How to Stop a Dementia Patient from Going Outside: A Caregiver's Guide

According to the Alzheimer's Association, 60% of people with dementia will wander at least once. This common and dangerous behavior can be prevented with a combination of environmental adjustments, strategic communication, and safety technology. Here is how to stop a dementia patient from going outside, ensuring their safety and your peace of mind.

Quick Summary

This guide provides practical strategies for caregivers to prevent wandering in dementia patients. It covers home security measures, behavioral management techniques, and the use of technology to ensure the person's safety. The article also addresses how to respond when a person insists on leaving the house.

Key Points

• Identify Triggers: Keep a log of wandering episodes to find patterns related to boredom, fear, or unmet needs.

• Install Secure Locks: Use keyed deadbolts or high/low locks on doors and windows to prevent unsupervised exit.

• Camouflage Exits: Disguise doors with curtains, wallpaper, or dark mats to make them less noticeable to the patient.

• Employ Redirection: Instead of arguing, validate their feelings and distract them with a familiar, calming activity.

• Use Tracking Technology: Personal GPS trackers worn as a bracelet or pendant can alert caregivers and help locate a missing person quickly.

• Prepare an Emergency Plan: Have a list of emergency contacts and recent photos ready to give to law enforcement if the person becomes lost.

• Inform Your Neighbors: Make neighbors aware of the person's condition so they can alert you if they see them out alone.

• Provide Engagement and Exercise: Offer structured, meaningful activities and supervised physical exercise to reduce restlessness and anxiety.

Understanding the Root Causes of Wandering

Wandering is not a random act but a behavior often driven by underlying needs or confusion. Identifying these triggers can help you address the root cause and reduce the impulse to leave the home.

• Searching for something or someone: The person may believe they need to pick up a child from school, go to work, or find a deceased family member.
• Boredom or restlessness: A lack of engaging activity can lead to a sense of purposelessness and the desire to leave.
• Anxiety or fear: A person may feel disoriented or unsafe in their current environment and seek the comfort of a remembered "home".
• Physical discomfort: Unmet basic needs, such as hunger, thirst, or the need to use the bathroom, can prompt a search for relief.
• Time-shifting: The individual may be reliving an earlier part of their life, when it was normal for them to leave the house at a particular time of day.

Environmental Adjustments for a Secure Home

Securing the physical environment is a crucial step in preventing a dementia patient from leaving unsupervised.

• Secure Doors and Windows: Install keyed deadbolts or locks placed either very high or very low, out of the person's typical line of sight. Consider alarms on doors and windows that chime when opened. For windows, install safety devices to limit how far they can be opened.
• Camouflage Exits: Make doors less obvious by covering them with a curtain, a mirror, or wallpaper that matches the surrounding wall. A dark rug or black tape placed in front of an exit can also act as a visual barrier, as some people with dementia may perceive it as a hole.
• Conceal Triggers: Hide items that signal departure, such as car keys, purses, coats, and shoes, in a closet or drawer out of sight. If the person is still able to drive, a steering wheel lock may be necessary.
• Create a Safe Outdoor Space: Fence off a yard or patio with a secure, locked gate so the person can still get fresh air safely.
• Improve Visibility at Night: Place night lights in hallways, bedrooms, and bathrooms to help reduce confusion and make nighttime wandering less likely.

Managing Behavior with Compassion and Strategy

Directly confronting or arguing with a person who wants to leave can increase their anxiety and agitation. Instead, use redirection and validation techniques.

• Validate Feelings and Redirect: If they say, "I need to go home," calmly respond with reassurance like, "We'll be going home soon, but first, can you help me with this?". This validates their feelings while creating a distraction with a familiar, purposeful activity, such as folding laundry, watering plants, or looking at a photo album.
• Identify Patterns: Keep a log of when the wandering behavior occurs to help identify triggers. For example, if it happens during late afternoon (known as sundowning), plan a structured, engaging activity for that time.
• Encourage Safe Movement: Supervised walks or structured physical activities can help reduce restlessness and provide a safe outlet for a person's energy.
• Consider a 'Therapeutic' Drive: For some, a short car ride around the block can provide the illusion of going somewhere and returning. You can say, "Looks like there's traffic, let's go back and try again later," or "We made it home!" as you pull into the driveway.

Comparison of Security and Management Tools

Feature	Physical Barriers (Locks, Fences)	Technology (Alarms, GPS)	Behavioral Strategies (Redirection, Activities)
Cost	One-time purchase, varies by type and installation.	Varies from low-cost alarms to expensive monitoring services.	Low to no cost, primarily requires caregiver time and patience.
Effectiveness	Highly effective for preventing access to exits.	Excellent for alerting caregivers and tracking location in case of elopement.	High success rate, but effectiveness varies by individual and situation.
Limitations	Cannot prevent all attempts; determined individuals may bypass.	Cannot prevent wandering, only alerts and tracks. May cause confusion.	Not always effective, especially during times of high agitation. Requires consistent effort.
Best For	Creating a secure perimeter and blocking exits.	Rapidly locating a person who has left the property.	Addressing the underlying cause of the behavior.
Ethical Considerations	Must not be used to lock a person in alone, which is a safety risk.	Privacy concerns and potential for causing distress to the person with dementia.	Respects the person's autonomy and emotional state.

Implementing a Comprehensive Safety Plan

A multi-pronged approach is the most effective way to ensure a dementia patient's safety. This includes preparing for potential wandering incidents.

• Create and Share an Emergency Plan: Develop a list of emergency contacts, local hospitals, and information about the person's routines. If they go missing, share this information with law enforcement and search volunteers immediately.
• Enroll in a Safe Return Program: Consider services like MedicAlert® + Safe Return®, which provide a 24/7 hotline and a medical ID bracelet.
• Inform Your Community: Tell trusted neighbors about the situation and ask them to call you if they see your loved one outside alone. Provide a recent photograph.
• Use Personal Identification: Ensure the person wears a medical ID bracelet or has identification sewn into their clothing. The ID should include their name, condition (e.g., “memory loss”), and an emergency contact number.
• Utilize Tracking Devices: GPS tracking devices are available as pendants, bracelets, and shoe inserts. These can alert you when the person leaves a predetermined area and provide their real-time location.

Conclusion

Managing wandering behavior in a dementia patient requires a combination of empathy, environmental security, and proactive planning. By understanding the reasons behind the behavior, implementing physical and technological safety measures, and using compassionate redirection, caregivers can significantly reduce the risks associated with a person going outside unsupervised. A comprehensive strategy ensures the person's safety while maintaining their dignity and quality of life. This approach, while demanding, allows caregivers to focus on meaningful engagement rather than constant anxiety over safety.

Frequently Asked Questions

Why does a dementia patient keep wanting to go outside or 'go home'?

This is often a sign of disorientation, anxiety, or boredom. The person may be searching for the safety and familiarity of a remembered "home" from their past, or they may be reliving old routines like going to work.

What is the best type of lock to install to prevent wandering?

Locks should be installed either high above or low below the patient's eye level to make them less noticeable. Keyed deadbolts, sliding bolts, and simple covers placed over doorknobs can all be effective deterrents.

Is it ethical to lock a dementia patient in their home?

Never lock a person with dementia in their home alone, as this creates a significant fire risk and can cause panic. Locks should only be used when another person is present and the escape route is not blocked. This action is a deprivation of liberty and should be managed with social services involvement if the person does not have the capacity to consent.

How can I distract a dementia patient who insists on leaving?

Try redirecting their focus to a pleasant, familiar activity. You can suggest a short car ride, looking at a photo album, or helping with a simple chore like folding towels. Validate their desire by agreeing to the idea of leaving 'soon,' then gently transition to the distraction.

What are some technological solutions to prevent wandering?

Technological aids include door and window alarms that chime when opened, pressure-sensitive mats placed by exits, and GPS tracking devices. Wearable GPS trackers are available in the form of watches, bracelets, or shoe inserts that can alert you if the person leaves a safe zone.

What should I do if my loved one with dementia has already wandered off?

If you cannot find the person within 15 minutes, call 911 immediately and inform them that the person has dementia and a tendency to wander. Provide a recent photo and a description of their last known clothing. Check common wandering destinations and notify your neighbors.

How can I make my home environment safer and less stimulating?

Reduce clutter, use non-glare lighting, and monitor noise levels to decrease agitation. Label doors with symbols or pictures to help the person orient themselves. Store items like coats and keys out of sight to avoid triggering the impulse to leave.