February 18, 2011
By Winnie Yu
It is a major problem with Alzheimer’s disease patients: the tendency to wander off, away from caregiving loved ones or even their residential care facilities. The results can be devastating. Here’s what you need to know, and what’s being done to help keep wandering at bay.
Twelve hours after he was placed in a nursing home in California, Mardig Avadian disappeared. Dressed nicely in khaki pants and a shirt, the 86-year old man had joined a group of visitors and snuck out of the nursing home. “He began walking the streets of north Los Angeles until he hitched a ride—or so we think—and was found walking along the freeway nine miles away in the Mojave Desert,” says his daughter Brenda Avadian, MA, who went on to launch TheCaregiversVoice.com, a Web site for caregivers. “He was trying to hitch a ride to Milwaukee, Wisconsin, where he had lived for 45 years.”
Like many people with Alzheimer’s disease, Mardig Avadian had a habit of wandering, a common behavioral problem that occurs with dementia, especially Alzheimer’s. According to the Alzheimer’s Association, up to 60 percent of all patients with the disease will wander.
The most dangerous form of wandering is elopement, in which the person leaves an area and is unwilling or unable to return, says Mark L. Warner, author of A Complete Guide to Alzheimer’s Proofing Your Home (Purdue University Press) and owner of The Alzheimer’s Store. “They can walk out the door and not realize that this is their home,” Warner says.
Why They Wander
Wandering occurs for numerous reasons, says Maria Wellisch, R.N., vice president of corporate education for Morningside Ministries in San Antonio, Texas. Some nursing-home residents head out the door when they see the staff getting their coats and purses to leave for the day. Other people wander because they think they need to go to a place they left years ago such as a former home, an office or someplace to fetch their kids. Some patients wander because they’re bored, anxious or physically uncomfortable. Some may simply be confused.
For the wanderer himself, the experience is much like going out into a mall parking lot and not knowing where you parked—without knowing why he’s out there. “We all do that, but at least I know I parked outside,“ Wellisch says. “These patients don’t have the connections in their brains to find their way back or even know why they are out there. And as the disease progresses, they lose the executive function to know to ask for help.”
Who’s at Risk
Certain people are at greater risk for wandering than others. Signs of a potential wanderer include someone who:
- Returns from a regular walk or drive later than usual
- Tries to fulfill former obligations, such as going to work
- Tries or wants to “go home” even when at home
- Paces, makes repetitive movements or is otherwise restless
- Has difficulty locating familiar places like the bathroom, bedroom or dining room
- Asks about the whereabouts of current or past friends and family
- Acts as if doing a hobby or chore, but nothing gets done
- Appears lost in a new or changed environment.
Wandering can be very dangerous for the Alzheimer’s patient, who could fall, get struck by a car or assaulted by a stranger. For loved ones like Brenda Avadian, whose father wandered constantly, wandering can become a constant source of worry and concern. “It was like having a baby and wanting to wake up every time the baby cries,” she says. “Your ears are constantly tuned in to sounds in the night. It was absolutely exhausting. We started to show signs of impaired thinking, too.”
After seven months of having her father in her home, Avadian put him in a nursing home. He died five years later at the age of 90 in 2001.
Simple steps can deter some wanderers or at least make it less likely they’ll go far. Here are some suggestions:
- Install an alarm system with a remote alarm that goes off in the caregiver’s bedroom. The alarm may be a motion detector or even one in the floor mat.
- Install a chain lock high above the patient’s head or near the ground but not at eye level. The lock won’t prevent emergency rescue teams from entering, but may be enough to stop a patient from getting out.
- Disguise the door. Hang a photo or mirror on the back, cover up the doorknob or place wallpaper on the door.
- Adjust the color or texture of the door. Hang a sheet of black fabric over the door, or place a dark mat in front of it. Warner says this technique is known as “visual cliffing.” Patients may misinterpret the change in color or texture as a change in elevation, which may deter them from moving forward.
- Install a fence or a gate with a gravity latch to limit their distance. Consider putting locks on outdoor gates.
- Place a bench or chair near the door where a patient might exit. “It might not stop him, but he might sit down,” Warner says.
- Dress the patient in bright colors. Bright clothes will make it easier for you to describe a wanderer later on to search teams if they do wander.
- Alert the neighbors. Let everyone living nearby know that your relative might wander and suggest they call you if they see him. Make sure they also know what he looks like. Keep a list of your neighbors’ phone numbers handy in case you need to track down your relative.
Finally, try to keep your relative occupied with purposeful tasks, which can help stave off the boredom and anxiety that may lead to wandering. “It should be something that can be done frequently, is purposeful and something they want to do,” Wellisch says. “Someone who likes to cook might want to ice cupcakes. With former nurses, I used to give them clipboards so they could make rounds with me. It should be something from their past that touches their memories.”
If you have a relative who wanders, consider registering him or her in the National Silver Alert program. The free online program allows you to record vital information about that person, which can be quickly given to emergency responders in the event the person wanders off and becomes lost. The program also records a photo of the senior along with his or her vital information in an online database that is available 24/7. For more information, check out www.nationalsilveralert.org.
Source: www.ALZinfo.org. Author: Winnie Yu, Preserving Your Memory: The Magazine of Health and Hope; Summer 2010.