What is considered wandering? A caregiver's guide to understanding the behavior

According to the Alzheimer's Association, 6 out of 10 people with dementia will wander at least once, creating a significant safety risk for them and stress for their loved ones. Understanding what is considered wandering is the first step toward proactive management and ensuring the safety of those with cognitive impairments.

Quick Summary

Wandering is when a person with cognitive impairment, often related to dementia or Alzheimer's, roams away from their safe environment and becomes lost or disoriented, driven by confusion, anxiety, or unmet needs. The behavior can range from aimless pacing to purposeful attempts to leave the home, posing a serious safety risk if not managed properly.

Key Points

• Definition: Wandering is when a person with cognitive impairment, such as dementia, roams or moves away from a safe area, often without purpose and becoming disoriented.

• Not Always Aimless: Wandering can be either random and aimless (like pacing) or goal-directed, motivated by a desire to fulfill past routines or search for a past home.

• High Risk: Approximately 60% of people with dementia will wander at least once, posing a significant safety risk, especially if they are not found quickly.

• Triggers: Common triggers include confusion, anxiety, boredom, unmet needs (like hunger or pain), and attempts to continue old routines.

• Prevention: Strategies for caregivers include securing the home with locks and alarms, creating a stable routine, and providing engaging activities to reduce restlessness.

• Emergency Response: If a senior goes missing, call 911 within 15 minutes after a brief search of the immediate area, and inform authorities of the person's dementia.

• Technology: GPS tracking devices and medical ID jewelry are effective tools for monitoring and ensuring a safe return.

Decoding Wandering: More Than Just a Walk

Wandering is a common and complex behavior in individuals with cognitive impairments, most notably dementia and Alzheimer’s disease. It extends beyond a simple walk or stroll; it is often an aimless or purposeful movement that can lead to confusion, disorientation, and danger. The motivation behind the behavior can vary, from feelings of boredom or anxiety to a deeply ingrained need to return to a past home or fulfill a former obligation, like going to work. Recognizing the nuance of this behavior is critical for caregivers to provide effective support and create a safer environment.

The Diverse Types of Wandering

Not all wandering looks the same. Experts have identified different patterns, each with its own set of potential triggers and risks. Understanding the type of wandering can help caregivers tailor their response and prevention strategies.

• Goal-Directed Wandering: This is purposeful movement with a destination in mind, even if that destination is not logical to others. The person may be trying to go "home" (a home from their past), go to work, or pick up children who are now adults. This type is often driven by a sense of duty or anxiety.
• Aimless or Pacing Wandering: This involves repetitive, random movement without a clear purpose. It might manifest as pacing up and down a hallway or circling a room. It is often linked to feelings of restlessness, boredom, or physical discomfort, and serves as a way to burn off anxious energy.
• Environmentally Cued Wandering: This occurs when a person is triggered by a specific object or situation. Seeing a coat by the door, for example, might trigger an urge to put it on and leave. The behavior is a response to environmental cues rather than a deeply felt need.
• Reminiscent Wandering: The individual may be reliving past experiences, searching for a long-deceased loved one, or responding to an imagined environment from the past. This type is deeply connected to memory and can be particularly distressing for both the senior and caregiver.

Why Do Seniors with Dementia Wander?

Several factors can trigger wandering in older adults with cognitive decline. Addressing these underlying causes can be a powerful tool for prevention.

• Confusion and Disorientation: As memory and spatial awareness decline, a person may not recognize their current surroundings, leading them to believe they are lost and must find their way home.
• Anxiety, Fear, or Stress: Feelings of being lost, overstimulated by a noisy environment, or uncertain can trigger a “flight” response, causing the person to seek an exit.
• Unmet Needs: Simple needs like hunger, thirst, or the need to use the restroom can prompt a senior to wander in search of a solution. Pain or discomfort can also cause restlessness and pacing.
• Maintaining Past Routines: The desire to fulfill a previous routine, such as leaving for a daily walk or driving to the grocery store, can be a powerful motivator.
• Boredom and Lack of Stimulation: A lack of engaging activities and a quiet environment can lead to restlessness. Wandering becomes a way to find purpose and activity.

Comparing Wandering and Pacing

Understanding the distinction between wandering and pacing is important for caregivers to identify the underlying cause and determine the best intervention. While they often look similar, their motivations and implications can differ.

Feature	Pacing	Wandering
Movement	Repetitive, back and forth motion in a confined, familiar area (e.g., hallway, living room).	Aimless or goal-directed movement, often leading the person away from their familiar and safe space.
Motivation	Often driven by anxiety, restlessness, boredom, or an unmet physiological need (hunger, pain).	Can be driven by a range of factors including confusion, searching for a past person or place, or trying to escape a perceived threat.
Direction	Predictable, often following a specific, repeated path.	Unpredictable and can occur in any direction, indoors or outdoors.
Immediate Risk	Lower immediate risk, but indicates an unmet need. Can increase agitation.	High immediate risk of getting lost, injured, or facing exposure to the elements.

Implementing Practical Prevention Strategies

Caregivers can implement several practical steps to reduce the risk of wandering and ensure safety. These are best used in combination and may need adjustment as a person's condition changes.

1. Secure the Home Environment: Install alarms on doors and windows that chime when opened. Place complex locks, such as sliding bolts, high or low on doors, out of the person's line of sight. Consider camouflaging doors with a curtain or painting them to match the wall.
2. Provide Routine and Engaging Activities: A structured daily routine can reduce anxiety and boredom. Plan meaningful activities, like folding laundry, listening to music, or taking a supervised walk outside during the time of day when restlessness is most likely to occur.
3. Use Identification and Tracking Devices: Ensure the person wears a medical ID bracelet with their name, condition (e.g., memory loss), and contact information. Consider a GPS tracking device, available as watches or shoe inserts, for an extra layer of safety. The Alzheimer's Association offers a nationwide emergency response service called MedicAlert® with 24/7 support. Learn more about the program here.
4. Inform Neighbors and Local Authorities: Tell trusted neighbors and the local police department about your loved one's condition and wandering risk. Provide them with a recent photograph and a description of the individual.
5. Address Underlying Triggers: Regularly assess if the person is in pain, hungry, thirsty, or needs to use the restroom. Ensure the home environment is calm and not overly stimulating with noise or clutter. Limit daytime naps to regulate nighttime sleep patterns.

What to Do During a Wandering Emergency

If a person with dementia does wander and cannot be found, acting quickly is crucial. Statistically, the risk of serious injury or death rises significantly if the person is not found within 24 hours.

• Begin Search Immediately: Check the home thoroughly, including closets, the garage, and any small or unusual spaces. Look in the yard and immediate neighborhood.
• Call 911 Immediately: If the person is not located within 15 minutes, call 911 and report them missing. Inform the authorities that the person has dementia and a tendency to wander. Provide a recent photo and their potential destinations based on past behaviors.
• Assemble a Search Party: Enlist neighbors, friends, and family to assist in the search. A clear plan can increase efficiency and reduce panic.

A Plan for Peace of Mind

Coping with wandering is one of the most challenging aspects of caring for someone with dementia. By understanding what is considered wandering, its root causes, and proactive safety measures, caregivers can create a safer, more predictable environment. Prevention is the best defense, and a well-thought-out safety plan is essential for peace of mind. While vigilance is necessary, these strategies can help manage the risks and allow for a more peaceful experience for both the caregiver and the senior.

Frequently Asked Questions

What is the main difference between pacing and wandering?

Pacing is typically repetitive, aimless movement within a confined, familiar area, often a sign of restlessness or anxiety. Wandering is a broader term that involves leaving a safe space, becoming disoriented, and can be either aimless or have a perceived goal.

Why would someone with dementia want to go home when they are already at home?

A person with dementia may have lost the ability to recognize their current residence as their home. They may be recalling a home from their past and feel a strong, anxious need to find it, even if it no longer exists.

Are some times of day more prone to wandering?

Yes, some seniors with dementia experience "sundowning," a state of increased confusion and agitation that begins in the late afternoon and continues into the evening. Wandering can be more common during this time due to heightened anxiety and restlessness.

What is the first thing a caregiver should do when a senior with dementia is missing?

The first step is to perform a quick, thorough search of the immediate area for no more than 15 minutes. This includes the home, garage, and yard. If they are not found, call 911 immediately and inform them the person has dementia.

Can medication cause or increase the risk of wandering?

Yes, certain medications can contribute to confusion, agitation, and restlessness, all of which can increase the likelihood of wandering. It is important to discuss any behavioral changes with a doctor for a medication review.

Is it safe to lock a person with dementia in the house to prevent wandering?

No, it is not safe or ethical to lock a person in a house unattended. This poses a significant fire and safety risk. Instead, use discreet, hard-to-operate locks that can be opened easily from the inside in case of emergency, and never leave them unsupervised if they are a high risk for wandering.

How can I prevent wandering during the night?

Nighttime wandering can be managed by maintaining a consistent bedtime routine, ensuring a calm environment, using nightlights to prevent disorientation, and limiting fluids before bed. Providing engaging activities during the day can also reduce nighttime restlessness.

What kind of ID should a senior with wandering tendencies wear?

They should wear an easily visible medical ID bracelet or necklace that states they have memory loss or dementia and includes an emergency contact number. For those who may remove jewelry, sewing ID information into clothing is a good alternative.