Which of these is a common reason why people living with dementia wander?

According to the Alzheimer's Association, six in ten people with dementia will wander at some point, a behavior that can be both frightening and dangerous. Understanding the root cause is the first step toward effective management, so which of these is a common reason why people living with dementia wander?

Quick Summary

A common reason for wandering among people with dementia is an attempt to fulfill a past routine or search for something familiar, often fueled by confusion and a desire to return to a perceived 'home' or prior responsibility. This behavior can also stem from restlessness, boredom, or an unmet basic need, such as hunger or discomfort.

Key Points

• Past Routines: A common reason for wandering is the attempt to follow a deeply ingrained past routine, like going to a former workplace.

• Searching for Familiarity: People with dementia often wander while looking for a person, place, or object they believe is lost or familiar.

• Unmet Needs: Basic unmet needs, such as hunger, thirst, or the need to use the restroom, can trigger wandering behavior.

• Boredom and Restlessness: Lack of physical or mental stimulation can lead to restlessness, causing a person with dementia to pace or wander.

• Environmental Factors: Overstimulation, stress, anxiety, or confusion caused by a new or noisy environment can trigger a desire to escape.

• Sundowning: Wandering often increases during the evening hours due to changes in light, fatigue, and disruption of internal body clocks.

Deciphering the Triggers: Why Wandering Occurs

For a caregiver, the sight of a loved one with dementia wandering can be terrifying. It's often misunderstood as aimless behavior, but in reality, wandering is frequently driven by an underlying need or emotion that the person can no longer communicate effectively. One of the most common reasons is the attempt to follow a deeply ingrained past routine, or the search for something familiar they perceive as lost. As cognitive abilities decline, the person's brain struggles to orient itself in the present, causing them to retreat into memories and attempt to live them out. This can lead them to seek out their former workplace, childhood home, or even a spouse or child from decades past.

The Role of Unmet Needs and Environment

Beyond past routines, wandering can be a direct result of unmet physical or emotional needs. The person with dementia may be feeling hungry, thirsty, or need to use the bathroom, but their ability to articulate this need has diminished. Instead of asking for help, they might get up and start walking in an attempt to find what they're looking for. Similarly, boredom or restlessness can prompt a person to wander. Lacking stimulation, they may feel a physical urge to move and find an activity. The environment itself also plays a significant role; an over-stimulating setting with loud noises or a confusing, unfamiliar space can cause anxiety and fear, leading the individual to seek an escape.

The Phenomenon of Sundowning

Many caregivers observe an increase in wandering during the evening hours, a behavior commonly referred to as "sundowning". This can be attributed to several factors. As the day winds down, changes in natural light can cause confusion and disorientation. Furthermore, disrupted sleep patterns common in dementia can leave a person feeling wide awake and restless at night. This combination often leads to aimless pacing and a heightened desire to leave the current location in search of something more familiar or comfortable.

Comparison of Common Wandering Triggers

To better understand the motivations behind wandering, consider this comparison of potential triggers and the appropriate responses.

Trigger	Description	Caregiver Response
Searching for something	Trying to find a lost item, a person, or a familiar place.	Redirect their focus. Calmly ask what they are looking for and offer to help find it, then suggest a different, engaging activity.
Fulfilling a routine	Attempting to follow a schedule from their past, like going to work or picking up children.	Validate their feeling but gently redirect. "It's a holiday today; let's have some tea" is better than correcting them.
Unmet basic needs	Feeling hungry, thirsty, needing the restroom, or experiencing pain.	Proactively check on their basic needs throughout the day. Label important rooms with pictures or text to help them find their way.
Boredom or restlessness	Lacking enough mental or physical activity during the day, leading to pacing or a desire to move.	Schedule regular, engaging activities like walking in a safe area, folding laundry, or gardening.
Environmental overstimulation	Feeling anxious or fearful due to loud noises, crowds, or unfamiliar surroundings.	Create a calm, quiet environment, especially during times of day when wandering is more likely. Reduce clutter and loud background noise.

Practical Strategies for Managing and Preventing Wandering

Effectively managing wandering requires a multi-faceted approach that addresses both the underlying triggers and the physical safety of the individual. Implementing a consistent daily routine is crucial, as predictability can reduce anxiety and confusion. This routine should include periods of both physical and mental activity to prevent boredom and restlessness.

• Secure the Environment: Install alarms on doors and windows that chime when opened to alert caregivers. Locks placed high or low on doors, out of the line of sight, can also be effective. Consider using camouflage techniques, such as covering doors with large posters or painting them to match the wall. Fencing in the yard with a locked gate can also provide a safe outdoor space.
• Use Identification and Tracking: Ensure the person wears a medical ID bracelet with their name, diagnosis, and emergency contact information. For a more advanced solution, GPS tracking devices built into shoes, watches, or pendants can provide real-time location monitoring. Services like the Alzheimer's Association's Safe Return program are also valuable resources.
• Manage Triggers: Pay attention to the times and situations when wandering occurs to identify patterns. If it happens in the evening, try a relaxing bedtime routine. If it seems linked to a past routine, gently redirect with a comforting lie rather than confronting them. Make sure basic needs are met consistently.
• Involve Loved Ones and Neighbors: Create a network of trusted neighbors and friends who are aware of the person's condition and can alert you if they are seen wandering alone. Have a recent photo readily available for use in case of an emergency.

Creating a Safety Plan

Preparing for the possibility of wandering is one of the most important steps a caregiver can take. A comprehensive safety plan can save crucial time and reduce stress during a crisis. This involves not only securing the environment but also having a clear, actionable plan for what to do if the person goes missing.

1. Register with Local Authorities: Contact your local police department or sheriff's office to see if they have a registry for at-risk individuals with dementia. This can help speed up the search process if they are reported missing.
2. Maintain Up-to-Date Records: Keep a recent, clear photograph of the person and a list of important contact numbers, including family, friends, and doctors.
3. Create a Rapid Response Network: Establish a phone tree to quickly notify a network of trusted individuals who can assist in a search.
4. Know Likely Destinations: Note places the person might wander to based on their personal history and memories. This could be a former home, a relative's house, or a favorite old park.

Always Best Care of Seattle offers resources and guidance on how to manage behaviors like wandering, and can help explore options including in-home care or memory care services. Understanding and addressing the reasons behind wandering is a critical part of providing compassionate, safe care for individuals living with dementia.

Frequently Asked Questions

What is the most common reason why a person with dementia wanders?

One of the most common reasons is the desire to follow a past routine or search for a familiar place or person, often driven by disorientation and memory loss.

Can boredom cause a person with dementia to wander?

Yes, boredom and a lack of physical or mental stimulation can lead to restlessness and trigger wandering behavior as the person seeks something to do.

Does sundowning increase the risk of wandering?

Yes, sundowning is a phenomenon where confusion and agitation worsen in the evening, often increasing the likelihood of wandering at night.

What should you do if your loved one with dementia wants to 'go home'?

Instead of arguing or correcting them, it's best to validate their feelings and gently redirect their attention to a calming activity, like looking at photos or listening to music.

How can a caregiver prevent wandering from happening?

Preventative measures include maintaining a consistent daily routine, ensuring basic needs are met, and creating a safe and secure environment with alarms and locks.

Is it safe to let a person with dementia wander in a secure area?

Yes, allowing a person to walk in a safe, enclosed area like a fenced yard can be a healthy outlet for restlessness, as long as they are supervised.

What is a 'Safe Return' program?

The Alzheimer's Association's 'Safe Return' program is a service that provides identification and a 24-hour support line to help locate a person with dementia who has wandered and gone missing.