Preventing Wandering in Dementia Patients

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The thought of a vulnerable, elderly person with dementia exiting the home and wandering around is chilling. Also frightening is the idea of turning one’s back for a moment only to find that an elderly loved one with dementia has disappeared in a public place.

Wandering is common behavior when an older person becomes cognitively impaired by dementia. According to the Alzheimer’s Association, six out of ten people living with dementia wander.

The association warns that one of the earliest signs of Alzheimer’s is when an older person gets lost going to a familiar place. What if a senior goes to the corner store—a journey he has made a thousand times—and doesn’t return in a reasonable amount of time? After an adrenaline-fueled search, loved ones find him sitting on a park bench. He says he forgot how to get home. This kind of wandering is a symptom of Alzheimer’s.

 

Rummaging and Agitated Pacing Are Wandering Behaviors

In the movie Driving Miss Daisy, at one point, the loyal chauffeur finds Miss Daisy frantically running around her house. She is rummaging through drawers searching for graded exam papers to return to her students. Miss Daisy has been retired from teaching for decades. The Alzheimer’s Association notes that this kind of behavior is also “wandering” behavior—someone with dementia thinks he or she has to go to work.  Rummaging, agitated pacing, and hyperactive behavior are all symptoms of “wandering” as well.

The Alzheimer’s Association warns that arguing with the person is futile. Such words as “You don’t go to work anymore, Mom,” or “You haven’t worked with the phone company for twenty years, Dad,” are not helpful. Gently re-directing the person to the routine at hand is. In fact, having a routine is one of the best ways to prevent wandering. Dementia patients respond well to things that occur in a calm, predictable order.

 

Caregivers Consistently Rank Anxiety About Wandering as a Top Worry

Caregivers consistently rank anxiety about wandering as their top worry. Obviously, a disoriented elderly person aimlessly shuffling about a neighborhood is in danger. Falls and other serious injuries are more than possible. Some people might elect to mock or tease the elderly person (or worse). He or she might even get trapped somewhere. Drowning cannot be ruled out. These are hair-raising possibilities. What’s more, wandering often results in a referral to a psychiatrist and the prescription of psychotropic drugs (with all their side effects) and hospitalizations. No wonder wandering is a caregiver’s worst nightmare.

 

Preventing Wandering In Dementia Patients through Low Tech Solutions

Good locks, installed either high or low on a door so they are difficult to find, can help. Investing in a home security system that goes off when a door or window is opened is wise. Some home-made solutions like red or yellow tape near exits and signs saying, “Caution: Do Not Open this Door” have some effect. Knowing the elderly person’s neighbors well enough to apprise them of the person’s situation and enlist their help in reporting sightings can be helpful, too. Simple remedies like making sure the elderly person eats a complete meal, gets enough exercise, and goes to the bathroom before bed can deter night excursions.

Another simple solution may include “Belling the Cat.” If the elderly person wears a jingling bell around the neck or wrist, the caregiver knows when he or she is moving. The sound will also give clues on the whereabouts of the wandering elderly person.

If an elderly person exits the home and a quick search doesn’t yield immediate results, the caregiver should call 911.

 

High Tech Solutions and their Limits

Some may ask why such old-fashioned means are used when today there are GPSs, microchips, and electronic “tags” to tell the whereabouts of any person at any time.

Advocates of ethical, humane, and dignified treatment for the elderly say that electronic tracking should not be used for the cognitively impaired. Electronic tracking, they say, is for animals and dangerous criminals. Issues of privacy, consent, and autonomy arise when we “track” someone who does not want a tracking device.

Of course, a heart-to-heart talk with Mom about her wandering could gain her consent to use a tracking device. Many elderly people are happy to wear a medical pendant. Some feel reassured to wear a device that warns if they fall or that they can press in an emergency. A heart-to-heart talk with Mom may also reveal why she wanders.

 

Finding Patterns to Prevent Wandering 

Nicola Ann Pastrow, a lecturer in Occupational Therapy at Brunel University, recommends only temporary use of electronic tracking with the elderly. It is best to use such devices only for diagnostic purposes to establish patterns, she says. Is there a time of day when the person consistently wanders? At least the caregiver will know from the tracking that such a time requires extra vigilance. Alterations in routine might take care of the problem. Temporary tracking may also reveal patterns about where the elderly person goes. Does he or she head for the grocery store every day at a certain time? Maybe the person wanders due to a craving for a snack and can’t communicate that in usual ways.

Given the potentially dangerous effects of wandering, it should be no surprise that caregivers want to take advantage of every technology available to safeguard those under their care. At the same time, over-reliance on technology for this common human problem may lead to violations of the elderly person’s rights. This could possibly even lead to worse behavior as the person acts out desires for autonomy and freedom. A helpful balance between using technology and honoring the rights of the dementia patient is likely the golden mean.

 

 

Sources

Alzheimer’s Association. (n.d.) Wandering and Getting Lost. Available online at http://www.alz.org/care/alzheimers-dementia-wandering.asp.

 

Corcoram, M.A., Gitlin, L.N. (2001). Family caregiver acceptance and use of environmental strategies provided in an occupational therapy intervention. Physical and Occupational Therapy in Geriatrics 19(1): 1-20.

 

Hope R.A,, Fairburn, C.G. (1990). The nature of wandering in dementia: a community based study. International Journal of Geriatric Psychiatry, 5:239–245.

 

Hughes, J.C., Louw, S.J. (2002). Electronic tagging of people with dementia who

wander: ethical considerations are possibly more important than practical benefits.

British Medical Journal, 325(7369):  847-848. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124366/.

 

Pastrow, N. A. Is Big Brother Watching You? Responding to Tagging and Tracking in Dementia Care. Available online at http://bura.brunel.ac.uk/bitstream/2438/2502/1/Is%20Big%20Brother%20Watching%20You%20Responding%20to%20Tagging%20and%20Tracking%20in%20Dementia%20Care.pdf.

 

WebMD. (n.d.).10 Ways to Prevent Wandering. Brain and Nervous System Health Center.

Available online at http://www.webmd.com/brain/10-ways-to-prevent-wandering?page=2.

 

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