Understanding the Urge: Why Do Dementia Patients Always Want to Leave?

An estimated 60% of dementia patients wander at some point, often fueled by an insistent desire to leave. Understanding why do dementia patients always want to leave is crucial for caregivers to address the underlying distress and ensure their loved one's safety.

Quick Summary

The desire to leave is often a complex, subconscious communication stemming from memory loss, confusion, unmet needs, or sensory overload, and it is rarely a simple, logical decision to depart.

Key Points

• Not malicious, but meaningful: The urge to leave is a direct result of cognitive and emotional changes in the brain, not a deliberate or defiant act.

• Address the feeling, not the facts: Arguing with a dementia patient that they are already home will increase their agitation and is ineffective. Validate the emotion of wanting comfort and security instead.

• Seek the underlying cause: The desire to leave can be triggered by confusion, boredom, pain, hunger, or anxiety. Investigating these basic needs is the first step.

• Use distraction and redirection: Calmly redirecting the person's attention to a pleasant activity, like looking at old photos or having a snack, can effectively de-escalate the situation.

• Create a safe environment: Modify the home with locks, alarms, and visual cues to ensure safety. This is a critical step for a person with a history of wandering.

• Manage sundowning symptoms: Be aware that confusion and agitation often increase in the evening. Adjust routines and environment to minimize stimulation during these hours.

• Embrace therapeutic fibbing: In some cases, using a gentle, reassuring fib can save both you and your loved one from distress and frustration.

The Emotional Core of the Behavior

For a person with dementia, the world becomes a confusing and often frightening place. The plea to “go home” is not always a literal request to go to a different house. It is frequently an expression of deep-seated emotions and a yearning for a feeling of safety, comfort, and familiarity that has been lost to the disease. As their sense of self and surroundings fades, they may believe they are in an unfamiliar or threatening environment, and the only logical response is to seek refuge elsewhere. This is what care partners must recognize—that the behavior has a purpose, even if the reasoning is flawed by cognitive impairment.

Unpacking the Underlying Triggers

To manage this behavior effectively, it's vital to identify the specific triggers causing the restlessness and desire to leave. These can vary widely depending on the individual and the progression of their illness.

Memory and Temporal Disorientation

• Memory loss: Damage to the hippocampus affects a person's ability to create and retrieve memories, leaving them disoriented and unable to recognize their current surroundings. The house they have lived in for decades may feel foreign, prompting the belief that they need to find their “real” home.
• Time-shifting: Individuals with dementia often lose track of time and may believe they are living in an earlier period of their life. They might feel the need to go home to their parents, or to a house they lived in as a child, because that is where their memory places them. This is not a malicious act but a consequence of a jumbled life timeline.

Environmental Factors and Sensory Issues

• Overstimulation: Too much noise, clutter, or activity can be overwhelming for a person with dementia, who has trouble processing complex sensory information. The resulting anxiety and confusion can trigger a flight response, leading them to seek a quieter, more peaceful space.
• Under-stimulation: On the flip side, boredom or a lack of meaningful activity can also cause restlessness and the urge to move. A person who was once very active may feel cooped up and seek a way to expend their excess energy.
• Perceptual problems: Changes in the brain can cause visual-spatial difficulties, making familiar places look different or creating misperceptions. A dark rug might look like a hole, or a reflection in a window might be misinterpreted, causing fear.

Unmet Needs and Emotional Distress

• Physical discomfort: Often, the urge to leave is a non-verbal cry for help. The person may be hungry, thirsty, in pain, too hot or cold, or need to use the bathroom and is unable to communicate this need effectively. Seeking “home” is their way of asking for comfort and basic needs to be met.
• Loneliness and fear: Feelings of isolation, fear, or anxiety can drive the person to seek out a familiar and comforting presence from the past, like a deceased spouse or parent.

The Impact of 'Sundowning' Syndrome

Sundowning is a phenomenon where confusion, agitation, and restlessness increase in the late afternoon and evening. It is a significant factor in exit-seeking behavior. Disrupted circadian rhythms, fatigue, and lower light levels can worsen symptoms and cause the person to feel more disoriented and insecure as the day winds down.

Practical Approaches for Caregivers

When dealing with a loved one who wants to leave, a calm, patient, and empathetic approach is key. Responding to the underlying emotion rather than the literal request is often the most effective strategy.

Response Comparison: Arguing vs. Validating	Strategy	Argumentative Approach	Supportive Approach
Initial Reaction	“You're already home, this is your house!”	“I hear that you want to go home. Tell me more about that place.”
Underlying Message	You are wrong; your reality is incorrect.	Your feelings are valid; I'm here to understand.
Consequences	Increased agitation, frustration, and distress.	De-escalation, reassurance, and validation.
Focus	On the factual inconsistency.	On the emotional need.

Key Strategies to Implement:

• Validate their feelings: Acknowledging their emotion without correcting their reality can be very reassuring. Phrases like, “It sounds like you feel uneasy, and that’s understandable,” can build trust.
• Redirect their attention: Instead of fighting the urge to leave, distract them with a calming and familiar activity. Look at a photo album, offer a snack, or suggest a short, supervised walk.
• Use therapeutic fibs: Gentle, well-intentioned lies can help defuse a situation. For example, if they insist on going to work, you could say, “You have the day off today”.
• Maintain a routine: Predictability provides a sense of security. A consistent daily schedule can help reduce confusion and restlessness, especially during the challenging sundowning hours.
• Meet basic needs: Proactively check for hunger, thirst, pain, or toileting needs. Offering a light snack or glass of water can sometimes solve the problem before it escalates.

De-escalating an Exit-Seeking Attempt:

1. Stay calm: Your tone and body language are powerful tools. A calm, soft voice and unhurried demeanor can prevent agitation.
2. Join their reality: If they believe they are somewhere else, don’t argue. Join their journey. “We can go home soon, but first, can you help me with this?”.
3. Offer a different activity: Divert their focus to a simple, enjoyable task. “Before we go, would you like to help me fold these towels?”.
4. Go for a supervised walk: For some, the urge to move can be satisfied with a walk in a safe, controlled environment, such as a fenced yard.

Adapting the Environment for Safety

Modifying the home environment can be one of the most effective long-term solutions to managing wandering and exit-seeking behavior. The goal is to remove triggers and create a safe space where the person with dementia can move freely without risk.

• Secure exits: Install locks out of the person's line of sight. Camouflaging doors with curtains or large stickers that resemble a bookcase can also be effective. Consider alarms that chime when a door or window is opened to alert caregivers.
• Hide departure cues: Keep items that suggest leaving, such as car keys, coats, and purses, out of sight.
• Improve lighting: Good, consistent lighting throughout the home, especially at night, can reduce confusion and fear. Use nightlights to illuminate pathways to the bathroom.
• Consider tracking technology: For individuals at high risk, wearable GPS devices can be lifesaving. The Alzheimer’s Association offers resources for tracking programs like MedicAlert® + Alzheimer’s Association Safe Return®.
• Create a safe wandering space: If possible, a securely fenced yard or a looped hallway can provide a safe outlet for restless energy.

Conclusion: A Shift in Perspective

At its core, understanding why do dementia patients always want to leave requires a shift from perceiving the behavior as problematic to recognizing it as a form of communication. The desire to leave is a signal of distress, confusion, or an unmet need. By identifying triggers, validating emotions, and creating a safe, supportive environment, caregivers can address the root cause of the behavior, reduce anxiety for their loved one, and promote a sense of security and well-being.

Frequently Asked Questions

What is the primary reason why dementia patients always want to leave?

A primary reason is disorientation caused by damage to the brain's memory centers. The person may no longer recognize their home and feel that they are in a strange, unfamiliar place, prompting them to seek the comfort and familiarity of a long-lost home.

How should I respond when a dementia patient says they want to 'go home'?

Do not argue with them or try to reason. Acknowledge their feeling of wanting to be somewhere comfortable. Redirect them by offering a familiar activity, a snack, or by looking at old photo albums together.

Is it normal for a dementia patient to get angry when they want to leave?

Yes, it is common for a person with dementia to become frustrated or angry when they feel misunderstood or when their reality is contradicted. Their frustration often stems from fear and confusion, not malice.

What is 'sundowning' and how does it relate to wanting to leave?

Sundowning is a phenomenon where dementia symptoms, including agitation and confusion, worsen in the late afternoon and evening. This heightened state of confusion can trigger or increase the desire to leave, as the person becomes more disoriented and anxious.

What are some practical safety measures to prevent wandering?

Install locks high or low on doors, use door alarms, keep keys out of sight, and consider using tracking technology like a GPS device. Ensuring a consistent routine also helps to reduce restlessness.

Can boredom cause a dementia patient to want to leave?

Yes, boredom and a lack of stimulation can cause a person with dementia to feel restless and lead them to wander. Engaging them in meaningful activities and exercise can help reduce this behavior.

What if my loved one is trying to leave to go to a job they haven't had in years?

This is often a result of 'time-shifting.' Use a therapeutic fib to calmly explain that they have the day off or that you’ll prepare to go later. Then, redirect their attention to a different activity.

Is a GPS tracking device an invasion of privacy for a dementia patient?

While it can be a sensitive topic, the safety of a person at risk of wandering is the primary concern. GPS devices can be a lifesaving tool, offering peace of mind to caregivers and ensuring a missing loved one can be found quickly.