Wising up to Wandering
Article written by David Hart, Ph.D.
Several general symptoms are associated with the onset of Alzheimer’s disease, including an impairment of memory, cognitive ability and personality; mood disorders; challenges completing routine tasks; and becoming lost in familiar places. As the disease progresses patients frequently exhibit more challenging, and sometimes dangerous, behaviors that require near constant supervision and redirection by often exhausted care partners. Wandering in one such behavior and is commonly defined as a compulsive need to walk and patients who tend to wander are also at greater risk for falls, accidents, and becoming lost.
Studies have suggested that 60-70% of patients with Alzheimer’s disease will wander at some point during the disease (Sink, Covinsky, Newcomer, & Yaffe, 2004) and almost two-thirds of those who wander are multiple repeat wanderers (Silverstein & Salmon, 1996). In the early stages of Alzheimer’s disease, the individual may become lost while driving to a familiar place such as the grocery store. As the disease progresses, and the patient becomes increasingly disoriented and confused, wandering often involves trying to fulfill a former obligation or striving to find a former home or an already deceased parent, sibling, or spouse.
Unfortunately, for families dealing with this difficult behavior the frequency and persistence of wandering generally increases as cognitive impairment worsens (Holtzer et al., 2003). Managing a family member who wanders can be frustrating for families because there is no magic “shut-off” switch to stop mom from constantly searching for her long lost love. It’s not a surprise that wandering can lead to a greater risk of falls, fractures, and other injuries. Sadly, in a study of 42 elders with Alzheimer’s disease who had been reported missing, 46% of those lost for more than 24 hours were found dead (Koester & Stooksbury, 1995). Factors that have been shown to increase wandering in patients with dementia include being in an unfamiliar environment, recent change in medications, acute changes in schedule or routine, or a desire to engage in a past practice, including visiting a relative or expressing a desire to “go home”.
The challenges associated with managing a patient with dementia who wanders are many but caregivers might find it helpful and therapeutic to develop some empathy for what may be the root of the behavior. Imagine the anxiety you might feel if you were constantly searching for and could never find your deceased husband (who you believed was living). What would it be like for you to wake up in the morning and not recognize your surroundings? Wouldn’t you want to get back to where you belonged? Many patients who wander experience levels of confusion that are extremely difficult to manage through reassurance and/or redirection. For this reason, care partners are invited to explore varying modes of intervention, including adult day health care, non-medical in-home support care, or medication that may help to contain the behavior.
As is often the case when caring for a loved one with dementia, finding a workable intervention for a patient who wanders is often a process of trial and error. Care partners have an obligation to ask the question: is my loved one safe in his or her current living situation? Whether that’s safe while driving, cooking, bathing, walking, or making financial decisions, the answer to the question must be a resounding yes. If the answer is ‘I’m not sure’ or ‘no’, a change plan needs to be developed and implemented as soon as possible. Whatever intervention is chosen, the safety of the person with dementia is paramount.
To assist care partners with managing a wandering family member, MedicAlert provides a service called Safe Return – a 24-hour emergency response service for finding a person with dementia who has wandered and other medical emergencies. If an individual with Alzheimer’s or a related dementia wanders and becomes lost, care partners can call the 24-hour emergency response line to report it. A community support network will be activated, including local law enforcement agencies, to help reunite the patient and care partner. With this service, critical medical information is provided to emergency responders when needed. In addition, the person with dementia is given a bracelet or pendant to indicate his or her diagnosis, address, and phone number in the event the patient becomes lost. Care partners are also given a form of identification distinguishing them as a caregiver of a person with dementia, which also serves as a safety precaution.
Another technique that may be useful is to minimize the patient’s levels of confusion by providing near constant reassurance and redirection. The first step in the process of simple redirection is to validate your loved one’s experience. If your mom is looking for your deceased father, do not attempt to reorient her to his death. You want to join mom as she looks for her husband. While you’re looking for dad, you might also look for something that you’ve misplaced, like a book or wallet. Now that you’ve validated mom and joined her in her search, you can attempt to change the topic of conversation to grandchildren or even the weather. Just as long as the topic is of interest to your loved one. After some time, you may find that you can redirect mom to take a walk around the block or to sit down for a meal. The take away point is to avoid reorienting people with dementia to the here and now, validate the feelings they’re experiencing (fear, anxiety, hopelessness, frustration, etc.), join them in their cause (unless the cause is unsafe), slowly and strategically attempt to change the topic of conversation to one that is less confusing and renders happy feelings, and then redirect the patient to another activity. This sounds simple but has been shown to have clinical validity with cognitively impaired patients.
For more information on managing some of the more challenging behaviors related to Alzheimer’s disease or another dementia, family members are welcome to attend our monthly Caregiving Essentials workshop that empowers family members with the coping skills to effectively manage the day to day trials of caring for a person with dementia. You may also schedule a Family Consultation to review your case privately. For more information on MedicAlert, you may go to www.medicalert.org/safereturn or call the Alzheimer’s Association at (800) 272-3900. For more information on Always Best Care South Bay and our Concierge Services including Family Consultations and Supportive Counseling, please call (310) 792-8666 or visit www.alwaysbesthomecare.com.