What Triggers Wandering in People with Dementia?
Wandering is a common symptom of dementia, but it is rarely a random or aimless action. Instead, it is a purposeful behavior for the individual, stemming from an underlying need or feeling that their deteriorating cognitive function cannot properly articulate. By understanding the potential triggers, caregivers can often address the root cause and de-escalate the situation before it becomes a safety risk.
Psychological and Emotional Triggers
- Confusion and Disorientation: As dementia progresses, individuals may become disoriented, even in familiar environments. This can lead to a sense of being lost and a compulsion to find their way to a place they feel is 'home,' even if they are already there.
- Anxiety, Fear, or Distress: A person may wander to escape a perceived threat or uncomfortable situation. This could be triggered by unfamiliar noises, a crowd, or even feelings of fear or sadness.
- Following Past Routines: Many people with dementia attempt to relive past routines, such as going to work, picking up children, or running an errand. This is a common form of goal-directed wandering.
Physical and Environmental Triggers
- Unmet Basic Needs: The urge to wander can be prompted by a simple, unmet need. The person may be looking for a bathroom, food, water, or trying to find comfort due to pain or being too hot or cold.
- Boredom and Restlessness: A lack of physical or mental stimulation can lead to restlessness and a need to move. For individuals who were very active before their diagnosis, this drive to be in motion often remains.
- Overstimulation or Environmental Changes: A new or confusing environment can easily overwhelm a person with dementia, causing them to seek escape. Loud noises, bright lights, or a busy setting can be disorienting.
- Environmental Cues: Seeing items associated with leaving, like a coat, keys, or a handbag, can trigger the impulse to go outside. Similarly, a visible doorway or exit can act as a trigger.
Comparing Wandering and Pacing
While often used interchangeably, wandering and pacing can have different characteristics. Understanding the distinction can help tailor a caregiver's response.
| Feature | Wandering | Pacing |
|---|---|---|
| Movement | Can be random or purposeful, often covers large distances. | Repetitive movement, typically within a small, confined area. |
| Purpose | Often driven by a specific, albeit cognitively impaired, goal, such as finding a past location. | May be a response to restlessness, anxiety, or boredom without a clear destination. |
| Risk Level | High risk, especially if it involves elopement, as the person may become lost and face exposure. | Generally lower risk, though continuous pacing can lead to fatigue, falls, and distress. |
| Triggers | Confused attempts to perform past routines, disorientation, searching for something. | Anxiety, boredom, unspent energy, or a physiological need. |
Dangers Associated with Dementia Wandering
Wandering is not just an inconvenience; it can be incredibly dangerous and even life-threatening for someone with dementia. The impaired judgment and navigational skills that accompany the condition mean that a person who wanders may face a variety of serious hazards.
- Getting Lost: The most immediate danger is becoming lost and being unable to find their way home. A person may not remember their address, name, or who to call for help.
- Exposure to Elements: If they wander outside, they are at risk of exposure to extreme weather, whether it's freezing temperatures or intense heat, which can lead to hypothermia or dehydration.
- Accidents and Injuries: Wandering can lead to falls, getting struck by a vehicle, or other accidental injuries. People may wander near busy roads, water bodies, or rough terrain.
- Victimization: A lost or confused person with dementia is vulnerable to exploitation or harm from strangers.
How to Manage and Prevent Wandering Safely
Caregivers can implement several proactive strategies to manage and prevent wandering, creating a safer environment for their loved one.
- Establish a Consistent Routine: Maintain a structured daily routine to provide a sense of stability and reduce anxiety and confusion. Plan engaging activities during times when wandering is most likely to occur.
- Address Unmet Needs: Regularly check for basic needs like hunger, thirst, or the need to use the bathroom. A simple trip to the kitchen for a snack or offering fluids might be all that is needed.
- Create a Safe Indoor Walking Area: If the person is restless, create a safe, supervised area indoors or a secured outdoor garden where they can walk freely and safely.
- Use Wandering Deterrents and Safety Locks: Install unobtrusive locking systems, such as sliding bolts placed high up or childproof covers on doorknobs. You can also use visual barriers, like painting doors to match the walls or placing a black mat in front of an exit to mimic a hole.
- Utilize Technology: Consider motion sensors or pressure-sensitive alarms on beds and doors to alert caregivers when a person is on the move. GPS tracking devices, available as watches or shoe inserts, can be an effective way to locate a person quickly if they do wander.
- Keep Trigger Items Out of Sight: Store items like keys, coats, and handbags away from the exit to avoid triggering the urge to leave.
Responding to a Wandering Incident: A Step-by-Step Guide
- Start Searching Immediately: Begin searching the immediate vicinity. Check all rooms of the house, including lesser-used areas like the garage, basement, or closets. Also, check the yard and surrounding landscape, as wanderers can sometimes be found in bushes or brush.
- Know Their Patterns: Consider the person's habits. Did they have a favorite place to walk or a past job they might try to visit? Many wanderers follow a path determined by their dominant hand, tending to turn right more often if right-handed.
- Mobilize Support: Enlist the help of family, friends, and neighbors. Show them a recent, clear photo of your loved one and their clothing description.
- Call 911 within 15 Minutes: If the person is not found within 15 minutes, do not hesitate to call 911. Inform them that the missing person has dementia. Every minute is critical in finding them safely.
- Use Search Resources: Inform authorities about any tracking technology your loved one might be wearing. Also, ask if your local area participates in programs like Silver Alert or MedicAlert, which can help in recovery efforts.
Conclusion
Wandering is a complex and challenging aspect of caring for someone with dementia, but it is a behavior that can be managed with understanding, planning, and swift action. By identifying and addressing the underlying triggers, implementing preventative strategies, and creating a robust emergency plan, caregivers can significantly reduce the risks associated with wandering. This proactive approach not only enhances the safety of the individual but also provides greater peace of mind for their family and caregivers. For more comprehensive resources and support, refer to the Alzheimer's Association.
