
- Remove items that may nigger desire to go out: shoes, coat. purse. coats, etc
- Take a drive in the car.
- Make sure person with dementia is safely buckled in and doors locked.
- Never leave a person with dementia unattended in a car. The person may become frightened about being alone, could wander away, release emergency brake or fiddle with gear shifts.
- Distract with conversation, food, drink or activity.
- Try to involve person in household activities, such as folding laundry, washing dishes. which will help him/her feel useful.
- Limit activities to 20-30 minutes or less, depending on level of impairment. Consider past skills and interests when presenting activities ... Is it possible to adapt activity to encourage participation? ... Is it possible for the wanderer to do one step of activity?
- Make sure the person isn't wandering because he/she needs to use the bathroom.
- Look for signals such as fidgeting with clothes.
- Improve lighting throughout environment, especially at night.
- Older people need about three times as much light to see properly as younger people.
- Try placing a large, digital clock by the bed to orient person to time. Large numeral clocks may help orient to time.
- Approach wanderer in a casual non-threatening manner. It is best to approach wanderer from the front slowly and calmly ... Fall into step beside person and walk a short distance with the person before gently guiding him/her back to activity, event or location.
- Give wanderer verbal identification of person, place and time.
Personal Note to Caregivers
I often give the example of one caregiver's solution to a 'Wandering' and 'Wanting to Go Home' issue.
This caregiver's loved one was repeatedly trying to wander off or trying to go home ... getting outside and getting on a public transport bus. Thinking outside the box his solution was build a mock bus stop (complete with cover and bench) in his front yard. The result was that it was used to wait for a bus that never arrived. He was able to locate her easily and bring her inside if need be OR she would wander back inside thinking she had returned from her outing. This is just an example of creative solutions that caregivers sometimes utilize to deal with day-to-day issues.
(It has to be pointed out that not every solution works in every instance.
This was just his solution and it seemed to work for him)
Coping Strategies (cont)
Try these communication techniques with wanderers:
- Reassure person frequently about where he/she is and why.
- Speak in calm, normal tone of voice.
- Try written reassurance for mildly impaired person, such as "Liz will be here at 3:00 o'clock to pick you up."
- Try not to confront or argue with the person.
- Limit number of people to redirect wanderer.
- If more than one person is needed for safety, second person can remain out of sight, or in background behind other caregiver.
- Increase the wanderer's trust by humoring and cajoling.
- Allow the person to verbalize feelings without arguing.
- Alleviate fears - "Your family knows where you are." "Your _____(misplaced object) is right here"
Keep the Wanderer Safe, Comfortable and Healthy:
- Weigh weekly to make sure the person is not losing too much weight ... Loss of five pounds in six weeks, for example, is of concern.
- Provide comfortable clothing such as jogging suits and tennis shoes.
- If the person wanders a great deal, try to get him/her to rest for a half hour every few hours, with feet raised to prevent swelling.
- Give frequent drinks of water or juice to prevent dehydration ... The person with dementia will often forget to drink or not recognize thirst.
- Dehydration can be dangerous and may increase confusion.
- Place night lights throughout the house.
- Try locks on doors that are out of sight or reach.
- Install slide bolts on either top or bottom of outside door.
- Use dead bolt locks.
- Models are available that require a key for exit or entrance.
- It is important to think about exiting in an emergency if key locks are being considered.
- Try childproof doorknob covers that prevent potential wanderer from turning doorknob.
- Covers are available at toy stores or medical supply stores.
- May be inadvisable for caregivers who have arthritic hands.
- Place warning bells above door ... Bells that jingle when door is opened will signal caregiver ... Try monitoring devices, available in a wide price range, which alert caregivers that exit door has been opened.
- Order a "toddler monitor," available through children's stores and catalogs.
- A small device attached to a person's clothing will set off a beeper when person goes outside of a 25-50 foot range.
- Make house accident proof.
- Keep medications, toxic substances such as cleaning supplies, sharp objects, alcohol, and matches locked in cupboards or closets.
- Put locks on outside gates.
- Fenced in back yards allow people to wander safely.
- Use a safety gate across doors and at top or bottom of stairs.
- This may help keep the wanderer in a limited area where he/she can explore safely.
- Consider using a bean-bag or more advanced Gel chair for sitting and resting. This may be helpful because they are comfortable yet difficult to get out of ... Person may need assistance in sitting down and getting out of chair.
- Provide the wanderer with some type of I.D.:
- Medic-Alert bracelet (available at many pharmacies),
- I.D. labels sewn in clothes, emergency cards in wallet, purse or pocket. I.D.
- Should have person's name, address and phone number and the statement "memory impaired person."
- Several Alzheimer's and Dementia related Care Centres carry "Memory Impaired Person" I.D. cards and an "Emergency Info Card" for the caregiver.
- Have a "Current" picture of person available, in case he/she becomes lost.
- A videotape of person may also be helpful.
- Alert neighbors and police that a memory impaired person lives at residence.
- Keep a list of important phone numbers, e.g., neighbors, police, physician and family members.
- Notify police about circumstances in caring for someone with dementia.
- They might want to keep a picture of person on file and perhaps fingerprints.
- These may be helpful if the person has wandered away.
- Use brightly colored outdoor clothing such as jacket, coat, pants.
- Reflectors sewn onto sleeves or pant legs may be helpful to police involved in searching for the person.
- Have an unwashed piece of clothing available for tracking dogs.
- If person has been missing a long time, this clothing may be helpful to police involved in the search
- Be aware that often the police do not consider someone a missing person until missing 24 hours ... You MUST convince police that 24 hours can be life threatening to a person with dementia.
- For caregivers at home, there are some physical restraints that can be used to keep the person in a bed or chair as A LAST RESORT.
- While it may be distressing for caregivers to restrain the person, there may be no other way to prevent injury.
- Restraints may also be helpful for the caregiver to use while in the bathroom, cooking, etc.
- A "posey" (harness or vest with ties) is one device which may be useful.
- Geriatric chairs keep the person in one place and have a tray for eating or doing activities.
- It is important that the person does get exercise regularly.
- Keep walker or cane, if used, in same place at all times.
In long term care settings:
- Provide opportunities for exercise, particularly when people are waiting for a meal or activity.
- Exercise might also include singing, rhythmic movements, dancing, etc.
- With help from families, develop a social/medical history that includes information on the person's style of coping with change and stress, patterns of physical exercise, and lifetime habits both at work and at home.
- This information may be helpful in determining whether the wandering is related to previous lifestyles.
- Develop areas indoors and outdoors where people can explore and wander independently.
- Reduce amount of noise and confusion in the environment. For example, change of shifts, loud speakers, "Muzak," noises from housekeeping activity, delivery of food or supplies are all potentially stressful situations.
- Use physical restraints such as belts, geriatric wheelchairs, half doors, for only brief periods of time and only as A LAST RESORT.
- Often restraints add to the amount of stress and tension the person may be experiencing.
- Reinforce where bathrooms and other public areas are by having rooms clearly labeled, painted bright colors, or marked with lights or awnings.
- Carefully monitor all medications, especially if antidepressants or anti-anxiety drugs have recently been changed or introduced.
- Try a yellow strip of plastic (symbolizing caution) that is velcroed across doors to prevent wanderers from entering.
- The strip is easy to get through in case of an emergency, allows patients to keep their doors open to see and hear what is happening inside or outside their room.
- Have a plan of action in place, in case someone wanders away from facility.
- Camouflage doors
- By painting exit doors same colors as walls.
- Cover doors with curtains or movable screens.
- A large NO! on doors may discourage wanderer from entering, exiting.
- Place full-length mirrors on exit doors ... Some people will turn around when they see the image, not recognizing themselves.
- Be aware that after a move into a nursing home, it is not uncommon for a person to become disoriented when awakening in the middle of the night.
- Often patients are searching for a familiar person, place or possession.
- Reassure with a calm voice.
- Listen to what feeling is being expressed.
- Distracting with food, drink or activity may be helpful.
- Walking with person to the bathroom may serve as a distraction as well as promote sleep.
- A written diary or log may be helpful to understand what leads to wandering.
- Write down your observations about wandering for several days.
- Is the person trying to find a room?
- What was going on before wandering started?
- What time of day is it?
- Consider how medications, mealtime, weather, bath time, other people relate to wandering.
- Wandering may be due to the person searching for a part of life lost to the disease or for a person, place or object from the past. Reminiscing about things from the past may be comforting... Photo albums, travel books, etc., may be helpful ways to reminisce
- For some people with dementia, wandering is a coping mechanism to relieve stress and tension ... Trying to stop the wandering may increase agitation and cause anger and frustration.
- Anticipating an event such as a visit to or from relatives may contribute to wandering ... Consider if person should be advised of plans ahead of time and, if so, what amount of time is necessary without causing anxiety or restlessness.
- A person who wanders at the same time every day may be returning to a former schedule or routine. For example, a person may be trying to get back to work after lunch ... Think of ways to accommodate this, such as going for a walk or drive, or distraction.
Alzheimer's Association (ADRDA) chapter newsletters
Aronson, Miriam (ed) Understanding Alzheimer's Disease. New York: Charles Scribner's Sons, 1988.
Coons, Dorothy. Wandering. Amencan Journal of Alheimer's Care and Related Disorders and Research, 3 (1), 1988.
Hiatt, Lorraine, Peter Rupprecht, Janine Pyrek, Sandra Brekhus, and Tom Moss. Wandering. The Gerontologist, 18 (3), 1978.
Haitt, Lorraine. The Happy Wanderer. Nursing Homes, March/April, 1980.
Mace, Nancy and Peter Rabins. The 36-Hour Day. Baltimore: The Johns Hopkins University Press, 1981.
Powell, Lenore and Katie Courtice. Alzheimer's Disease: A Guide for Families. Massachusetts: Addison-Wesley Publishing Company, 1983.
Rader, Joan, Judy Doan, and Sr. Marilyn Schwab. How to Decrease Wandering, A Form of Agenda Behavior. Geriatric Nursing, July/August, 1985.
Schmall, Vicki and Marilyn Cleland. Helping Memory Impaired Elders: A Guide for Caregivers. Pacific North West Cooperative Extension, 1987.
Understanding and Caring for the Person With Alzheimer's Disease: A Practical Guide. Alzheimer's Association (ADRDA), 3120 Raymond Drive, Atlanta, GA 30340,1985.
Zgola, Jitka. Doing Things: A Guide for Programming Activities for Persons With Alzheimer's Disease and Related Disorders. Baltimore: The Johns Hopkins University Press, 1987.
THE CAREGIVER ROLE
What is a Caregiver
The Caregiver Defined
Who Do Caregivers Care For
Accepting the Reality of Dementia
6 Steps to Successful Caregiving
Caregiver's Are Not Alone
Asking For & Getting Help
The Caregiver Code
Rights of a Caregiver
Unmet Needs Of A Caregiver
Caregiver And Work
Feelings And Caregiver Stress
Questions & Answers
STRESS, COPING & FEELINGS
The Caregiver Code
Rights of The Caregiver
Coping With Stress
Feelings And Caregiver Stress
Stages Of Alzheimer's
Helping Children Understand
Protecting Yourself From Burnout
Making Time For Reflection
How is Competency Defined?
Power of Attorney
What is an Advanced Directive?
Do I Really Need a Will or a Trust?
Importance of Communication
Communicating With Someone Who Has Alzheimer's
Your Approach Sets The Tone
Think Before You Speak
Doing Tasks Together
Having Trouble Being Understood
Things NOT To Do
When It Just Fails
TIPS AND ISSUES
New To Family Caregiving?
Places To Turn For Caregiver Supoort
Take Advantage of Community Support
Random Tips From Other Caregivers
Providing Long Distance Care
When To Stop Driving
Dealing With Family Conflict
Tips on Sundowning
Helping Children Understand
Pet & Toy Therapy
Tips For Medical Appointments
Dealing With Resistance
Tips For Day To Day
Intimacy And Sexuality
Visiting A Person With Dementia
Music And Dementia
Tips For Holidays And Gatherings
Art as Home Therapy
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