Why do people with dementia go outside? Understanding the causes of wandering

According to the Alzheimer's Association, an estimated 6 in 10 individuals with dementia will wander at least once, with many doing so repeatedly. Understanding why people with dementia go outside is crucial for their safety and for the peace of mind of their caregivers.

Quick Summary

Wandering outdoors in dementia patients can be triggered by confusion, unmet needs, restlessness, or attempting to follow old routines. It often stems from a distorted sense of time and place, leading them to seek something or somewhere familiar. Addressing the root cause with reassurance and structured activities can help manage this behavior.

Key Points

• Cognitive Decline: Disorientation and confusion about their current location or time period are primary motivators for wandering.

• Unmet Needs: Wandering often signals a basic need, such as hunger, thirst, pain, or the need for a restroom, that the person cannot verbally express.

• Past Routines: A person may act out old, ingrained routines, such as going to work or running errands, due to long-term memory recall.

• Restlessness and Boredom: A lack of activity or mental stimulation can cause agitation, leading to a physical need to walk or pace.

• Environmental Triggers: Items like coats and keys or overstimulating environments can prompt a desire to leave the current location.

• Validation and Redirection: Responding to the emotion behind the behavior and distracting with meaningful activities is more effective than correcting them.

• Home Safety is Crucial: Secure locks, door alarms, and disguised exits are vital for preventing dangerous elopement.

Understanding the complex reasons for wandering

While the urge to go outside can be distressing and dangerous, it's essential for caregivers to understand that it's often not a conscious decision but a symptom of the disease's progression. The behavior, often called "wandering" or "elopement," can be driven by a variety of factors, including emotional, environmental, and cognitive changes. Recognizing these triggers is the first step toward effective management and ensuring the safety of your loved one.

Cognitive confusion and disorientation

One of the most significant factors is a person's deteriorating cognitive function, which impairs their ability to recognize their current surroundings. They may:

• Relive the past: A person might believe they are still living in a previous home, and wander out to find it. This can be particularly confusing if they are in their own home, as they may feel the need to "go home."
• Misinterpret reality: Familiar environments can become strange and frightening. A busy, noisy home during a family gathering might be overwhelming, causing the person to seek an escape.
• Experience disorientation: Visual-spatial problems can make it hard for a person to navigate familiar places, leading them to get lost even in their own backyard. Shadows might appear as holes, and reflections as strangers, increasing anxiety.

Fulfilling unmet physical or emotional needs

Sometimes, wandering is a nonverbal way of communicating an unmet need. When a person with dementia is unable to express themselves, they may act out these needs physically. Common reasons include:

• Physical discomfort: They might be hungry, thirsty, need to use the restroom, or be in pain.
• Boredom and restlessness: A lack of engaging activities and exercise during the day can lead to restlessness, especially in the evening, prompting them to get up and pace.
• Emotional distress: Anxiety, fear, and depression can drive a person to seek a change of scenery or a way to escape their current feelings.
• Searching for something or someone: The person may be looking for a deceased spouse, a former coworker, or a lost object, driven by a persistent search behavior.

Following old routines

Many people with dementia retain long-term memory longer than short-term memory, leading them to act out old routines that are no longer relevant. They may:

• Attempt to go to work at the same time they always did.
• Walk down the street to the bus stop to pick up children who are now grown adults.
• Go out to buy groceries or run other errands they used to do daily.
• Try to walk the dog, even if the pet is no longer in their life.

Environmental factors

Certain elements in the home can trigger the urge to leave. For example, leaving car keys, a hat, or a coat near the door can be a visual cue that suggests it is time to go out. A person may also be trying to get away from a situation that makes them uncomfortable, such as a noisy environment.

Managing wandering and ensuring safety

Effective management of wandering requires a multi-pronged approach that focuses on safety, engagement, and understanding the triggers. It’s a balance between providing a secure environment and allowing for autonomy where possible.

Home Safety Modifications:

• Install locks out of the person's sight, either high or low on exterior doors.
• Use motion sensors or door alarms that chime when an exterior door is opened.
• Disguise doors with curtains, wallpaper, or paint that matches the surrounding wall to make them less obvious.
• Place large, clear "STOP" signs on exit doors.
• Remove visual cues for leaving, such as keys, coats, or handbags from plain sight.
• Fence the yard with a locked gate to provide a safe outdoor space for walking.
• Ensure proper lighting, especially at night, and eliminate confusing mirrors or reflective surfaces that could cause agitation.

Behavioral and routine strategies:

• Maintain a consistent daily routine: This provides structure and predictability, reducing restlessness.
• Plan engaging activities: Schedule meaningful activities during times when the person is most likely to wander. This can include simple chores, walks in a secure garden, or creative projects.
• Redirect, don't correct: If a person insists on going to work or going "home," avoid correcting their reality. Instead, validate their feelings and gently redirect their attention to another activity, like looking at old photo albums.
• Incorporate exercise: Regular physical activity, such as a daily walk in a secure area, can reduce agitation and improve sleep patterns.
• Address underlying needs: Proactively check for hunger, thirst, pain, or the need to use the restroom, as these basic unmet needs can trigger wandering.
• Encourage safe outdoor time: Spending supervised time outdoors offers numerous benefits, including sensory stimulation, improved sleep, and reduced agitation. It's a natural way to fulfill the desire to be outside safely.

A comparison of management strategies

Strategy	Description	Benefits	Drawbacks
Environmental Control	Modifying the home with locks, alarms, and disguised doors.	High level of safety; reduces caregiver stress.	Can feel restrictive; may not address root cause; can be expensive.
Distraction/Redirection	Diverting attention from the urge to leave to another activity.	Avoids confrontation; preserves dignity; effective for mild wandering.	Requires constant vigilance; may not work for persistent wandering.
Routine-Based Care	Following a consistent daily schedule with engaging activities.	Promotes a sense of security and purpose; can prevent wandering.	May be challenging to maintain; requires planning and consistency.
Medical Management	Consulting a doctor about medications or underlying conditions.	Can address medical causes of agitation; highly effective in some cases.	Side effects from medication are possible; last resort approach.
Assisted Living/Memory Care	Moving to a specialized facility with a secure environment.	24/7 supervision; dedicated memory care programs; professional staff.	Significant life change; can be costly; may cause initial stress.

Planning for emergencies

Even with the best preventative measures, wandering can happen. It is vital to have a plan in place to ensure a quick and safe response. This includes creating a communication plan with family, neighbors, and local authorities. Keep a recent photo and a list of familiar places your loved one might go. Consider a GPS tracking device or an ID bracelet to aid in a search. The Alzheimer’s Association offers a Safe Return program that provides identification products and a 24/7 helpline. If your loved one is missing for more than 15 minutes, call 911 immediately.

Conclusion: Prioritizing safety and well-being

Wandering is a common and challenging aspect of dementia care, driven by a complex interplay of cognitive decline, emotional distress, and environmental triggers. By understanding the underlying motivations for why people with dementia go outside, caregivers can move from reactive stress to proactive management. Implementing home safety modifications, establishing consistent routines, and utilizing distraction and validation techniques are all critical components of a comprehensive strategy. While the risk can never be fully eliminated, a well-thought-out plan and a focus on compassionate, person-centered care can significantly reduce the risk of harm and enhance the well-being of the individual. For more resources on this topic, consider exploring reputable caregiver support organizations.

Visit the Alzheimer's Association website for additional resources

Frequently Asked Questions

What is the primary reason people with dementia wander outside?

The primary reason is often disorientation. The person may become confused about where they are, believing they need to go 'home' to a previous address or return to a past routine, like going to work.

How can I prevent a loved one with dementia from wandering?

Preventative measures include securing doors with out-of-sight locks and alarms, hiding items that trigger leaving (like keys or coats), and ensuring the person has engaging activities to reduce boredom and restlessness.

Is it safe to let a person with dementia walk outside?

Allowing supervised time in a secure, fenced-in yard or garden is beneficial for exercise and mood. However, a person with a tendency to wander should never be left unsupervised in an unsecured outdoor area.

What should I do if a person with dementia is determined to go outside?

Instead of arguing, validate their feelings and try to redirect them. If they say they need to go home, you can say, "I know you want to go home, but let's have a cup of tea first," and then offer a calming activity.

Do medications for dementia cause wandering?

While not a direct cause, some medications can increase agitation or affect sleep patterns, which may indirectly contribute to the urge to wander. It is always best to discuss medication effects with a doctor.

What are some practical safety measures for a wandering person?

Beyond securing the home, consider a GPS tracking device, a medical ID bracelet with contact information, and informing neighbors and local police about the person's tendency to wander.

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

Sundowning is a state of confusion and anxiety that can occur in the late afternoon or evening in people with dementia. The heightened restlessness and agitation during this period often increase the risk of wandering.