Which of the following is the best strategy for an older adult with dementia who often wanders?

It is estimated that 60% of people with Alzheimer's disease will wander at some point, posing a significant safety risk. Understanding which of the following is the best strategy for an older adult with dementia who often wanders is a critical step toward providing compassionate and secure care.

Quick Summary

For an older adult with dementia who wanders, the most effective approach combines identifying triggers, creating a secure environment, implementing daily routines, and using modern tracking technology to ensure safety and well-being.

Key Points

• Understand Triggers: Identify if wandering is caused by confusion, unmet needs, boredom, or stress to address the underlying issue.

• Secure the Environment: Use discreet high/low locks, alarms on doors/windows, and visual barriers like black floor mats to prevent unsupervised exits.

• Create Routines and Activities: A predictable daily schedule and engaging, repetitive tasks can reduce restlessness and the urge to wander.

• Leverage GPS Technology: Utilize wearable trackers or GPS shoe inserts with geofencing capabilities to monitor location and receive alerts if the person leaves a designated area.

• Establish a Community Network: Inform neighbors and local police about the wandering risk and consider enrolling in a wandering response program for a coordinated search effort.

• Prepare for Emergencies: Keep a 'Wandering Kit' with a recent photo and vital information to share with emergency services if the person goes missing.

Understanding the Root Causes of Wandering

To effectively manage wandering behavior, it is essential to first understand why it occurs. Wandering is often purposeful, not aimless, and can be triggered by various factors related to the individual's cognitive and emotional state.

• Confusion and disorientation: The person may not recognize their current environment as home and feel compelled to 'go home' to a place from their memory, such as a childhood house or previous job.
• Unmet basic needs: A person may wander in search of something they need, such as food, the bathroom, or relief from pain or discomfort they cannot express verbally.
• Routine fulfillment: The individual might be reliving an old routine, like going to a former workplace or picking up children from school.
• Anxiety and overstimulation: A noisy, crowded, or confusing environment can trigger anxiety, and wandering may be an attempt to escape to a calmer, safer place.
• Boredom and restlessness: A lack of physical or mental stimulation can lead to restlessness and a desire to move and explore.

Implementing Environmental Safety Measures

Creating a secure and controlled environment is the most fundamental strategy for managing a wandering risk. Caregivers should focus on making the home safe for movement while deterring unsafe departures.

• Secure doors and windows: Install locks that are difficult to operate or are placed out of the person’s line of sight, either high or low on the door. Use door and window alarms that chime when opened to alert caregivers.
• Create visual deterrents: A large, dark-colored doormat or a black piece of tape placed in front of an exit can be an effective visual barrier, as some people with dementia may perceive it as a hole they cannot step over.
• Remove 'going out' cues: Keep car keys, hats, coats, and purses out of sight to prevent a person from associating them with leaving the house.
• Camouflage exits: Some caregivers have success by disguising doors with removable curtains or murals that blend in with the wall.
• Ensure clear pathways: Remove clutter, loose rugs, and excess furniture to create clear, safe paths for pacing or walking, reducing the risk of falls.

Establishing Calming Routines and Engaging Activities

Providing structure and purposeful activity can help reduce restlessness and the impulse to wander.

• Maintain a structured daily routine: A predictable schedule for meals, activities, and sleep can help the person feel more secure and oriented.
• Plan engaging activities: Schedule meaningful activities during times when wandering typically occurs, such as during 'sundowning' hours in the late afternoon. This could include sorting objects, folding laundry, or listening to music.
• Encourage safe physical activity: Supervised walks or gentle exercises during the day can help burn off restless energy and improve sleep patterns.
• Use redirection, not confrontation: If the person is intent on leaving, do not argue or correct them. Instead, calmly redirect them with a new activity or offer a soothing cup of tea.

Utilizing Technology for Enhanced Security

Modern technology offers additional layers of protection for a wandering senior.

• GPS tracking devices: Wearable devices, shoe inserts, or clip-on trackers can provide real-time location data to a caregiver's smartphone or a monitoring service.
• Geofencing: This feature, available with many GPS trackers, allows caregivers to set virtual 'safe zones' and receive an alert if the person leaves the designated area.
• Motion and pressure sensors: These can be placed on doors, driveways, or bedsides to notify caregivers of any movement.

Comparison of GPS Tracking Devices

Device Type	How It Works	Pros	Cons
GPS Watch	Worn like a wristwatch, uses cellular network and GPS satellites.	Discreet, easy to wear, often has an SOS button.	May be removed by the person; battery needs charging.
GPS Shoe Insert	Placed inside the person's regular shoe, tracks via GPS.	Extremely discreet, harder for the wearer to remove.	Requires purchase of special shoes; depends on person wearing the shoes.
Clip-on Tracker	A small device that can clip onto clothing, a belt, or a purse.	Versatile, can be moved between items of clothing.	Can be easily lost, misplaced, or removed.
Smartphone App	Uses a smartphone's built-in GPS and location services.	Requires no extra hardware if the person already carries a phone.	The person may not carry the phone or know how to use it in an emergency.

Creating a Community Safety Plan

Extending your safety net beyond the home can significantly increase the chances of a safe and speedy return if wandering occurs.

• Inform neighbors and community: Introduce your loved one to neighbors and inform them about their condition and tendency to wander. Give them your contact information.
• Register with a wandering response service: Programs like MedicAlert or Project Lifesaver provide crucial support by registering the person's information for use by emergency responders.
• Enroll in a Silver Alert program: Some states offer a Silver Alert system to help locate missing adults with cognitive impairments.

Responding to a Wandering Incident

If a person with dementia goes missing, time is critical. An immediate, coordinated response is necessary.

1. Search Immediately: Begin a thorough search of the house and immediate outdoor areas. Many individuals are found within 1.5 miles of their last known location.
2. Call 911: If the person is not found within 15 minutes, call 911 and inform the dispatcher that a vulnerable adult with dementia is missing.
3. Use a 'Wandering Kit': Have a pre-prepared kit with a recent, clear photo, identifying information, medical conditions, and a list of familiar places they might go. This will save valuable time when communicating with authorities.

For a person with dementia who wanders, the single 'best' strategy does not exist. Instead, the most effective approach is a comprehensive, multi-layered plan. By combining environmental modifications, daily routines, engagement, and advanced technology, caregivers can significantly reduce risks and provide a safer, more stable environment for their loved one. For additional resources and support, visit the Alzheimer's Association website.

Final Thoughts

Managing wandering requires constant vigilance and adaptation. By staying informed, utilizing the right tools, and approaching the situation with patience and understanding, caregivers can provide a better quality of life for their loved one while ensuring their safety. Regularly reassessing the situation and adapting strategies as the person's condition changes is key to long-term success.

Frequently Asked Questions

What is the very first thing I should do when I notice my loved one with dementia is missing?

Immediately call 911 and inform them that a vulnerable adult with dementia has gone missing. Do a quick search of the house and immediate area, but do not delay contacting authorities, as time is of the essence.

How can I prevent my loved one from unlocking doors if they figure out how the locks work?

Consider installing deadbolts high up or low down, out of the person's direct line of sight. You can also use keyless or childproof locks, door alarms, or place a visual deterrent like a dark mat in front of the door.

Is using a GPS tracker for a person with dementia an invasion of their privacy?

This is a complex ethical issue. While it does involve monitoring, many caregivers feel it is a necessary safety tool to prevent harm, injury, or death. The decision should be made with the person's consent whenever possible, focusing on their overall safety and well-being.

My loved one often gets agitated and wants to leave in the evenings. What can I do?

This is a common phenomenon known as 'sundowning.' Try to plan calming activities for the late afternoon and evening, such as listening to music, folding laundry, or quiet conversation. Ensure the home is well-lit and avoid overstimulation during this time.

How do I deal with the wandering impulse without resorting to physical restraints?

Never use physical restraints. Instead, focus on redirection and engagement. Approach calmly, gently touch their arm, and redirect their attention with a familiar activity, a snack, or a soothing conversation. Addressing underlying needs like hunger or boredom can also help.

Should I inform my neighbors and local police that my loved one has dementia and may wander?

Yes, this is a crucial step. By informing neighbors, they can help keep an eye out and notify you if they see your loved one alone. Registering with local police or a Silver Alert program provides emergency responders with vital information in case of a missing person incident.

What kind of daily activities can I incorporate to reduce boredom and restlessness?

Engaging activities can include simple, repetitive tasks like sorting cards, folding laundry, gardening, or listening to their favorite music. Regular, supervised walks or other gentle physical exercises can also be very helpful in channeling restless energy.