"Wandering" in Dementia Patients: the Home Care Perspective
Wandering is one of the greatest challenges faced by family caregivers whose loved one has Alzheimer's or other memory loss. Over 60% of Alzheimer's patients will become lost at some time. Most are gone only briefly, though long enough to frighten their loved ones. Others may be lost for an extended period of time, and unfortunately, there are news reports each year of missing Alzheimer's patients who are never located. It is a sobering fact that if a person with dementia is lost for over 24 hours, he or she is likely to suffer a fall or other serious injury, or even death from injury or exposure. Reports one family caregiver, "The thought that Dad would climb onto a bus at the corner and we would never find him again keeps me awake at night, even on nights when he is getting a good night's sleep."
Why do people with dementia wander?
For people with Alzheimer's or other memory loss, confusion and disorientation make it increasingly difficult to recognize familiar faces and places, even a spouse or child, or a lifetime home. Geriatricians point out that the term "wandering" is something of a misnomer, because many times, in the person's mind, his or her activity is not purposeless. She may be looking for the bathroom but be unable to find it. He may think it is time to leave for work, even if he retired years before. A great-grandmother might be searching for her children, in the belief that they are still small and in need of her care.
Other factors that contribute to wandering include restlessness, agitation and stress; boredom and lack of a sense of purpose; sleep disorders; physical pain; and the side effects of medications.
Keeping loved ones safe
When a loved one with dementia wanders, family often decide that a nursing home or memory care community is the best choice for the person. However, many patients fare much better at home, in familiar surroundings. How can families keep their loved one safe at home, for as long as possible? Home care professionals offer these suggestions:
Observe your loved one's patterns. The first step is to understand as best you can the reason for your loved one's wandering. What are his "triggers"? Where does he usually try to go? During what time of day is he most restless? Does he seem to be looking for something, someone, or someplace?
Adapt the home to keep your loved one safe. Beyond the usual "aging in place" home modifications, you can add special locks to doors, safety gates to prevent exit, and an alarm that will sound if the front door is open. See the resources at the end of this article for information about other home modifications.
Be sure your loved one always carries ID, and a medical alert to tell others he has memory loss. If he doesn't consistently carry a wallet, try a bracelet, pendant, or clothing labels. Contact your local Alzheimer's Association office to learn about their Safe Return program. In addition, more and more families are also using a GPS or other tracking device to help locate loved ones quickly.
Notify neighbors and local merchants about your loved one's condition. Ask them to contact you if they see your loved one alone when he shouldn't be. Having this conversation makes it more likely that others will feel comfortable getting involved.
Find out if your state has a "Silver Alert" program, similar to the "Amber Alert" for missing children. As law enforcement agencies recognize the needs of growing numbers of adults with dementia, more states are implementing this broadcast notification system.
Try "behavior modification" strategies. If your loved one expresses feelings of being lost or abandoned, reassure him he is safe. Redirect him to safe activities that fill his need for a sense of purpose. If "sundowning" (restlessness at night) is a problem, limit daytime naps. In-home care professionals have learned from experience that "correcting" a dementia patient frequently can increase agitation. "Don't correct—redirect" is their guideline.
Hire professional in-home care. With jobs and other obligations, families are often overwhelmed by providing the full-time supervision their loved one needs. For many, hiring in-home care is the answer. In-home caregivers are trained to provide a watchful but non-intrusive presence in the home. Says one home care aide, "We've learned that for many seniors, 'hovering' makes things worse and leads to increased wandering." Families report that they have a more peaceful relationship with their loved one when the home caregiver takes over some of the basic personal care tasks.
A professional caregiver can support the well-being of loved one and family in several important ways:
- In-home care provides respite for loved ones. Family caregivers need a break to renew their energy and take care of other responsibilities. A home health aide can fill in occasionally, or several days a week, or full-time. Overnight care is also available if the person with dementia wanders at night.
- In-home care helps decrease disorientation. Wandering increases when memory loss interferes with the activities of daily living. A home health aide will help your loved one maintain their comfortable routine, helping with toileting, grooming, and preparing healthy meals.
- Home health aides can supervise "safe wandering." Physical activity promotes better sleep and lessens agitation. With a caregiver along, your loved one can take a walk in the park or go on an outing. One home health aide reports, "I am there if my client needs me, but she feels a sense of independence because as much as possible, I allow her to decide where we will walk, when we will sit down."
- In-home care promotes appropriate stimulation and activities for your loved one. Boredom is stressful for dementia patients, and increases wandering. Consulting with family, the home health aide will find the right activities to improve their loved one's quality of life. Folding laundry, setting the table, helping in the kitchen, dementia-appropriate crafts, music, dancing, and conversation are a few of the purposeful tasks that can be calming for people in the early and middle stages of Alzheimer's.
- Home health aides assist with medication management. A person with Alzheimer's may take medications for the disease itself, for mood or other behavior changes, and for other medical conditions they might have. It is important to take medicines correctly, and it is just as important to be alert for side effects that might increase wandering and other difficult behaviors. A home health aide can provide medication reminders, help organize medications, and be alert for side effects.
In-home care helps those with memory loss remain at home, as comfortably and safely as possible. Home health aides know that caring supervision can enhance your loved one's sense of independence, while providing greater peace of mind for family members.
The Alzheimer's Association has extensive resources for dementia caregivers, offering tips for preparing for and preventing wandering.
The Alzheimer's Disease Education and Referral Center of the National Institute on Aging offers information for caregivers, including the free booklets Home Safety for People with Alzheimer's Disease and Caring for a Person with Alzheimer's Disease: Your Easy-to-Use Guide from the National Institute on Aging.
Right at Home is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned, franchised providers of in-home care and assistance services.