How to prevent Alzheimer's patients from wandering? A Comprehensive Caregiver's Guide

An estimated 6 in 10 people with Alzheimer's disease will wander, becoming lost, confused, or disoriented. For caregivers, preventing this behavior is a primary concern. Understanding how to prevent Alzheimer's patients from wandering requires a multi-faceted approach, combining environmental safety measures, behavioral strategies, and technology.

Quick Summary

Secure the home with alarms and locks, create structured routines, engage them with meaningful activities, manage triggers like boredom or anxiety, and use technology such as GPS trackers to help prevent an Alzheimer's patient from wandering.

Key Points

• Secure the Environment: Install high or low locks on exterior doors and use alarms to alert you if a door is opened.

• Manage Triggers: Identify and address the causes of wandering, such as boredom, confusion, or unmet needs, through engaging activities and reassurance.

• Create Structure: A consistent daily routine provides comfort and reduces agitation that can lead to wandering.

• Utilize Technology: Employ GPS tracking devices and monitoring systems for an added layer of safety and to quickly locate a patient if they wander.

• Plan for Emergencies: Keep up-to-date photos and critical information on hand and inform neighbors and local authorities about the patient’s condition.

• Camouflage Exits: Disguise doors with paint, curtains, or posters, and use visual barriers like black floor mats to deter a patient from leaving.

• Engage and Redirect: Instead of correcting a patient who wants to leave, redirect their focus with a preferred activity or a comforting conversation.

Understanding the Triggers of Wandering

To effectively manage wandering, it’s vital to understand its underlying causes. Wandering is not random but often stems from confusion, restlessness, or a search for something or someone familiar.

Common Reasons for Wandering:

• Confusion: The patient may not recognize their current home and may set out to find their 'real' home or a past one.
• Delusions: They might be reliving a past responsibility, such as going to work or picking up children.
• Disorientation: A change in environment or schedule can trigger anxiety and restlessness.
• Boredom and Restlessness: A lack of physical or mental stimulation can lead to aimless pacing.
• Unmet Needs: The person may be searching for food, the bathroom, or responding to pain or medication side effects.

Environmental Safety and Security Measures

Creating a secure environment is the first and most critical step in preventing wandering. These safety measures should be implemented discreetly to minimize distress.

Securing Entrances and Exits:

1. Install High/Low Locks: Place deadbolts or sliding bolt locks well out of the patient's line of sight, either very high or very low on exterior doors.
2. Use Door Alarms: Motion sensors or chimes on exterior doors can alert caregivers when someone opens them. Pressure-sensitive alarm mats can also be placed at bedsides or in front of exits.
3. Camouflage Doors: Disguise doors by painting them the same color as the surrounding walls or covering them with curtains or posters. For instance, a poster of a bookshelf can make the door less noticeable. A black doormat can also create a visual barrier, as some Alzheimer’s patients perceive it as a hole.
4. Hide 'Trigger' Items: Keep items associated with leaving, such as car keys, purses, hats, or coats, out of sight.

Creating Safe Interior and Exterior Spaces:

• Clear Pathways: Reduce clutter and remove tripping hazards like throw rugs and extension cords. Ensure paths to common areas like the bathroom are well-lit with night lights.
• Secure Outdoor Areas: If possible, create a secure, fenced-in yard or garden where the patient can walk safely outdoors.
• Use Visual Cues: Place signs with simple, clear images or labels on doors to help with reorientation. For example, a picture of a toilet on the bathroom door.

Behavioral and Routine Management Strategies

Addressing the root causes of wandering through daily routines and engagement can be highly effective.

Establishing a Consistent Daily Routine:

• Structured Days: A predictable routine can reduce agitation and confusion. Regular mealtimes, bedtimes, and planned activities provide a sense of security.
• Engaging Activities: Plan meaningful activities to combat boredom and restlessness, especially during periods when wandering is most likely to occur. Activities like folding laundry, listening to music, or light exercise can help.

Responding to the Urge to Wander:

• Redirect, Don't Correct: If the person expresses a desire to 'go home' or 'to work,' validate their feelings without directly contradicting them. Redirect their attention with a calming activity or by suggesting a cup of tea.
• Consider Timing: Many patients experience increased agitation and restlessness in the late afternoon and early evening, a phenomenon known as 'sundowning'. Plan engaging activities during these hours to help manage this behavior.

Technology and Identification

When other strategies aren't enough, technology can provide an additional layer of security and peace of mind.

Utilizing Wearable Trackers:

• GPS Devices: Watches, shoe inserts, and pendants with GPS capabilities can track a person's location in real-time. Some services, like Project Lifesaver, partner with law enforcement to aid in searches.
• Emergency ID: MedicAlert's Safe Return program offers ID jewelry with a 24/7 hotline. Engraving an ID with contact information and 'memory loss' can assist in a safe return.

Home Monitoring Systems:

• Motion Sensors: Wireless motion sensors can be placed at bedsides or near doorways to alert caregivers of movement.
• Smart Doorbells and Locks: Modern smart home systems can provide alerts and remote locking capabilities, offering added control.

Comparison of Wandering Prevention Strategies

Strategy	Pros	Cons	Best for...
Environmental Security (Locks, Alarms)	High effectiveness, immediate alert, physical barrier.	Can be distressing for patient, requires installation, potential for unintended lockouts if unsupervised.	Households with moderate to high wandering risk; nighttime monitoring.
Behavioral Management (Routine, Activities)	Non-intrusive, addresses root cause, improves quality of life.	Requires consistent effort from caregiver, effectiveness varies by individual.	Early to mid-stage Alzheimer's, managing daily restlessness and agitation.
Wearable Technology (GPS, ID Bracelets)	Real-time tracking, peace of mind, valuable in emergencies.	Relies on patient compliance to wear device, may have subscription fees.	All stages of Alzheimer's; especially those with higher wandering risk or who leave home frequently.
Community Awareness (Neighbors, Police)	Creates a network of support, no cost.	Depends on community cooperation, not a substitute for active prevention.	Creating a safety net around the home and neighborhood.

Partnering with the Community and Planning for Emergencies

Despite the best prevention efforts, a patient might still wander. Having a community network and an emergency plan is crucial.

Informing the Local Network:

• Alert Neighbors: Inform trusted neighbors about your loved one's condition and wandering tendency. Provide your phone number and ask them to call if they see the person alone.
• Register with Authorities: Contact local police or sheriff departments to see if they have a registry for individuals with dementia. The Silver Alert system in many areas can help locate missing persons with cognitive impairments.

Creating an Emergency Plan:

• Keep Information Handy: Maintain a recent close-up photograph and a detailed list of identifying features, health conditions, and likely wandering destinations.
• Use Scent Items: Keep a plastic bag with an unwashed item of the person's clothing for search-and-rescue dogs.
• Immediate Action: If the person goes missing, begin searching immediately. Most wanderers are found within a short distance. If not found within 15 minutes, call 911.

The Importance of Professional Guidance and Caregiver Support

Caring for someone with Alzheimer's is challenging. Seeking professional help ensures you are using the most effective and humane strategies.

• Consult a Doctor: A healthcare professional can assess if certain medications contribute to agitation or wandering.
• Support Groups: Connect with other caregivers through organizations like the Alzheimer's Association for shared experiences and coping strategies.
• Professional Care: Consider hiring in-home care for respite or transitioning to a specialized memory care facility when safety becomes a constant concern.

For more in-depth resources on Alzheimer's care, visit the Alzheimer's Association website.

Conclusion

Preventing an Alzheimer's patient from wandering is a continuous process that requires a combination of vigilance, a secure environment, and proactive behavioral strategies. By understanding the causes, implementing physical and technological barriers, establishing routines, and having an emergency plan, caregivers can significantly reduce the risks associated with wandering. Prioritizing the safety and well-being of the individual allows for a calmer, more secure living situation for everyone involved.

Frequently Asked Questions

What are the first signs that an Alzheimer's patient might wander?

Early signs often include restlessness, pacing, forgetting familiar places, or talking about going to a former home or job. The patient might also appear lost or anxious in new or busy environments.

Are there any specific times of day that wandering is more likely?

Yes, many people with Alzheimer's experience 'sundowning,' a state of increased confusion and agitation that occurs in the late afternoon and evening. This is a high-risk time for wandering.

Should I lock an Alzheimer's patient in the house alone?

No, you should never lock a person with dementia in the house alone. This can create a dangerous situation in case of an emergency, such as a fire. Supervision is always necessary.

What should I do immediately if an Alzheimer's patient goes missing?

Begin searching the immediate area and nearby familiar places first. If you don't find them within 15 minutes, call 911 immediately and inform them that the person has dementia.

How can I get my loved one to wear a GPS tracker?

Disguise the tracker as a normal accessory, like a watch, pendant, or a keychain they are accustomed to carrying. Some trackers are even built into shoe inserts to increase compliance.

Can daily routine and activities really help prevent wandering?

Absolutely. A predictable and structured routine helps reduce confusion and anxiety. Engaging activities can combat boredom and restlessness, which are common triggers for wandering.

Is it better to correct them if they say they need to 'go home'?

It is not recommended to correct them directly. This can cause more agitation. Instead, use validation and redirection. Say something reassuring like, 'We are safe here,' and then offer a distraction like a snack or a walk in the secure backyard.