Deciphering the Deeper Meaning Behind the Desire to Leave
When a person with dementia expresses an urge to go outside, it is rarely a simple request. Their complex brain changes mean they are often unable to articulate their true needs or feelings. Instead, their actions—like walking toward a door—are a form of communication. For caregivers, understanding this is vital to responding with patience and compassion rather than correction or frustration.
The 'Going Home' Phenomenon
One of the most frequent expressions of this desire to leave is the phrase, “I want to go home.” For someone with advanced dementia, the place they are currently living, even if it has been their home for decades, may not feel like “home.” Their cognitive reality may have regressed to a time earlier in their life, perhaps to a childhood home or a past apartment. The feeling of 'home' is a symbolic concept representing security, familiarity, and a time when they felt more capable and in control.
The Role of Restlessness and Boredom
Boredom and restlessness are significant triggers for the desire to go outside. A person with dementia may have been highly active throughout their life, perhaps working, volunteering, or raising a family. When their routine is disrupted, and they are confined to a more sedentary life, they may feel a deep, unrecognized need to fulfill a sense of purpose. This internal restlessness, combined with a lack of verbal communication skills, often manifests as an urgent need to leave. A desire to simply walk or engage in a meaningful activity may be misinterpreted by the person as needing to go outside.
Disorientation and Environmental Triggers
Sensory confusion can be a powerful motivator for exit-seeking behavior. Reflections in glass, busy patterns on carpets, or poor lighting can be disorienting and cause anxiety. Seeing a coat, keys, or a handbag by the door can serve as a powerful cue, triggering a memory or past habit of leaving the house. Changes in routine, unfamiliar faces, or loud noises can also cause confusion and stress, prompting the person to seek an escape route to a quieter, more familiar place.
Sundowning: The Evening's Agitation
Sundowning, a phenomenon in which confusion and agitation worsen in the late afternoon and evening, is a common reason why do people with dementia want to go outside. As the day winds down and light fades, the person's internal body clock may be disrupted. This can cause increased anxiety, pacing, and a need to be active. The fading light can also cause shadows that are easily misinterpreted as threatening figures, prompting a desire to flee to safety.
Strategies for Compassionate and Safe Intervention
Validation and Redirection
When your loved one says they want to go home, arguing about where they are is counterproductive. Instead, validate their feelings. You might say, “Tell me about the home you're thinking of.” This allows you to connect with their emotional need without challenging their reality. From there, you can gently redirect their attention to another activity. If they are restless, suggest a walk in a safe, enclosed area or engage them in a simple task they enjoy.
Environmental Modifications
Creating a safer and more stimulating environment can significantly reduce the urge to wander.
- Secure Exits: Install locks on exterior doors that are either out of eye-level or require a more complex action than a simple turn of a knob.
- Camouflage Doors: Paint doors the same color as the surrounding wall or hang curtains to make them less noticeable.
- Safe Walking Paths: Ensure there is a safe, enclosed garden or outdoor path for supervised walks.
- Address Sundowning: Increase lighting in the evenings to minimize shadows and reduce background noise. A consistent, calming evening routine can also help.
Comparison of Responses to Wandering Triggers
| Trigger | Ineffective Response | Effective Response |
|---|---|---|
| Desire to 'Go Home' | "But you are home!" or correcting their memory. | "Tell me about your home. What do you miss most?" (Validating feelings). |
| Restlessness/Boredom | "Just sit down and relax." or getting frustrated. | Offer a simple, engaging activity like folding laundry, listening to music, or a walk. |
| Environmental Noise | Telling them to ignore the noise. | Lead them to a quieter room, use white noise, or offer headphones with calming music. |
| Sundowning Agitation | Challenging them or restraining them. | Establish a consistent, calming evening routine. Use light therapy or offer a familiar snack. |
Proactive Engagement and Routine
Preventing wandering often involves addressing the root cause before it escalates. Maintaining a predictable daily routine helps reduce confusion and provides a sense of security. Incorporate regular exercise and engaging activities into the day. For those who once had a job, providing a sense of purpose through simple, meaningful tasks, like sorting items or wiping tables, can be a powerful de-escalation tool.
The Need for Outdoor Stimulation
It's important to remember that the outdoors offers significant therapeutic benefits for people with dementia. Exposure to fresh air and natural light can improve mood, regulate sleep patterns, and provide sensory stimulation. The goal is not to prevent them from going outside entirely but to ensure it is done safely and with purpose. A walk in a secure garden, a picnic, or simply sitting on a patio can satisfy the need for the outdoors in a controlled manner.
Using Technology for Safety
While person-centered care is paramount, technology offers an important layer of safety. Tracking devices, GPS wearables, and door alarms can alert caregivers if a loved one attempts to leave unsupervised. These tools can provide peace of mind and are an invaluable part of a comprehensive safety plan. When considering such devices, ensure they are comfortable for the person to wear and do not cause additional distress. For more information on creating a safe environment, the Alzheimer's Association offers extensive resources.
A Conclusion of Care
Understanding why do people with dementia want to go outside involves looking beyond the action itself and into the emotional and cognitive needs driving the behavior. By responding with validation, providing a secure environment, and engaging in purposeful activities, caregivers can significantly reduce the risks associated with wandering. The focus should always be on preserving the person's dignity while ensuring their safety, transforming a moment of potential crisis into an opportunity for connection and care.
