Ineffective and Counterproductive Methods for Managing Wandering
Many caregivers, in their efforts to ensure safety, resort to methods that are not only ineffective but can also cause distress and confusion for someone with dementia. These methods often focus on restriction rather than understanding the underlying reasons for the wandering behavior. Effective wandering control strategies must be person-centered, addressing the individual's needs and emotions, not just their physical movements.
Hiding Shoes or Personal Belongings
Hiding items that signal an imminent departure, such as shoes, keys, or coats, is a common but harmful practice. While the intention is to physically prevent the person from leaving, this approach often backfires:
- Increased Anxiety and Confusion: When a person with dementia cannot find a familiar item like their shoes, it can cause significant distress and agitation. They may have a routine or memory associated with that item, and its absence is confusing and upsetting.
- Does Not Address the Root Cause: This method does nothing to resolve the underlying reason for the wandering. A person may be searching for a past routine (like going to work) or experiencing boredom, and removing their shoes does not satisfy this unmet need.
- Erodes Trust: The individual may become suspicious of their caregivers, believing someone has stolen their belongings. This can damage the trusting relationship and make caregiving more difficult in the long run.
Using Physical Restraints
Physical restraints, such as tying a person down, confining them to a chair with a tray table, or using bed rails, are dangerous and ineffective methods for controlling wandering. Restraints can lead to physical injury, increased agitation, and a loss of dignity. Best practice guidelines strongly advise against using physical restraints as a method of wandering control.
Locking the Person Inside
While securing the environment with high locks or alarms is a recommended safety measure, locking a person inside a room or isolating them is not a form of control but a form of confinement. Long-term or unreasonable confinement can be considered abuse and often leads to increased agitation and distress. The goal should be a secured environment that provides safety, not isolation.
Effective Strategies for Compassionate Wandering Control
Instead of focusing on restrictive measures, effective wandering control addresses the psychological and physical needs behind the behavior. A compassionate approach focuses on redirection, engagement, and understanding the person’s unique triggers.
Address Unmet Needs and Triggers
Many times, wandering is a symptom of an underlying problem. Caregivers can proactively address these needs to reduce the urge to wander:
- Hunger, thirst, or toileting needs: The person may be wandering in search of food, a drink, or the bathroom.
- Pain or discomfort: Discomfort from an illness, injury, or poorly fitting shoes can cause restlessness.
- Boredom: A lack of engaging activities can lead to aimless wandering.
- Past routines: Some individuals wander to follow a lifelong routine, like heading to a former workplace.
Create a Safe and Secure Environment
Environmental modifications are key to managing wandering safely:
- Secure Exits: Install locks on doors that are out of the person's line of sight (either high or low). Use door alarms or chimes that alert caregivers when an exit is opened.
- Camouflage Doors: Paint doors the same color as the walls or hang curtains over them to make them less conspicuous. A dark doormat can also be used, as some people with dementia perceive it as a hole they should not step into.
- Create Safe Spaces: Designate a secure outdoor area, like a fenced yard or patio, where the individual can walk and explore safely.
- Remove Clutter: Keep pathways clear of clutter and remove small throw rugs that could cause a fall.
Engage in Purposeful Activities
Keeping a person with dementia engaged and occupied can significantly reduce the tendency to wander. Activities should be personalized to their interests and abilities:
- Regular Exercise: Supervised walks during the day can help release pent-up energy.
- Hobbies and Tasks: Provide simple, meaningful activities like folding laundry, watering plants, or sorting items.
- Sensory and Reminiscence Therapy: Music, photo albums, or other sensory experiences can be calming and engaging.
Utilize Tracking Technology
For individuals at high risk of elopement, GPS tracking devices can provide peace of mind and aid in a quick recovery if they do wander away. These can be worn as a bracelet, pendant, or even embedded in shoe insoles.
Comparison Table: Effective vs. Ineffective Wandering Control
| Feature | Ineffective/Harmful Strategy | Effective/Compassionate Strategy |
|---|---|---|
| Hiding Shoes | Can increase agitation, anxiety, and confusion. Erodes trust. Does not address underlying cause. | Does not hide shoes. Instead, uses gentle redirection and provides safe walking areas. Addresses the trigger for wandering. |
| Physical Restraints | Increases agitation, risk of injury, and emotional distress. Seen as a loss of autonomy and dignity. | Avoids physical restraints. Focuses on environmental safety, engagement, and supervision. |
| Isolation/Confinement | Causes distress and can be considered abuse. Doesn't solve the problem, only contains it. | Creates safe, secure, and engaging spaces. Allows for supervised, purposeful movement. |
| Ignoring Needs | Causes frustration, anxiety, and restlessness, which can increase the urge to wander. | Identifies and addresses unmet needs such as hunger, thirst, or pain. |
| Confrontational Redirection | Can worsen agitation and cause arguments. Puts stress on the caregiver and the individual. | Uses gentle, calm redirection. Validates the person's feelings and suggests an alternative activity. |
| Disrupted Routines | Unpredictable schedules and environments increase confusion and anxiety. | Establishes a consistent daily routine to provide structure and reduce restlessness. |
Conclusion
When considering which strategies will not help control wandering, it is clear that methods that restrict a person's freedom without addressing their underlying needs are counterproductive and harmful. Hiding shoes, for instance, can increase confusion and agitation, exacerbating the problem rather than solving it. Effective wandering control relies on a compassionate, person-centered approach that involves understanding the causes of the behavior, ensuring the person's comfort and safety, and providing meaningful activities to keep them engaged. By focusing on positive interventions, caregivers can minimize risks while maintaining the dignity and well-being of the person they are supporting. Implementing environmental safety measures, identifying triggers, and using appropriate technology are far more effective than resorting to restrictive tactics.
Keypoints
- Hiding belongings is ineffective: Hiding personal items like shoes is a harmful practice that increases anxiety and distrust without addressing the root cause of the wandering.
- Avoid physical and chemical restraints: Restrictive measures and sedatives are dangerous, increase agitation, and should be avoided in managing wandering behavior.
- Address the root cause: Wandering is often triggered by unmet needs, such as hunger, boredom, or discomfort. Identifying and addressing these triggers is the most effective approach.
- Create a safe environment: Use environmental modifications like obscured exits, door alarms, and safe, fenced outdoor areas to allow for safe movement.
- Engage with purposeful activities: Offering meaningful, stimulating activities and regular exercise can reduce restlessness and redirect attention away from wandering.
- Use tracking technology for safety: GPS tracking devices can provide a safety net for high-risk individuals, allowing for quick location if they do wander.
FAQs
Q: Why is hiding a person's shoes not an effective way to control wandering? A: Hiding a person's shoes is not effective because it does not address the underlying reason for the wandering, such as boredom, a need to exercise, or unmet basic needs. It can also increase anxiety, confusion, and suspicion, making the situation worse.
Q: What is a more effective alternative to hiding shoes to prevent wandering? A: A more effective strategy is to engage the individual in meaningful activities, establish a predictable routine, and ensure all their basic needs are met. Creating a safe, supervised environment where they can walk freely can also help.
Q: Is it safe to use door alarms to prevent wandering? A: Yes, door and window alarms are a recommended safety measure. They alert caregivers when a door is opened, allowing for timely intervention and preventing the individual from leaving the safety of their home or facility undetected.
Q: How can I identify why a person with dementia is wandering? A: Keeping a diary of when the wandering occurs and what happens right before can help you identify triggers like boredom, hunger, pain, or the time of day. You can then address these specific needs proactively.
Q: Can a change in environment affect wandering? A: Yes, new or overly stimulating environments, such as a noisy shopping mall, can increase confusion and trigger wandering. A calm, familiar environment with clear pathways and visual cues can be helpful.
Q: Are GPS trackers a good solution for preventing wandering? A: GPS trackers are an excellent safety tool for locating a person who has wandered, but they do not prevent the wandering itself. They are best used as part of a broader strategy that also includes addressing the root causes of the behavior.
Q: What should I do if a person with dementia disappears? A: Call 911 immediately and provide law enforcement with a recent photo and description. Informing neighbors and enrolling in a wandering response service beforehand can also expedite the search.
