Elderly Wandering: Tips for Caregivers on Prevention and Safety

Alzheimer’s disease and related disorders (ADRD) and Wandering

As life expectancy increases in the US, due in one way or another to medical advances and changes in health care, so does the population of elderly or people over the age of 60. This in turn leads to an increase the number of people with age-related diseases such as Alzheimer’s disease and other forms of dementia.  Alzheimer’s disease is the sixth leading cause of death in the US and it is estimated that 1 in 3 seniors will die from Alzheimer’s or another dementia.¹

Although Alzheimer’s disease is the most common form of dementia, other dementia-related diseases/disorders may lead to wandering as well, such as vascular dementia (post-stroke), Parkinson’s disease, Huntington’s disease, etc.  It is estimated that 5.2 million Americans have Alzheimer’s disease, and the numbers are expected to triple in the coming years.  6 out of 10 of these individuals will wander at some point.²  The patient may simply be wandering aimlessly or trying to achieve an objective such as finding a bathroom or home. In either case, the patient could wander by walking, driving, or by some other means into dangerous situations.

Anyone who has memory problems and is able to walk is at risk for wandering.  Wandering, in some cases, could be a positive exercise for the elderly.  It provides movement, exercise, sensory stimulation or maybe even a release of anxiety or stress as long as it is done in a safe environment and some precautions are taken.  But in some cases it is, what some authors refer to as “critical wandering,” or any wandering event in which an elder leaves a home or institution and is unaware of their surroundings.  This exposes the person to potential dangers such as falling, traffic accidents, and/or weather conditions (exposure).³⁴ Whatever the case may be, any wandering event is a stressful burden on the caregiver that has the potential to be prevented.

Reasons for Wandering⁵

Wandering is a complex behavior and there may be many different reasons why a person may wander. For the caregiver, it could be helpful to keep a journal of these occurrences to determine what the individual is trying to achieve or what may trigger the wandering event. This may help in the future to alleviate stress and frustration that may lead to further events. Some of these reasons may include:

• Continuing a habit – Whether it be walking to the bus, work, or simply a person that had enjoyed walking on a daily basis, it is natural the person would want to continue a repetitive behavior.
• Relieving boredom – People with dementia have an underlying anxiety and restlessness and need to keep mentally engaged and physically active.
• Using up energy – Some individuals, if kept inactive, may have some stored or unspent energy feel the need for more exercise.
• Relieving pain and discomfort – People often get up and walk around to ease pain or relieve discomfort. They may even possibly want to escape from the pain.
• Feeling lost – If a person recently moved home from the hospital or a care facility or is moving in to a new center, they may feel unsure of their surroundings.  This may lead to some confusion and cause the person to feel lost and need extra help in finding their way about.
• Memory loss – Short-term memory loss is associated with dementia and lead a person to become confused. They may have a purpose in mind when they begin a particular task and later forget the particular goal they had in mind.  Alternatively, they may forget that their caregiver has walked away for a short time and wander to look for them.
• Searching for the past – Another possibility is that as the individual’s dementia progresses they may attempt to find someone or something related to their past. It is important to recognize these feelings and help to meet their emotional needs.

Other reasons for wandering include: physical needs such as using the bathroom or other basic needs, social interactions, insomnia or restlessness due to their condition or even some medications, seeking fulfillment of tasks they have routinely done in the past and feel the need to continue them, or possibly getting confused about the time of day and wake in the middle of the night believing it to be time to get ready for the next day.

Collectively, it’s important to realize that individuals suffering from Alzheimer’s and other dementia-related diseases are interested in retaining their independence, and it’s important to encourage them to do so.  Of course, some degree of risk is inevitable.  It is important as a caregiver to maintain the quality of life as long as possible, keeping in mind the person’s environment and safety in order to help them cope with the situation and the possible reasons they wander.

Tips for Caregivers on Wandering and Prevention

The National Institutes of Health/National Institute on Aging gives these suggestions for steps to take BEFORE the person with Alzheimer’s disease wanders:⁶

• Make sure the person carries some kind of ID or wears a medical bracelet. If the person gets lost and can’t communicate clearly, an ID will let others know about his or her illness. It also shows where the person lives.
• Consider enrolling the person in the MedicAlert® + Alzheimer’s Association Safe Return® Program (see www.alz.org or call 1-888-572-8566 to find the program in your area).
• Let neighbors and the local police know that the person with Alzheimer’s tends to wander. Ask them to alert you immediately if the person is seen alone and on the move.
• Place labels in garments to aid in identification.
• Keep an article of the person’s worn, unwashed clothing in a plastic bag to aid in finding him or her with the use of dogs.
• Keep a recent photograph or video recording of the person to help police if he or she becomes lost.

There are instances where even people that are considered to be at high-risk of wandering will be left unattended and they may get up and wander.  These are some tips to help PREVENT the person with Alzheimer’s from wandering away from home:

• Keep doors locked. Consider a keyed deadbolt, or add another lock placed up high or down low on the door. If the person can open a lock, you may need to get a new latch or lock.*
• Use loosely fitting doorknob covers so that the cover turns instead of the actual knob.*
• Place STOP, DO NOT ENTER, or CLOSED signs on doors.
• Divert the attention of the person with Alzheimer’s disease away from using the door by placing small scenic posters on the door; placing removable gates, curtains, or brightly colored streamers across the door; or wallpapering the door to match any adjoining walls.
• Install safety devices found in hardware stores to limit how much windows can be opened.
• Install an “announcing system” that chimes when the door opens.
• Secure the yard with fencing and a locked gate.
• Keep shoes, keys, suitcases, coats, hats, and other signs of departure out of sight.
• Do not leave a person with Alzheimer’s who has a history of wandering unattended.

* Due to the potential hazard they could cause if an emergency exit is needed, locked doors and doorknob covers should be used only when a caregiver is present.

Programs to Help the Elderly That Have Gone Missing

There are several programs in place to aid in locating individuals who wander, each of which have their pros and cons. It is difficult to research the issue because, as the authors routinely state, it is an area that is understudied. However, studies that have taken place note that individuals found in the first 24 hours usually return unharmed. Most missing person reports happen only after the 24 hour window has passed.  They also note that there is a large percentage of individuals found after 24 hours who have died or require immediate medical attention once found due to falls or some other type of harm.

Safe Return +Medic Alert (http://www.alz.org/care/dementia-medic-alert-safe-return.asp) –  Safe Return, established by the Alzheimer’s Association in 1993, is a 24 hour nationwide emergency response system for individuals with Alzheimer’s disease or a related dementia.  The emergency responders maintain a database of information on these individuals who wear a MedicAlert + Safe Return ID bracelet. When found, citizens and emergency personnel can contact the toll-free number (1.800.625.3780) to report it. MedicAlert + Safe Return will in turn contact the listed contacts as well as provide any medical history if required in order to facilitate a safe return home.

Project Lifesaver International (PLI) (http://www.projectlifesaver.org/) – PLI is a non-profit organization with a mission to “provide police, fire/rescue and other first responders with a comprehensive program including equipment and training to quickly locate and rescue “at risk” individuals with cognitive disorders who are at constant risk to the life threatening behavior of wandering including those with Alzheimer’s disease, Autism, and Down Syndrome. Project Lifesaver has over 1,300 participating agencies throughout 47 states in the U.S., Canada, and Australia.”⁷

Silver Alert – Modeled after the AMBER Alert program, the Silver Alert relies on law enforcement, the media (radio and television broadcasts), and highway signs to inform the public of information regarding missing elders and others who are cognitively impaired. Although a national legislation has yet to be put into place, several congressional members have introduced a National Silver Alert Act since 2008.  32 states already have Silver Alert programs in place along with several others that have legislation pending.  Unlike Safe Return and PLI, the Silver Alert is administered at the state level and Individual registration is not required (except in Texas).  People typically are required to meet certain criteria (age and cognitive function) in order to activate an alert. For more information, check with your individual state organizations on locating missing elders.

It is not difficult to see that Alzheimer’s disease and other dementia-related diseases do present a problem as our older population grows in this and other countries. Issues concerning wandering and safe return is a subject that is understudied. It is important to mention that not one program is fool-proof and each has its pros and cons and each vary in costs depending on the type of coverage and response system. Its best to evaluate the programs and determine what works best for the caregiver and loved one along with assessing the individual’s tendency to wander and cognitive ability.

Full Article & Source:
Elderly Wandering: Tips for Caregivers on Prevention and Safety