Which one of the following is a strategy to prevent your client living with dementia from wandering?

According to the Alzheimer's Association, 60% of people with dementia will wander at some point, making it a common and serious safety concern. Addressing this behavior requires a proactive and compassionate approach. Understanding which one of the following is a strategy to prevent your client living with dementia from wandering is essential for all caregivers to ensure their client's well-being.

Quick Summary

Securing the client's home environment with strategically placed locks, alarms, and visual cues is a key strategy to prevent wandering. This must be combined with proactive engagement and consistent routines to address the underlying causes of the behavior, such as boredom or restlessness.

Key Points

• Secure the Home Environment: Install high or low locks, alarms, and use visual deterrents like black mats or curtains to camouflage exits.

• Maintain Routine and Engagement: Establish a consistent daily schedule and plan meaningful activities to reduce restlessness and anxiety.

• Utilize Identification and GPS Technology: Ensure the client has a medical ID and consider a wearable GPS tracking device for added safety and quick location.

• Communicate and Redirect: Use validation techniques when a client expresses the desire to leave, then gently redirect them to a safe, engaging activity.

• Create an Emergency Plan: Have a 'wandering kit' ready with a recent photo and vital information, and inform neighbors and local authorities beforehand.

• Address Underlying Needs: Check for unmet physical needs like hunger, thirst, or pain, as these can be triggers for wandering behavior.

Understanding the Root Causes of Wandering

To effectively prevent a client with dementia from wandering, it is crucial to understand the potential triggers behind the behavior. Wandering is often not a random act but a response to confusion, anxiety, or an unmet need.

Common Triggers for Wandering

• Disorientation: A client may feel lost, even in familiar surroundings, and wander in an attempt to find a more recognizable place. They might be searching for a long-lost home or trying to get back to a past routine, like going to work.
• Restlessness and Boredom: A lack of physical or mental stimulation can lead to restlessness. A person may start pacing or wander out of boredom to seek an engaging activity.
• Unmet Needs: Wandering can be a non-verbal way of communicating a basic need. They might be thirsty, hungry, in pain, or need to use the bathroom. A client might wander the house looking for food or a water source.
• Stress or Overstimulation: Noisy, crowded, or unfamiliar environments can be overwhelming and lead to the desire to escape to a quieter place. The phenomenon known as 'sundowning,' where confusion and agitation increase in the late afternoon and evening, can also trigger wandering.
• Following an Old Routine: A client may be trying to follow a deeply ingrained past routine, such as picking children up from school or going to a former workplace.

Environmental Modifications for a Safer Home

One of the most effective and direct strategies to prevent wandering is to modify the home environment to increase safety and reduce exit-seeking behavior. These changes should be implemented subtly to avoid causing anxiety or frustration for the client.

Securing Exits and Windows

• Install Locks: Placing deadbolts or other security latches high above or low below the usual line of sight can prevent a client from easily unlocking doors. For a client who can navigate standard locks, a more complex latch or key-locked system may be needed. Always ensure keys are readily accessible for emergencies, but out of the client's reach.
• Use Door Alarms: Sensors that chime or sound an alarm when a door or window is opened can provide an immediate alert. Pressure-sensitive mats placed in front of exits can also alert caregivers when a client is approaching a doorway.
• Camouflage Doors: Painting doors the same color as the surrounding walls or hanging a curtain over them can make them less conspicuous. Another visual trick is to place a black doormat in front of the door, as some people with dementia may perceive the dark color as a hole they should not step over.
• Remove Triggers: Keep items that signify leaving, such as coats, shoes, car keys, and purses, stored in a closet or drawer out of plain sight. The visual cue of these items can prompt the instinct to leave.

Creating a Safe Space

• Declutter Pathways: Restless pacing is common, so ensure walkways are clear of clutter, throw rugs, and other obstacles that could cause a fall.
• Secure Outdoor Areas: If possible, a fenced-in yard with a locked gate allows the client to enjoy the outdoors safely without the risk of wandering into unfamiliar territory.
• Provide Clear Signage: Use simple pictures or large, clear signs to label common areas like the bathroom or bedroom. This can help orient a confused client and reduce the urge to wander in search of a specific room.

Behavioral Strategies and Routines

Beyond environmental changes, a multi-faceted approach includes focusing on the client's emotional and physical state. Consistency and engagement are powerful tools for managing the behavior.

The Importance of Routine

1. Establish a Structured Day: A consistent daily routine, with regular times for meals, exercise, and sleep, can provide a sense of security and predictability, reducing confusion and anxiety.
2. Plan Meaningful Activities: Engage the client in simple, enjoyable tasks throughout the day. Activities like folding laundry, watering plants, or listening to music can redirect restless energy and provide a sense of purpose.
3. Address Restlessness: If wandering tends to happen at a certain time of day (e.g., during sundowning), plan a relaxing activity for that period. A short, supervised walk or some quiet music could be beneficial.

The Power of Redirection and Validation

When a client expresses a desire to leave, do not contradict or argue with them. This can increase agitation. Instead, use validation and gentle redirection. For example, if they insist they need to go to work, you could respond, "You worked so hard today, let's sit and have a cup of tea now," and then transition to a different activity.

Technology, Identification, and Community

Modern solutions and a strong support network offer additional layers of safety.

Comparison of Wandering Prevention Security Measures

Feature	Low-Tech Solutions	Mid-Tech Solutions	High-Tech Solutions
Cost	Low (signs, mats)	Moderate (alarms, specialized locks)	High (GPS trackers, smart home)
Effectiveness	Varies by individual	Generally effective	Very effective
Setup Difficulty	Easy	Easy to moderate	Moderate to difficult
Caregiver Effort	Requires constant monitoring	Provides alerts for intervention	Provides real-time tracking
Client Independence	Minimal impact	Minimal impact, adds safety	Can feel more restrictive
Best Used For	Initial deterrence or visual cues	Active alerts for exits	Finding a lost client quickly

Essential Safety Measures

• Wearable GPS Trackers: Devices disguised as watches or pendants can track a client's location in real-time, providing peace of mind and allowing for quick action if they do wander.
• Medical ID: Ensure the client wears a medical identification bracelet or necklace stating their condition and providing an emergency contact number. Consider sewing labels into clothing for an extra layer of security.
• Alert the Community: Inform trusted neighbors, local businesses, and law enforcement about the client's tendency to wander. Provide a recent photo and contact information to speed up response time in an emergency. The Alzheimer's Association has a wealth of information and resources for caregivers dealing with wandering behavior, and their website is an invaluable tool for education and support: https://www.alz.org/help-support/caregiving/safety/wandering.

Developing an Emergency Plan

No matter how many precautions are taken, it is always wise to have a plan in case of an emergency.

1. Create a Wandering Kit: Assemble a file with a recent, clear photograph of the client, medical information, and a list of familiar places they might try to go, such as a former home or workplace. This information can be critical for law enforcement.
2. Know Who to Call: If a client goes missing, call 911 immediately. Time is of the essence. Inform the dispatcher that a vulnerable adult with dementia is missing.
3. Mobilize Your Network: Have a pre-made list of friends and family to call for help in the search. Informing this network quickly can help expand the search area and increase the chances of a fast and safe return.

Conclusion: A Holistic Approach is Key

Preventing wandering in a client with dementia requires a combination of strategies. There is no single answer to the question of which one strategy is most effective; rather, it is the integration of environmental safety measures, consistent behavioral routines, and a robust support network that provides the highest level of protection. By understanding the reasons behind the behavior and approaching the situation with patience and compassion, caregivers can significantly reduce the risk of wandering and ensure the safety and well-being of their client.

Frequently Asked Questions

What is the most immediate way to secure my home from wandering?

Installing door and window alarms or pressure-sensitive mats that alert you when an exit is opened is one of the most immediate and effective steps. This provides an instant notification if your client attempts to leave.

How can I stop my client from leaving at a specific time, like during sundowning?

If wandering occurs at a predictable time, plan a calming activity for that period. This could be a gentle, supervised walk, listening to soft music, or engaging in a familiar, pleasant task to redirect their energy and focus.

Are there any visual tricks I can use to prevent my client from using a door?

Yes, some visual tricks can be effective. You can camouflage the door by painting it to match the wall or hanging a curtain over it. Another technique is to place a black doormat in front of the door, as some people with dementia perceive it as a hole they will not cross.

What should I do if my client with dementia wants to 'go home'?

Do not argue or tell them they are already home. This can cause agitation. Instead, validate their feelings and use gentle redirection. Acknowledge their desire, then distract them with a pleasant activity, like looking at old photo albums or having a cup of tea.

How important is a daily routine in preventing wandering?

A consistent daily routine is very important. Predictable schedules for meals, activities, and sleep reduce anxiety and confusion, helping to minimize the restless energy that often leads to wandering.

Is it safe to use a GPS tracker for a client with dementia?

Yes, GPS trackers are a safe and effective way to monitor a client's location. They come in various forms, such as watches, pendants, or apps, and provide an essential safety net, especially for clients with a high risk of wandering.

What information should I share with my neighbors about my client's wandering?

Inform trusted neighbors about your client's dementia and their tendency to wander. Provide them with a recent photo and your contact information. Ask them to call you immediately if they see your client out alone.