What is the best way to prevent wandering in residents with dementia?

According to the Alzheimer's Association, six in ten people living with dementia will wander at least once, with many doing so repeatedly. Understanding the root causes of this behavior is the first step in implementing a multifaceted approach to prevent wandering in residents with dementia and ensure their safety and well-being.

Quick Summary

The most effective approach to preventing wandering in residents with dementia combines environmental modifications, engaging daily routines, technology like GPS tracking, and addressing underlying triggers. Understanding and validating the person's needs while ensuring a safe, supervised environment is paramount for caregiver peace of mind and resident safety.

Key Points

• Identify Triggers: Pay close attention to what causes restlessness, such as boredom, anxiety, or unmet basic needs, to address the root cause of wandering.

• Modify the Environment: Implement simple changes like high locks, door alarms, and camouflage techniques to create physical and visual deterrents for exiting.

• Establish Routines and Activities: Provide structured daily schedules and engaging activities, especially during periods like 'sundowning,' to reduce agitation and provide a sense of purpose.

• Utilize Technology: Employ GPS tracking devices and motion sensors to provide an extra layer of security and enable quick location tracking if a resident wanders.

• Validate and Redirect: Instead of correcting the person, validate their feelings and gently redirect their attention to a new activity or topic to de-escalate their urge to leave.

• Create a Preparedness Plan: Have a clear plan in place, including recent photos and informing neighbors, to ensure a quick and effective response in case a wandering incident occurs.

Understanding the Root Causes of Wandering

Wandering in individuals with dementia is not a random act but often has a specific trigger. These triggers can be both internal and external, stemming from confusion, memory loss, anxiety, or a desire to fulfill a previous routine. Caregivers must become detectives, observing patterns and identifying potential reasons for wandering to address the behavior effectively and compassionately.

Common Triggers for Wandering

• Searching: The resident may be searching for a familiar person, place, or object from their past. This often manifests as asking to "go home," even when they are already there.
• Sundowning: Increased restlessness and confusion in the late afternoon or early evening, known as sundowning, can lead to wandering.
• Boredom or Restlessness: A lack of meaningful stimulation or physical activity can lead to pacing and the urge to leave.
• Basic Needs: The person may be looking for a bathroom, food, or water and be unable to express these needs clearly.
• Stress or Agitation: Overstimulation from noise, crowds, or new environments can cause anxiety, triggering a desire to escape.

Environmental Modifications for a Safer Home

Making changes to the living space is a critical first line of defense against wandering. These adjustments can help camouflage exits, create visual barriers, and improve the overall safety of the environment.

Securing Entry and Exit Points

• Install locks that are out of the resident's line of sight, such as high or low on doors. Consider keyed deadbolts where appropriate, but always ensure emergency access is possible.
• Use door alarms or chimes that alert caregivers when a door is opened. Pressure-sensitive mats placed near doors can also serve this purpose.
• Camouflage doors by painting them the same color as the walls or covering them with removable curtains, screens, or posters (e.g., a landscape scene) to make them less noticeable.
• Place a large, dark-colored rug or black tape in front of exits. Many people with dementia perceive this as a hole or a barrier they cannot cross.

Creating a Safe, Engaging Space

• Keep the home well-lit, especially at night, using nightlights in hallways, bedrooms, and bathrooms. This helps prevent disorientation.
• Remove trip hazards like throw rugs, clutter, and electrical cords from walking paths.
• Create a secure, enclosed outdoor space, such as a patio or garden, where the resident can wander freely and safely under supervision.
• Label rooms with signs or pictures (e.g., a toilet on the bathroom door) to help with orientation.
• Store items that might trigger leaving, such as coats, keys, and wallets, out of sight.

Behavioral and Activity-Based Interventions

Addressing the emotional and physical needs of the resident can significantly reduce the urge to wander. Consistent routines and engaging activities are key to providing a sense of purpose and calm.

Establishing a Predictable Routine

• Maintain a consistent daily schedule for waking, meals, and bedtime. Predictability reduces anxiety and confusion.
• Plan activities during peak wandering times, such as the late afternoon, to provide distraction. This can be as simple as folding laundry, listening to music, or watching a favorite film.
• Incorporate regular physical exercise, like supervised walks, to help burn off restless energy and promote better sleep.

Redirecting and Validating Concerns

• If the resident expresses a desire to go home or to work, respond by validating their feelings rather than correcting them. For example, say, “I know you want to go home, but we are safe and sound right here,” or "The office is closed today, let's have a cup of tea instead."
• Explore the emotional connection behind their words. Ask what they miss about their job or home to help them reminisce and feel heard.

Harnessing Modern Technology and Safety Devices

Technology provides an added layer of security, offering peace of mind to caregivers and improving response times in the event of an elopement.

GPS and Tracking Devices

• Wearable GPS trackers are available in various forms, including watches, shoe inserts, and clips for clothing. These devices can be essential for locating a resident quickly if they wander away.
• Enroll in community programs like Project Lifesaver, which partners with local law enforcement to locate individuals with tracking devices.

Home Monitoring Systems

• In addition to door alarms, motion sensors can be placed at bedsides or in key areas to alert caregivers of a resident's movement during the night.
• Smart home systems can provide monitoring features and allow for remote management of locks or sensors.

Comparison of Wandering Prevention Strategies

Strategy	Pros	Cons	Best for...
Environmental Modifications	Low cost, passive security, non-invasive, reduces triggers.	Can be overcome by determined individuals; may require multiple solutions.	Home-based care and proactive prevention.
Routine & Activity Interventions	Addresses underlying causes, improves quality of life, promotes engagement.	Requires consistent effort from caregivers; may not work during periods of high agitation.	Reducing restlessness and anxiety.
Technology (GPS)	Provides immediate location tracking, enhances safety for high-risk individuals.	Can be removed or forgotten; costs involved (device + subscription).	Ensuring safety for individuals with a high likelihood of wandering.
Community Services	Coordinated response with local experts; provides external support.	Limited by local program availability; relies on external aid.	Comprehensive safety planning and emergency response.

Ethical Considerations and Planning Ahead

As an individual's dementia progresses, balancing their autonomy with safety becomes a major ethical concern. Caregivers should involve the resident in safety decisions whenever possible and document their wishes. Consulting an elder law attorney can help with legal considerations and future care plans. Never resort to locking a resident inside a home or room, as this infringes on their rights and is dangerous in an emergency.

The Importance of a Preparedness Plan

Even with all precautions, wandering can still happen. Having a plan in place is crucial for a quick and effective response. The Alzheimer's Association provides excellent resources for developing an emergency plan.

• Keep a recent, high-quality photograph of the resident easily accessible.
• Create a list of places the person might wander to (past homes, jobs, places of worship).
• Inform neighbors and local police that the resident has dementia and may wander.

Conclusion: A Multi-Pronged Approach

There is no single "best" way to prevent wandering in residents with dementia. Instead, a successful strategy involves a combination of compassionate understanding, environmental safety measures, engaging activities, and modern technology. By addressing the root causes of the behavior, creating a secure living space, and having a plan, caregivers can significantly reduce the risk of wandering, ensuring the safety and enhancing the quality of life for their loved ones. Ultimately, the best prevention strategy is one that is tailored to the individual's specific needs and respects their dignity and autonomy. The Alzheimer's Association offers extensive support and resources for caregivers navigating this challenging behavior.

Frequently Asked Questions

Why do residents with dementia wander?

Residents with dementia may wander for a variety of reasons, including disorientation, confusion, anxiety, boredom, or a desire to fulfill a past routine, such as going to work or returning to a childhood home. Often, they are searching for something or somewhere familiar.

Are GPS trackers effective for preventing dementia wandering?

Yes, GPS trackers are a highly effective tool for safety. While they don't prevent the act of wandering, they allow caregivers to quickly and accurately locate a resident who has eloped, which is crucial for their safety.

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

Sundowning is a state of confusion and agitation that occurs in the late afternoon or early evening for some people with dementia. This increased restlessness can often lead to an increased urge to wander. Maintaining a calm environment and engaging activities during these hours can help.

How can caregivers talk to a resident who wants to 'go home'?

It's best to validate their feelings and gently redirect them rather than argue. You can say, 'I know you want to go home, but we are safe here,' and then offer a comforting activity like a warm drink or a walk in a secure area.

Should I lock a resident with dementia in their room to prevent wandering?

No, you should never lock a resident in their room or the home. This is a violation of their rights and can be extremely dangerous in case of an emergency, such as a fire. Safety measures should always prioritize autonomy and emergency access.

Can environmental changes really help prevent wandering?

Yes, they are one of the most powerful and passive prevention strategies. Camouflaging doors, using visual stop barriers like black mats, and installing door alarms can all be highly effective in reducing exit-seeking behavior.

What should I do immediately if a resident with dementia wanders away?

Act immediately. If the person is not found within a few minutes of searching the immediate vicinity, call 911. Be prepared with a recent photo and a list of potential destinations based on their history or past routines.