Effective Strategies: How to deal with wandering patients?

An estimated 6 in 10 people with Alzheimer's disease are at risk of wandering, highlighting a serious safety concern for caregivers. Understanding how to deal with wandering patients is a critical skill for ensuring the well-being of your loved one while managing your own stress levels.

Quick Summary

Successfully managing patient wandering requires a multi-faceted approach, including identifying triggers, securing the home, and creating a structured daily routine. Caregivers should also utilize modern safety technology and develop a clear emergency response plan.

Key Points

• Prioritize Safety First: Secure the home with locks, alarms, and camouflaged exits to prevent unsupervised wandering.

• Identify and Address Triggers: Look for patterns related to confusion, boredom, or unmet needs, and plan activities accordingly.

• Establish a Consistent Routine: Predictable daily schedules can reduce anxiety and the impulse to leave, especially during evening hours.

• Utilize Modern Technology: Wearable GPS trackers, pressure mats, and medical ID bracelets offer valuable tools for locating a person quickly.

• Have an Emergency Plan in Place: Create a clear, rehearsed plan with authorities and neighbors for a missing patient incident.

• Seek Caregiver Support: Coping with the stress of a wandering patient requires support from family, friends, or professional services.

Understanding the Root Causes of Wandering

Before implementing management strategies, it's crucial to understand why a person wanders. Wandering is often not a random act but a purposeful, though confused, behavior. Common triggers can include:

• Confusion and Disorientation: A patient may not recognize their current surroundings and attempt to 'go home' to a past residence.
• Reliving Past Routines: The patient may be following a long-established pattern, such as going to work, picking up children, or running errands.
• Boredom or Restlessness: A lack of engaging activity or stimulation can lead to a sense of unease, causing the person to pace or leave the house in search of purpose.
• Unmet Needs: Simple needs like hunger, thirst, or the need to use the bathroom can cause a patient to wander in search of these things.
• Anxiety and Fear: Feeling frightened by a noise, a person, or a perceived threat can lead a person to try and escape.
• Medication Side Effects: Some medications can increase restlessness or agitation, prompting wandering.

Proactive Strategies for a Safer Home

Creating a secure home environment is the first and most vital step in preventing wandering. These physical modifications and daily practices can make a significant difference:

• Secure Exits: Install deadbolts at the top or bottom of exterior doors, where they are out of the person's usual line of sight. Consider door and window alarms that sound an alert when opened.
• Camouflage Exits: Make doors less obvious by painting them the same color as the surrounding walls or covering them with removable curtains, screens, or posters of a bookshelf. Placing a black doormat in front of a door can also act as a visual deterrent.
• Reduce Clutter: Maintain clear, uncluttered pathways inside the home to reduce confusion and the risk of falls.
• Secure the Yard: If possible, fence your yard and ensure all gates are locked. This provides a safe outdoor space for walking and fresh air.
• Hide Trigger Objects: Keep items that signal 'going out,' such as coats, keys, and purses, out of sight.

The Power of Routine and Engagement

Engaging the patient in daily life can help reduce restlessness and the impulse to wander. A predictable routine provides a sense of security and purpose.

• Establish a Consistent Schedule: Maintain a routine for meals, exercise, and bedtime. This can be especially helpful in managing 'sundowning,' a phenomenon where confusion and agitation increase in the evening.
• Provide Meaningful Activities: Involve the patient in simple, repetitive tasks like folding laundry, watering plants, or dusting. These activities provide a sense of accomplishment and purpose.
• Incorporate Regular Exercise: Daily supervised walks or other forms of gentle exercise can help channel restless energy. This can lead to better sleep and less agitation.
• Address Basic Needs Promptly: Pay close attention to signs of hunger, thirst, pain, or the need to use the bathroom. Promptly addressing these needs can prevent a wandering attempt triggered by discomfort.

Using Technology and Identification as a Safety Net

In today's world, technology provides valuable tools to help keep wandering patients safe. These tools should be used as a supplement to, not a replacement for, constant supervision.

Technology Type	How It Helps	Best For
Wearable GPS Device	Provides real-time location tracking via a smartphone or computer.	Patients with a history of wandering outside the home.
Pressure-Sensitive Mats	Placed by bedsides or in front of doorways, these sound an alarm when stepped on.	Alerting caregivers to nighttime or early morning movements.
Door/Window Alarms	Simple, battery-operated sensors that trigger an alert when a door or window is opened.	Cost-effective and useful for securing main exits.
Medical ID Bracelet	Displays information like the patient's name, medical condition, and emergency contact details.	Ensuring a safe return if the patient is found by a stranger.

What to Do If a Patient Goes Missing

Despite the best prevention efforts, wandering can still occur. Having an emergency plan is crucial.

1. Act Immediately: Do not delay. Start the search immediately. The majority of missing individuals are found within 1.5 miles of where they disappeared.
2. Call 911: Inform the dispatcher that a person with dementia is missing. Provide a recent, close-up photo and a physical description.
3. Notify Neighbors: Alert trusted neighbors and ask them to call if they see the person. Provide them with a photo beforehand.
4. Check Known Locations: Search places the patient has visited in the past, such as former homes, places of worship, or familiar parks.
5. Utilize a Registry: Enroll the patient in a wandering response service like the Alzheimer's Association's Safe Return program.

Final Thoughts and Caregiver Support

Caring for a person who wanders is challenging and stressful. It is essential for caregivers to prioritize their own well-being and seek support. Building a strong support network with family, friends, or professional services can help prevent caregiver burnout and provide much-needed respite. Remember that you are not alone in this journey.

For additional support and resources, visit the Alzheimer's Association's website which offers valuable information and support networks for families dealing with dementia and wandering behaviors.

Frequently Asked Questions

Why do patients with dementia wander?

Patients with dementia may wander due to confusion, disorientation, a search for something familiar, or restlessness caused by boredom or unmet needs like hunger or pain.

What are some immediate actions to take if a patient wanders?

If a patient goes missing, act immediately. Call 911, inform the dispatcher that a vulnerable person with dementia is missing, and provide a recent photo and description. Begin searching nearby areas and places the person has visited before.

How can I secure my home to prevent a patient from wandering?

To secure your home, install locks out of the patient's line of sight, use door and window alarms, and cover or camouflage exterior doors. Hide items that may trigger the instinct to leave, such as keys and coats.

Are GPS trackers a good solution for wandering patients?

Yes, GPS tracking devices are an excellent tool. They can be worn as watches, bracelets, or clipped to clothing and provide real-time location data, which is vital in an emergency.

How do I handle a patient who insists on 'going home'?

Instead of arguing, redirect and distract the patient calmly. Engage them in a simple activity, offer a snack, or suggest a supervised walk. Reassuring them that they are safe is often more effective than trying to correct their reality.

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

Sundowning is a state of increased confusion and agitation that can occur in people with dementia during the late afternoon and evening. This can increase restlessness and the likelihood of wandering.

What kind of information should I give to my neighbors?

Provide trusted neighbors with a recent photo of the patient, a brief explanation of their condition, and your contact information. Ask them to call you immediately if they see the patient alone.