The Deeper Meaning Behind Wandering
Wandering is a common and often distressing behavior for both the person with Alzheimer's and their caregivers. However, viewing wandering not as a random, meaningless action but as a behavior with a purpose can change how it is perceived and managed. This shift in perspective can lead to more effective and compassionate care strategies. The purpose behind the wandering may be a search for something or someone, a need to fulfill a deep-seated routine, or an attempt to express an unmet physical or emotional need that the person can no longer articulate.
The Search for Familiarity
One of the most powerful drivers of wandering is the profound sense of confusion and a deep desire for familiarity. As the disease progresses, the world around them becomes strange and unrecognizable. The person may be trying to 'go home' even when they are already there, driven by a memory of a childhood home or a place from their past. This is not a logical journey but an emotional one, a quest for a sense of comfort, security, and belonging that has been lost. Caregivers can often redirect this search by providing familiar objects, photos, or by engaging in calming activities.
Unmet Physical and Emotional Needs
Wandering can also be a non-verbal cue that the person is experiencing discomfort, pain, or emotional distress. Since their ability to communicate effectively is diminished, they may express their needs through physical movement. This can be a form of self-soothing or an attempt to escape a perceived threat or uncomfortable situation.
Physical Discomfort
- Pain: The person may be in pain from arthritis, a headache, or a bladder infection but cannot verbalize it. They may walk around to find a more comfortable position.
- Restlessness: A feeling of restlessness or an excess of energy can cause a person to pace or move around. This can be more pronounced in the late afternoon or early evening, a phenomenon known as 'sundowning'.
- Environmental Triggers: The temperature in the room may be too hot or too cold, or the person may be thirsty or hungry and is searching for a drink or snack.
Emotional Distress
- Anxiety and Fear: Feeling lost, scared, or anxious can trigger a person to move in an attempt to find safety or escape the source of their fear.
- Boredom: A lack of stimulating activities can lead to restlessness. Wandering can be an attempt to find something to do or engage with.
- Overstimulation: Loud noises, a crowded room, or too much activity can be overwhelming, causing the person to seek a quieter, more predictable environment.
The Need to Fulfill a Past Routine
For many individuals with Alzheimer's, the drive to follow old routines remains, even when the context is gone. A person may have had a routine of walking the dog every evening or leaving for work in the morning. Even if they are long retired, the deep-seated impulse to perform this ritual can trigger wandering. This is often a predictable form of wandering and can sometimes be managed by incorporating a similar, safe activity into their daily schedule, like a supervised walk around the yard.
Identifying and Interpreting Triggers
Effective management of wandering begins with becoming a detective, observing and documenting patterns and potential triggers. By understanding the 'why' behind the action, caregivers can preemptively address the underlying need before the wandering begins.
Common Triggers for Wandering
- Time of day (e.g., sundowning).
- Changes in environment or routine.
- Feeling lost or disoriented.
- Pain, hunger, or thirst.
- Need for exercise.
- Anxiety or stress.
- Disorientation after waking up.
A Comparison of Wandering Triggers and Their Possible Causes
| Trigger | Possible Underlying Cause | Compassionate Response |
|---|---|---|
| Pacing at dusk | Sundowning, confusion, restlessness, fear | Create a calming evening routine, use dim lighting, play soft music. |
| Trying to 'go to work' | Old routine, need for purpose, boredom | Offer a structured, meaningful activity during that time, like folding laundry or organizing a drawer. |
| Leaving the house unexpectedly | Unmet need (food, bathroom), search for familiarity, anxiety | Ensure needs are met. Use door alarms or safety locks. Check for pain or discomfort. |
| Following caregiver around | Separation anxiety, feeling lost, need for reassurance | Provide reassurance and engage them in a simple task near you. |
Compassionate Management and Prevention Strategies
Caring for someone who wanders requires a multi-faceted approach that prioritizes safety while addressing the root causes of the behavior. Here are some strategies:
- Create a Safe Environment: Install alarms on doors and windows. Use GPS tracking devices. Secure the perimeter of your home. Hide car keys to prevent driving.
- Establish and Maintain a Routine: Consistent daily schedules can reduce anxiety and confusion. Include regular mealtimes, bedtimes, and activity periods. For a deeper understanding of Alzheimer's care, consider the resources available from the Alzheimer's Association.
- Engage in Calming Activities: Provide purposeful and calming activities, especially during periods when wandering is most likely to occur. This could include sorting cards, listening to favorite music, or looking at family photos.
- Address Unmet Needs: Regularly check for potential discomfort, hunger, or the need to use the bathroom. Offering a snack or helping them to the toilet can sometimes prevent wandering.
- Use Redirection and Distraction: If wandering begins, gently redirect the person's attention to another activity. Avoid confrontation or arguing with them about their destination. Instead, acknowledge their feeling and offer an alternative.
- Maintain Physical Activity: Regular, supervised physical activity can help manage restlessness and excess energy. A daily walk can fulfill the urge to wander in a safe manner.
- Manage Sundowning: If wandering occurs more frequently in the evenings, use bright light therapy during the day, reduce caffeine, and create a calm, quiet evening environment.
Conclusion
Understanding that wandering in Alzheimer's is a purposeful behavior is the first step toward better management. By interpreting the underlying triggers—whether it’s a search for familiarity, an unmet physical need, or a drive to fulfill an old routine—caregivers can implement proactive and compassionate strategies. These approaches not only improve the safety of the individual but also their overall well-being, fostering an environment of understanding and support rather than frustration and fear. The purpose is not to stop movement entirely but to ensure that all movement is safe, understood, and a positive part of their daily life.
