What stage of Alzheimer's is wandering?

According to the Alzheimer's Association, six in ten people with dementia will wander at least once, making it a critical safety concern for families and caregivers. This guide answers the question, What stage of Alzheimer's is wandering? and provides essential information for navigating this challenging symptom.

Quick Summary

Wandering is a behavioral symptom that can occur at any stage of Alzheimer's disease, but it becomes more common and concerning during the moderate to advanced stages due to increased confusion and impaired judgment. Understanding the triggers and implementing safety measures is key to managing this behavior effectively.

Key Points

• Wandering Occurs Throughout the Disease: While most common in moderate to advanced stages, wandering can happen at any point in Alzheimer's progression.

• Peak Risk in Middle Stages: The risk for wandering significantly increases in the middle stages of Alzheimer's due to deepening confusion and restlessness.

• Trigger Identification is Key: Common triggers include restlessness, boredom, disorientation, and unmet needs like hunger or fatigue.

• Safety Measures are Critical: Caregivers should focus on creating a secure environment with locks and alarms, as well as maintaining a stable routine.

• Technology Provides Support: GPS tracking devices and identification bracelets can be invaluable tools for locating a person who has wandered.

• Immediate Action is Vital: If a person with Alzheimer's goes missing, it is crucial to contact authorities immediately, as a quick response is essential for their safety.

Understanding the Stages of Alzheimer's Disease and Wandering

While the answer to What stage of Alzheimer's is wandering? is that it can happen at any point, it is most prevalent during the middle to advanced stages of the disease. The progression of Alzheimer's brings about cognitive decline that directly contributes to the disorientation, poor judgment, and memory loss that can lead to wandering. Knowing the typical symptoms associated with each stage helps caregivers understand and anticipate this behavior.

Early Stages: Subtle Changes

In the early stages, cognitive decline is mild. Wandering is less common but can still occur. Early signs might be subtle, such as getting lost on a familiar route or misplacing items. The individual may ask repetitive questions or show decreased motivation. Caregivers might notice a person becoming withdrawn or irritable, which can be an early indicator of the underlying cognitive changes that could later contribute to wandering. Recognizing these early signals can help in proactive planning for future safety concerns.

Middle Stages: Increased Risk and Confusion

As the disease progresses into the moderate or middle stage, wandering becomes a more significant risk. This is often the longest stage and is marked by more pronounced symptoms.

• Deepening Confusion: The individual may lose track of where they are and forget the day or season.
• Impaired Judgment: Poor judgment and a search for more familiar surroundings are common motivators for wandering.
• Behavioral Changes: Restlessness and agitation can increase, especially in the late afternoon and evening, a phenomenon known as sundowning.
• Memory Gaps: Forgetting recent events and personal details, such as their address, becomes more frequent.

During this stage, the person may feel an urge to 'go home' even when they are already in their own house, a common trigger for wandering behavior.

Late Stages: Severe Decline and Loss of Function

In the severe or late stage, wandering can still occur, particularly as a result of disorientation or restlessness. However, physical abilities decline significantly, often limiting mobility over time. Speech may become severely limited, and total support is needed for daily living activities. While the physical capacity to wander long distances may decrease, the risk of a person leaving a safe area without supervision remains present.

Understanding the Triggers for Wandering

Beyond the specific stage, several factors can trigger wandering behavior. Caregivers must be vigilant in identifying these triggers to prevent dangerous situations.

• Boredom or Restlessness: A lack of stimulating activity can lead a person to seek an outlet for their energy by walking.
• Disorientation: Being in unfamiliar or crowded environments can cause confusion and prompt the person to try and leave.
• Unmet Needs: Simple needs like hunger, thirst, or needing to use the restroom can trigger wandering if the person cannot express themselves.
• Searching: Some individuals may wander while searching for something or someone, such as a long-deceased family member or a past obligation.
• Stress and Fear: Feeling overwhelmed or stressed by new situations or unfamiliar places can cause a person to feel the need to escape.

Strategies for Managing Wandering

Managing wandering requires a combination of preventative measures and a clear action plan. The following strategies can help keep a person with Alzheimer's safe:

• Creating a Safe Environment: Install secure locks on doors and windows, placing them out of the person's line of sight. Consider alarms that sound when a door or window is opened. Keep car keys stored out of sight.
• Establishing a Routine: Maintaining a consistent daily routine can help reduce agitation and restlessness. Plan activities for times when wandering tends to occur.
• Redirecting Behavior: If the person expresses a desire to leave, validate their feelings instead of arguing. Gently redirect them to another activity, such as listening to music or doing a simple puzzle.
• Ensuring Basic Needs are Met: Regularly check for hunger, thirst, pain, or the need to use the bathroom. A full stomach and a comfortable environment can reduce restlessness.
• Using Identification: Ensure the person wears an ID bracelet with their name, address, and an emergency contact number.
• Utilizing Technology: GPS tracking devices are available to help monitor a person's location. This can provide peace of mind and aid in a quick recovery if they wander.

Comparison of Stages and Wandering Risk

Feature	Early Stage	Middle Stage	Late Stage
Wandering Frequency	Infrequent; potential for getting lost on familiar routes.	Frequent and more concerning; often tied to confusion and agitation.	Can occur, but decreased mobility may limit physical wandering.
Primary Triggers	Confusion in new or complex situations, misplacing items.	Disorientation, unmet needs, searching for familiar places or people.	Discomfort, restlessness, communication issues.
Caregiver Concerns	Awareness of potential for getting lost. Monitoring early behavioral changes.	Immediate safety risk. Preventing elopement from the home.	Monitoring for restlessness and managing safety in restricted mobility.
Intervention Focus	Routine, cognitive activities, gentle reminders.	Secure environment, redirection, satisfying basic needs.	Comfort measures, ensuring a secure living space, meeting all personal care needs.

What to Do in an Emergency

If a person with Alzheimer's wanders and cannot be found, immediate action is crucial. In Massachusetts, for example, the Silver Alert program is used to broadcast information about missing persons with dementia. Familiarize yourself with local missing persons protocols. Time is of the essence, as statistics show the danger increases significantly the longer a person is missing.

For more detailed guidance on handling wandering, including information on specific technologies and support networks, refer to the resources provided by the Alzheimer's Association. A proactive approach is the best defense against the dangers of wandering.

Conclusion

Wandering is a serious and potentially life-threatening behavior associated with Alzheimer's disease, occurring most often in the moderate to advanced stages. While it can happen at any point, the increased confusion and disorientation in later stages make individuals more susceptible. By understanding the underlying causes, identifying triggers, and implementing robust safety measures—from environmental adjustments to technological aids—caregivers can significantly reduce the risk and ensure the safety of their loved ones.

Visit the Alzheimer's Association website for comprehensive support on caregiving and safety.

Frequently Asked Questions

Why do people with Alzheimer's start to wander?

People with Alzheimer's may wander for various reasons, including feeling disoriented or confused, searching for something or someone, trying to fulfill a past obligation, or simply feeling bored or restless.

Can a person in the early stage of Alzheimer's wander?

Yes, a person in the early stage can wander, although it is less common than in later stages. Early wandering might be subtle, such as getting lost on a familiar walk, and can indicate early disorientation.

Is wandering a sign of worsening Alzheimer's?

Wandering often becomes more frequent and problematic as Alzheimer's progresses from the moderate to advanced stages. While not exclusively tied to a specific stage, an increase in wandering often signals worsening confusion and memory loss.

What is sundowning and how is it related to wandering?

Sundowning is a state of increased confusion, anxiety, and agitation that occurs late in the afternoon or evening. This can increase the likelihood of wandering behavior during these specific hours due to the heightened restlessness and disorientation.

What should I do if a person with Alzheimer's goes missing?

If a person with Alzheimer's goes missing, you should contact local authorities immediately and provide a recent photo and description. Time is a critical factor in ensuring their safety and a successful return.

How can I prevent a person with Alzheimer's from wandering?

To prevent wandering, create a secure home environment with alarms and secure locks, maintain a consistent daily routine, and engage the person with meaningful activities. It's also helpful to address any unmet needs like hunger or restlessness.

Can GPS tracking help with wandering?

Yes, GPS tracking devices can be a valuable tool for monitoring and locating a person with Alzheimer's who is prone to wandering. These devices can provide peace of mind and help ensure a quick and safe recovery if they wander.