Understanding and Preventing Wandering

By Margie Monin Dombrowski

Wandering is a common problem for those living with Alzheimer’s disease and other forms of dementia, and it can make for a scary situation when families and caregivers aren’t prepared.

Roughly 60 percent of elders with Alzheimer’s occasionally wander away from their home or caregivers. Even if your loved one hasn’t wandered yet, it’s important to understand wandering and what you can do to protect them.

While wandering can happen at any stage of Alzheimer’s, it tends to happen more at the early to mid-stage. “It’s usually when the person is still living at home and hasn’t yet gotten to the point where they have to move into an assisted living facility,” explains Elizabeth Landsverk, M.D., geriatrician for ElderConsult Geriatric Medicine, a house call practice in Burlingame, CA.

Warning Signs

People with dementia can live independently as long as their memory allows them to handle everyday tasks. Watch out for the following signs and symptoms to reduce the risk of wandering and determine what kind of assistance is needed.

An elder with AD is more likely to wander when they’re stressed, or when trying to follow an old routine. Other wandering risk factors include sleep aids and anti-anxiety medications, which may seem to calm them at first, but can later make them more confused or irritated.

While the person may experience some memory problems, Landsverk warns that it’s when they start forgetting they’re already at home and keep saying that they have to go home, for example, that a person may be at risk to wander.

“They get a little more delusional about what’s reality,” Landsverk says, recalling the story of one of her patients, a woman who was living by herself and would still attend church or go to the bank on her own, but would claim they took her money. “At night she would start wandering, but she didn’t want caregivers, so that was a problem.”

Sometimes the person gets scared once it’s dark and they want to go somewhere, which sometimes involves getting into a car and driving off. That can prove particularly frightening to patient and caregiver alike, all the more so when the person with Alzheimer’s is found without their car and needs to get back home.

By keeping an eye on your Alzheimer’s patient, closely watching for these signs and being proactive, you can hopefully avoid elopement. Sometimes this calls for round-the-clock caregivers. The bottom line: If a person with Alzheimer’s starts wanting to go out, a caregiver should be with him or her every step of the way.

An Alzheimer’s patient prone to wandering needs someone to stay awake at night to watch out for them. During the day you can be pretty vigilant and keep track of them… but if they wander at night and you’re asleep, that’s dangerous.

“When they start saying, ‘I have to go to school,’ or ‘I have to go to work,’ and start going for the door, take it seriously and come up with plans,” Landsverk says.

Planning for Safety

There are many ways to keep someone with dementia safe at home, or an assisted living facility—and it all depends on the needs of the elder. Take action before you start to see warning signs.

At home, you can put child safety locks on doors, or use a home security system that alerts you if a door or window is opened, which can tip you off if the elder is trying to leave. An identification bracelet with GPS tracking is another option (but consider they may try to remove or cut it off).

Keeping the elder engaged in their favorite activities can tire them out so they sleep at night, which can curb wandering. This can include allowing the elder to go out and take walks on their own during the day.

“For some, their independence is worth more than living in a facility,” says Landsverk. “Helping them preserve their independence with some risk is preferable than putting them in a facility. Families need to decide what risk they want to live with.”

After a while, having 24/7 caregivers can get difficult and costly, and at that point, it may come time to transition to a nursing home or assisted living facility. But don’t assume that a nursing home automatically means better care, warns Landsverk, so do your homework on the facility.

“Folks often think if someone’s wandering we should put them in assisted living, but it’s mainly made for elders who are frail,” says Landsverk. “You need to be candid with the facility if your mom is prone to wandering. It’s best to find a facility with a secured door and somebody at the door 24 hours a day.”

When visiting a family member who’s been trying to elope from a facility, Landsverk suggests to have a picnic instead of taking them out to eat, until the elder’s more relaxed in the new surroundings. “If you want to take mom out to dinner, she may think she can leave now, and that doesn’t help the folks at the facility.”

Elders can enjoy their independence and quality of life, and that usually requires adjusting the care plan along the way and reassessing whether the plan works for everyone.

“Your aim is for the elder to be safe and get the care they need in the least restrictive environment possible,” says Landsverk. “If one application doesn’t work, have plans B and C ready to go.”