How do you care for a client who has wandering behavior? A comprehensive guide

According to the Alzheimer's Association, up to 60% of individuals with dementia will wander at some point, making it a critical safety issue for caregivers. Knowing how do you care for a client who has wandering behavior is essential for their safety and well-being.

Quick Summary

Managing wandering requires a person-centered approach, focusing on identifying triggers, creating a safe environment, and using distraction and redirection techniques. Caregivers can proactively reduce risks by maintaining routines, securing the home, and utilizing monitoring devices.

Key Points

• Identify Triggers: Pay attention to patterns and triggers, whether medical, psychological, or environmental, to address the root cause of wandering.

• Secure the Environment: Modify the living space with alarms, specialized locks, and visual barriers to prevent unsupervised exits.

• Create a Routine: Establish a predictable daily schedule with regular exercise and meaningful activities to reduce restlessness and boredom.

• Use Distraction and Redirection: When wandering occurs, respond calmly by validating feelings and redirecting the client toward a positive activity.

• Utilize Identification and Technology: Ensure the client has proper ID (bracelets, labels) and consider GPS tracking for added safety and peace of mind.

• Prioritize Non-Pharmacological Methods: Favor behavioral and environmental strategies over medication, which can have adverse side effects.

Understanding the Root Causes of Wandering

To effectively manage wandering behavior, it is crucial to first understand its potential causes. Wandering is often not a random act but a purposeful, albeit sometimes confusing, search for something familiar, a need to fulfill a former routine, or a response to internal discomfort.

Medical Triggers

• Pain or Discomfort: An unmet physical need, such as hunger, thirst, or pain from an untreated infection like a UTI, can cause restlessness that leads to wandering.
• Medication Side Effects: Certain medications can increase confusion, agitation, or restlessness. A doctor should be consulted to review the client's prescriptions.
• Sleep Disturbances: Disrupted sleep patterns, common in dementia, can lead to nighttime wandering, a phenomenon sometimes referred to as 'sundowning'.

Psychological and Emotional Triggers

• Anxiety and Fear: Feeling lost, confused, or disoriented can trigger a sense of panic and the urge to flee to a 'safer' place.
• Boredom or Loneliness: A lack of stimulating activities can lead a client to wander in search of something to do or someone to interact with.
• Past Routines: A client might wander to try and return to a past home, go to a former job, or pick up their children from school, following old, deeply ingrained patterns.

Environmental Triggers

• Overstimulation: A noisy or chaotic environment can be overwhelming, prompting the client to seek a quieter space.
• Clutter and Confusion: Disorganized or cluttered spaces can be disorienting and lead to a client becoming lost or agitated inside the home.
• Exits: Visible coats, keys, and exterior doors can act as potent reminders to leave.

Creating a Safe and Secure Environment

Modifying the living space is a primary and highly effective strategy for managing wandering. These changes prioritize safety without restricting the client’s freedom unnecessarily.

• Install door and window alarms or bells that signal when they are opened.
• Use keypad or high/low-mounted locks that are out of the client’s line of sight.
• Use visual barriers to disguise exits, such as placing a mural or a full-length curtain over the door.
• Place a black mat in front of exits. Some people with dementia perceive this as an impassable dark hole.
• Hide car keys, coats, purses, and other items that might trigger the impulse to leave.
• Ensure the home is free of clutter, throw rugs, and other tripping hazards.
• Use nightlights throughout the house and hallways to prevent disorientation at night.

Proactive Strategies and Routine Management

Structured routines and engaging activities can significantly reduce the urge to wander.

1. Establish a Predictable Daily Routine: Regular meal times, bedtimes, and planned activities provide a sense of structure and security.
2. Incorporate Daily Exercise: Supervised walks or simple indoor exercises can help burn off excess energy and reduce restlessness. Exercise also promotes better sleep.
3. Provide Meaningful Activities: Engage the client in simple, purposeful tasks they used to enjoy, like folding laundry, watering plants, or listening to music.
4. Schedule Supervised Outings: Safe, planned walks or drives can satisfy the client's need to move and explore without risk.
5. Address Basic Needs: Regularly check for hunger, thirst, or the need to use the bathroom, as these unmet needs are common triggers for restlessness.

Managing a Wandering Episode

If a client begins to wander, a calm and reassuring approach is vital.

1. Stay Calm and Approach from the Front: Avoid startling the person. Make eye contact and use a calm, gentle tone of voice.
2. Validate and Join Their Reality: Instead of arguing or trying to 'correct' their reality, acknowledge their feelings. For example, if they want to 'go home,' say, "Let's get ready to go home after we have a snack." Then redirect.
3. Use Distraction: Shift their attention to a pleasant activity or object, such as a favorite family photo album, a snack, or a song they enjoy.
4. Reassure Them: Remind them that they are safe and that you are there to help them. A gentle touch on the arm can sometimes be comforting.
5. Go for a Walk with Them: If they insist on walking, walk with them in a safe, controlled area like a fenced yard. Sometimes the act of walking itself is the goal.

Using Technology and Identification

Technology offers additional layers of safety and can provide peace of mind for caregivers.

• GPS Trackers: These devices, often worn as a bracelet, pendant, or clipped to a belt, can track a client's location in real-time.
• Identification Jewelry: A medical ID bracelet or necklace can provide critical information, including the client's name, medical condition, and an emergency contact number.
• Sew-in Labels: Adding labels with contact information to the client's clothing can help if they remove their jewelry.
• Caregiver Support Programs: Enrolling in services like the Alzheimer's Association's 24/7 Wandering Support program can provide immediate assistance during an elopement.

Non-Pharmacological vs. Pharmacological Approaches

The table below compares common strategies for managing wandering behavior.

Feature	Non-Pharmacological Approaches	Pharmacological Approaches
Primary Goal	Address root causes and manage environment	Address symptoms (agitation, anxiety)
Interventions	Redirection, routine, meaningful activities, environmental modifications	Use of anti-anxiety or sedative medications
Effectiveness	Often highly effective, particularly for mild-to-moderate wandering	Mixed results; potential for side effects	n	Risks	Low risk; primarily safety precautions for the environment	Potential for serious side effects, including increased confusion and falls	n	Sustainability	Long-term and sustainable with consistent care	Often used as a last resort when other methods fail	n	Ethical Considerations	Focuses on client dignity and autonomy	Restraint issues; requires careful monitoring and evaluation

Conclusion

Caring for a client who exhibits wandering behavior requires patience, consistency, and a multi-faceted approach. By combining an understanding of the client's individual triggers, creating a safe environment, establishing predictable routines, and utilizing proactive engagement and redirection techniques, caregivers can dramatically reduce the risks associated with wandering. Remember that seeking support from other caregivers and professional organizations is also a crucial step in maintaining both the client's well-being and your own. For more resources on dementia care, visit the Alzheimer's Association website.

Frequently Asked Questions

What is the first thing a caregiver should do when a client starts wandering?

The immediate first step is to ensure the client's safety. Remain calm, approach them gently, and try to redirect their attention with a pleasant activity. Avoid showing frustration or arguing with them.

How can I prevent a client from wandering at night?

To prevent nighttime wandering (sundowning), ensure the client gets enough exercise during the day, limit naps, and create a calm, well-lit environment in the evening. Install door alarms or motion sensors for added security.

Are GPS trackers effective for clients who wander?

Yes, GPS trackers are highly effective for providing peace of mind and can help locate a client quickly if they wander away. They come in various forms, including watches and shoe inserts.

What kind of activities can help reduce wandering behavior?

Engaging, repetitive, and simple activities can be very effective. Examples include folding laundry, sorting objects, listening to favorite music, or looking at old photo albums.

Should I hide the client's car keys and coat?

Yes, it is highly recommended to hide car keys, wallets, purses, coats, and shoes from sight, especially if the client is prone to wandering. These items can act as triggers.

What if a client insists on 'going home' when they are already home?

Do not argue or correct them. Instead, validate their feelings by saying something like, "It sounds like you want to go home." Then, reassure them that they are safe and distract them with an activity or a walk.

When should I contact a doctor about a client's wandering?

You should contact a doctor if the wandering behavior is new, escalating, or if you suspect it's caused by an underlying medical issue, pain, or medication side effects.