Which of the following is the best strategy for an older adult with dementia who often wanders in and around their home?

According to the Alzheimer's Association, six in ten people with dementia will wander at some point, making it a critical safety concern. Addressing the question, 'Which of the following is the best strategy for an older adult with dementia who often wanders in and around their home?' requires a multi-faceted approach centered on both prevention and safety protocols.

Quick Summary

Creating a secure home environment with preventative measures, using personal tracking devices, and establishing a structured routine are key to managing wandering in an older adult with dementia. Combining these strategies provides comprehensive protection, reduces caregiver stress, and helps ensure safety.

Key Points

• Combine Prevention and Tracking: The best strategy integrates proactive home safety modifications with modern GPS tracking technology for comprehensive protection.

• Secure the Environment: Use strategic lock placements, visual deterrents, and door alarms to create a secure living space and prevent unsupervised exits.

• Implement a Structured Routine: Filling the day with meaningful activities and exercise can reduce boredom and anxiety, which are common triggers for wandering.

• Utilize GPS Technology: Wearable GPS devices provide real-time location tracking and can be life-saving in an emergency.

• Have an Emergency Plan: Develop a clear plan for what to do if your loved one goes missing, including notifying authorities immediately and activating a neighbor network.

Understanding the Causes of Wandering

To effectively manage wandering, caregivers must first understand why it occurs. Wandering is not random; it is often driven by underlying needs or triggers related to the dementia progression. Common causes include searching for something or someone, responding to stress or boredom, reliving past routines, and experiencing confusion about time and place. Identifying these patterns is the first step toward a successful intervention plan.

Common Triggers for Wandering

• Reliving Past Routines: The person may think they need to go to work, pick up their children from school, or visit a past home.
• Unmet Needs: The individual might be hungry, thirsty, or need to use the restroom but cannot communicate it effectively.
• Anxiety and Fear: Feeling lost, abandoned, or overwhelmed by noise can prompt a person to seek a quieter, safer place.
• Boredom or Restlessness: A lack of physical or mental stimulation can lead to pacing and the desire to be active.
• Sundowning Syndrome: Increased confusion and agitation in the late afternoon and evening are common triggers for wandering.

Securing the Home Environment

Creating a secure and calming home is the most crucial strategy. This goes beyond simply locking doors and involves environmental modifications that reduce the urge to wander and prevent unsafe exits.

Door and Window Safety

• Strategic Lock Placement: Install keyed deadbolts out of the person’s line of sight, such as high or low on the door. This makes them less likely to notice or try to open the lock. Conceal keys nearby but out of reach.
• Visual Deterrents: For some, a black floor mat in front of an exit can be perceived as a hole, acting as a visual barrier. Alternatively, camouflage doors by painting them the same color as the wall or hanging a decorative curtain or poster over them.
• Alarms and Sensors: Install door and window alarms that chime or alert a caregiver when an exit is opened. Pressure-sensitive floor mats near the bed or main exits can also provide an early warning. Many modern security systems offer these features.

General Home Modifications

• Clear Pathways: Remove tripping hazards like throw rugs, clutter, and extension cords from high-traffic areas to allow for safe pacing.
• Manage Stimuli: Ensure the home is well-lit to reduce shadows that can cause confusion. Consider using nightlights in hallways and bathrooms. Reduce noise and other overwhelming stimuli, especially during periods of sundowning.
• Secure Hazardous Areas: Lock doors to basements, garages, and other areas that may contain hazards like tools or chemicals. Install child-proof covers on electrical outlets and store dangerous items out of sight and reach.

Using Technology for Enhanced Safety

Modern technology offers valuable tools for monitoring and locating a person with dementia. These devices act as a backup to environmental and routine-based strategies.

Comparison of Tracking Devices

Feature	GPS Wearable (e.g., Watch)	Door/Window Alarms	Smart Home Systems
Function	Tracks location in real-time, often with geo-fencing alerts.	Alerts caregiver when doors/windows open.	Integrates sensors, cameras, and locks for comprehensive monitoring.
Range	Unlimited (cellular signal required)	Local (within Bluetooth/Wi-Fi range)	Unlimited (remotely accessible via smartphone)
Best For	Finding a person who has left the home and is lost.	Notifying caregiver of exit attempts within the home.	Creating a complete safety network, including motion alerts and video monitoring.
Cost	Subscription-based service.	Low to moderate one-time cost.	Higher initial cost and potentially monthly fees.

Other Technological Aids

• Motion Sensors: Strategically placed motion sensors can alert caregivers to movement in unauthorized areas, such as near an exit or at the top of a staircase.
• Wearable IDs: In addition to GPS, a medical ID bracelet or a tag sewn into clothing with contact information and medical details is vital in case the person is found by a stranger.

Implementing Behavioral and Routine-Based Strategies

Beyond securing the home, addressing the behavioral drivers of wandering through routine and engagement is a powerful preventative strategy. A predictable and meaningful daily schedule can reduce anxiety and restlessness.

Steps for Developing a Calming Routine

1. Identify Patterns: Keep a log of when wandering or agitation occurs to anticipate needs. Is it before meals? In the late evening?
2. Schedule Activities: Plan engaging and purposeful activities to fill restless periods. This could include folding laundry, gardening in a secured space, or listening to calming music.
3. Encourage Exercise: Supervised walks or gentle physical activity during the day can help burn off restless energy and improve sleep quality, reducing the urge to wander at night.
4. Meeting Basic Needs: Proactively offer food, drinks, and bathroom breaks to prevent wandering motivated by unmet needs. A regular check-in schedule can be highly effective.

What to Do When Wandering Happens

Despite all preventive measures, an individual may still wander. Having a pre-planned response is essential for a safe and quick return.

Emergency Response Plan

1. Search Immediately: Check the house and immediate surrounding area first. The Alzheimer's Association reports that most missing persons with dementia are found close to home.
2. Call 911: Do not wait more than 15 minutes. Inform the operator that a vulnerable adult with dementia is missing. Provide an up-to-date photo and a description.
3. Alert Neighbors and Local Businesses: Pre-emptively inform neighbors about your loved one's condition and wandering tendency. Have a quick contact list ready for emergencies.
4. Enroll in a Registry: Programs like MedicAlert® + Alzheimer's Association Safe Return® offer 24/7 emergency support and tracking assistance Learn more here.

Conclusion

The best strategy for managing wandering in an older adult with dementia is a layered, comprehensive approach. It starts with understanding the root causes of the behavior, followed by implementing a combination of home safety modifications, leveraging modern technology like GPS trackers, establishing a structured daily routine, and having a clear emergency plan. By addressing both the environment and the individual's needs, caregivers can significantly reduce the risk and ensure the safety of their loved ones while maintaining their dignity and quality of life.

Frequently Asked Questions

Why do people with dementia wander?

People with dementia may wander for various reasons, including searching for something familiar, relieving boredom or anxiety, or acting on a past routine, such as thinking they need to go to work or find their home.

Are door alarms effective for preventing wandering?

Yes, door alarms are highly effective. They provide an immediate alert to the caregiver when a door or window is opened, allowing for rapid intervention. They work best in combination with other safety measures.

Can a GPS tracker really help an older adult with dementia?

Absolutely. GPS trackers, often available as watches or pendants, can pinpoint the wearer's location. They are a critical safety net that can significantly reduce search time and ensure the person is found quickly and safely.

What is 'sundowning' and how does it relate to wandering?

Sundowning is a state of increased confusion, anxiety, and agitation that often occurs in the late afternoon and evening in people with dementia. This can be a major trigger for wandering and requires calm, distracting activities during that time.

Should I hide car keys and other items that might prompt a person with dementia to leave?

Yes, it is a recommended strategy. Keeping items like car keys, coats, and purses out of sight can help prevent the person from feeling a false sense of urgency to leave the home.

Is it safe to lock a person with dementia inside the house?

It is never safe to leave a person with dementia locked in a house alone, as it poses a serious fire hazard. Locks should be used in a way that allows a caregiver to be alerted and intervene, not to trap the person inside. It is crucial for a caregiver to be present.

What should I do first if my loved one with dementia wanders and gets lost?

Begin searching immediately, but if the person is not found within 15 minutes, call 911 right away. The first minutes are the most critical. Inform the dispatcher that a vulnerable adult with dementia is missing.