Why do dementia patients wander around? Understanding the Causes

It is estimated that 6 in 10 people with dementia will wander at some point, a behavior that is both common and potentially dangerous. Understanding why do dementia patients wander around is the first step toward managing this challenging behavior and ensuring their safety and well-being.

Quick Summary

Dementia patients wander for various reasons, including confusion, anxiety, restlessness, searching for something familiar, or attempting to follow past routines. This behavior is often a response to unmet needs, environmental triggers, or altered perceptions.

Key Points

• Wandering is a common symptom of dementia, not a deliberate act of defiance: For most dementia patients, wandering is a behavioral manifestation of confusion, anxiety, or unmet needs, not an intentional choice.

• Wandering is often a form of communication: The behavior can indicate boredom, loneliness, discomfort, or the need to use the bathroom, especially when verbal communication is impaired.

• Triggers can include disorientation and past routines: A patient may wander due to visual-spatial problems, a desire to 'go home' even when already there, or an impulse to repeat a former daily routine.

• Sundowning significantly increases the risk of wandering: This evening-time restlessness and confusion can trigger wandering episodes, especially during periods of low light.

• Safe and secure environments are crucial for management: Implementing home modifications like door alarms, secure locks, and visual deterrents can help prevent a person from leaving unsupervised.

• Effective strategies involve reassurance and distraction, not confrontation: Arguing or reasoning with a patient is often counterproductive. Validating their feelings and redirecting their attention to a safe activity is more effective.

• Technology can enhance safety and peace of mind: GPS tracking devices and medical ID bracelets can assist in locating a patient who has wandered and ensures their safe return.

• Preventative planning and community awareness are vital: Having a safety plan, informing neighbors, and enrolling in a national registry like MedicAlert + Safe Return can make all the difference in an emergency.

Wandering in dementia patients is a complex behavior driven by a combination of cognitive, emotional, and environmental factors. For caregivers, recognizing the underlying causes is crucial for implementing effective and compassionate management strategies. While the behavior can be a normal outlet for energy, it poses a significant safety risk if not managed properly.

Unmet Needs and Emotional Triggers

Many instances of wandering can be attributed to an underlying, unmet need. Because of cognitive impairment, the person with dementia may have difficulty communicating their needs or feelings, leading to wandering as a form of expression.

• Restlessness or Boredom: A lack of physical or mental stimulation can lead to restlessness. Pacing or walking aimlessly may be an attempt to find something to do.
• Anxiety and Stress: Unfamiliar or overstimulating environments can cause anxiety and fear. A crowded mall, a room with loud noise, or a change in routine can trigger a patient to try and escape the situation.
• Basic Needs: The patient may be searching for the bathroom, food, or water, but may have forgotten where these are located.
• Loneliness or Isolation: The need for human contact can sometimes cause a person with dementia to wander in search of social interaction.
• Pain or Discomfort: Unidentified or unexpressed pain can lead to agitation and an increase in walking or pacing.

Disorientation and Memory Impairment

Cognitive decline significantly impacts a patient's sense of direction and memory, which are direct causes of wandering.

• Reliving the Past: Patients may attempt to follow past routines, such as going to work or picking up children from school, even if these events occurred years ago.
• Visual-Spatial Problems: Damage to parts of the brain controlling visual guidance and navigation means the patient can get lost even in familiar places, including their own home.
• The Desire to "Go Home": Even when living in their long-time residence, a person with dementia may feel they need to "go home." This is often not about a physical location but a deeper search for a sense of comfort, familiarity, and safety from an earlier time.
• Sundowning: This phenomenon involves increased confusion, agitation, and restlessness that occurs in the late afternoon and evening. It is often linked to disruptions in the person's internal body clock and is a major contributor to nighttime wandering.

Management Strategies: Intervention Comparison

Managing wandering requires a combination of preventative measures and compassionate intervention. Below is a comparison of different strategies.

Strategy	Description	Benefits	Considerations
Behavioral Redirection	Gently guide the patient to a different, safe activity or topic when they express a desire to leave.	Avoids confrontation, validates emotions, and can calm the patient.	Requires patience and knowledge of the patient's preferences. Might not work in all cases.
Home Safety Modifications	Install door and window alarms, high-mounted deadbolts, or visual deterrents like black mats.	Provides alerts to caregivers and physically restricts exit-seeking.	Must not impede emergency exit. Can be perceived as restrictive by some patients.
Routine and Engagement	Establish and maintain a consistent daily schedule, including regular exercise and purposeful activities like folding laundry.	Reduces anxiety and boredom, providing structure and meaningful engagement.	May be difficult to maintain, especially for family caregivers with other responsibilities.
Tracking Technology	Use GPS devices worn as a bracelet or in clothing to monitor a patient's whereabouts.	Offers a reliable way to locate a patient quickly in an emergency.	Raises ethical concerns about privacy and dignity. Must be used with consent where possible.
Medical Management	Consult a doctor to review medications, as some drugs can increase confusion and agitation.	Can identify and address underlying medical causes exacerbating wandering.	Requires professional medical consultation. May involve adjusting or changing prescriptions.

Practical Steps for Caregivers

Caregivers can take several practical steps to manage wandering behavior effectively:

• Identify Triggers: Keep a journal of wandering episodes to find patterns, such as the time of day, circumstances, or specific triggers.
• Meet Basic Needs: Ensure the person is not hungry, thirsty, in pain, or needing to use the bathroom. A consistent routine for meals and toileting helps.
• Create a Safe Environment: Remove obstacles and clutter from pathways. Use nightlights to illuminate the path to the bathroom at night.
• Limit Departure Cues: Keep items that suggest leaving, like coats, keys, and purses, out of sight.
• Alert the Community: Inform neighbors and local police about the patient's condition and tendency to wander. Keep a recent photo on hand in case they go missing.
• Distract and Reassure: When the patient is fixated on leaving, offer gentle reassurance and redirect their attention. Avoid arguing or correcting their perception.
• Consider a Safe Return Program: Enroll the individual in a program like MedicAlert + Alzheimer's Association Safe Return, which provides a 24/7 emergency response service.

Conclusion

For caregivers of those living with dementia, understanding why patients wander is essential for providing compassionate and effective care. This behavior is not willful but rather a symptom of cognitive and emotional distress. By addressing underlying triggers, creating a safe and structured environment, and utilizing technology and community resources, caregivers can significantly reduce the risks associated with wandering. Focusing on meeting the patient's needs and responding with patience and reassurance are key to managing this difficult aspect of dementia. Caregiver support networks also provide invaluable shared experiences and emotional strength for navigating these challenges.

Frequently Asked Questions

What is the primary reason dementia patients wander?

The primary reasons dementia patients wander include confusion, anxiety, restlessness, attempting to follow past routines, or searching for someone or something familiar. It is often a communication of an unmet need, such as hunger, boredom, or the need for a restroom.

What is 'sundowning' and how does it relate to wandering?

Sundowning is a phenomenon where people with dementia experience increased confusion, agitation, and anxiety in the late afternoon and evening hours. This period of heightened restlessness often triggers nighttime wandering.

How can I prevent a dementia patient from leaving the house?

You can prevent a patient from leaving by installing locks on exit doors out of their line of sight, using door alarms that signal when an exit is opened, or creating visual deterrents like black mats in front of doors. You should also keep items like keys, coats, and purses out of sight.

What should I do if a dementia patient insists on 'going home'?

Do not argue or correct them. Reassure the person gently and respond to the emotion behind their words. Validate their feeling of wanting to be home, then distract them with a different, calming activity, such as looking at photo albums or listening to music.

Is it safe to let a dementia patient walk around inside the house?

Yes, it can be beneficial. Pacing or walking around inside a safe, uncluttered environment can provide exercise and relieve anxiety. The key is to ensure the environment is secure and they cannot accidentally exit the home unsupervised.

What technology is available to help find a wandering patient?

GPS tracking devices are available that can be worn on the wrist, ankle, or attached to clothing, which allows caregivers to monitor a patient's whereabouts. Enrollment in a program like MedicAlert + Safe Return also provides a 24-hour emergency response service.

Should I tell my neighbors that my family member with dementia might wander?

Yes, informing neighbors and the local police is a crucial safety measure. You should provide them with a recent photo and ask them to contact you immediately if they see your family member wandering alone.