Dementia and Wandering: Prevention and Protection are Key

Wandering away from home is terrifying for people suffering from dementia--as well as their family members who worry their loved one won't find their way back. Unfortunately, it's a common fear--six out of 10 people with dementia wander at least once, according to the Alzheimer's Association.

"Because the likelihood of wandering is great, and because it can pose serious danger if the person can't remember their name or address, or suddenly can't recognize their surroundings, it's important for caretakers to be proactive. They need to take precautionary measures to prevent wandering, and know what to do if a loved one leaves the house and becomes lost," says Blanca Bisuna, MD, a board-certified family medicine physician at Mission Heritage Medical Group. With National Alzheimer's Disease Awareness Month taking place in November, Dr. Bisuna outlines a three-point plan for anyone responsible for a person with dementia.

1. Pay close attention.

Knowing the habits and past behaviors of the person with dementia can help caregivers predict future wandering tendencies. "Sometimes a person will want to wander as a return to old habits--they'll say they need to 'go to work' or 'go home'," Dr. Bisuna says. "That means the person might be more likely to leave at a certain time of the day. Stress, boredom or restlessness can also be triggers for wandering. Noting these tendencies helps caregivers plan ahead by making sure someone is present during these times or diversions can be scheduled."

Caregivers should also be alert to potential warning signs for wandering. "A dementia patient might pace around the house, as if he's anxious to get out," Dr. Bisuna says. "He may also exhibit signs of disorientation at home--an inability to find a familiar room such as the kitchen or trouble recognizing family members. These can be forerunners to wandering episodes."

2. Take steps toward prevention.

When planning each day, structure and routine are the mantras to keep in mind. "Having a prescribed set of daily activities can help give people with dementia a sense of order, which can reduce any anxiety that may lead to wandering," Dr. Bisuna says. "It keeps them busy, especially if there are activities planned for the times of day when the person is more susceptible to wandering."

It's also important to make sure the patient is well cared for and isn't hungry, thirsty or in need of a bathroom. "If the person with dementia feels his needs aren't being met, he may set out on his own," Dr. Bisuna says. "And don't neglect the need for physical activity. He may want to get out and move around, so if possible, take him on a supervised walk outdoors, or create a safe place such as a fenced yard where he can stretch his legs. The exercise can also be a stress reliever, and providing company during the walk can also meet another basic need--companionship."

A person may be dissuaded from wandering by a caretaker's careful words or actions. "Don't argue or debate with your loved one if he insists he has to get to work, even though he no longer has a job," Dr. Bisuna says. "Tell him he has the day off, or say that he can leave in a little bit, then guide him toward an activity that will distract him." Simple steps may also help, such as hiding car keys or a wallet--things the person typically takes when leaving the house--or installing alarms that are triggered when a door opens.

Eventually, the dementia can progress to a point where wandering off would be extremely dangerous. Modifications could be made to the living quarters--locks installed where they aren't easily accessible or doors covered with a curtain so they can't be seen. "Someone should always be present, so the person with dementia doesn't feel trapped or is left unsupervised," Dr. Bisuna says.

3. Be prepared for an emergency.

But taking all these precautions won't help if there's no backup plan in case the person does wander away. "Caregivers must be ready if the worst happens, and this plan should be developed as soon as possible after a dementia diagnosis. Ideally, it will never be used--but if it is, these measures can be instrumental to getting the person safely home," Dr. Bisuna says. Caretakers should:

• Include neighbors and family members who live nearby. "Tell them about the person's dementia, so they can help keep an eye on him--family members can schedule visits and neighbors can be on the lookout if the person leaves the house alone," Dr. Bisuna says. "Keep a list of all their contact numbers in case you need to call them in an emergency, and make sure they know how to contact you if they see something amiss."
• Have the patient's information handy if it needs to be given to police. This should include a recent photo and a brief summation of his medical history.
• Draw up a map. "Identify places the person may want to try and visit--it could be the church they attend, the grocery store where they used to shop, or a favorite restaurant," Dr. Bisuna says. "Trace those routes from the person's home, and note any danger spots along the way, such as busy intersections, bridges or secluded roads. It can also help to note whether the person is right- or left-handed; that's the direction they'll tend to wander in."
• Use an identification system. The person should wear an ID bracelet at all times that notes dementia as well as any other serious medical conditions. Dementia patients can also be enrolled in the Safe Return program administered by the Alzheimer's Association, which, for a small fee, provides assistance with any police searches.

Do not waste too much time looking for a missing dementia patient--if he doesn't turn up after a quick search of the nearby area, call 911 so the police can get involved. There is also a national Silver Alert program, similar to Amber Alerts, which helps publicize searches for missing dementia patients. The Alzheimer's Association says half of all missing people are in grave danger of injury or death if not found within the first 24 hours, so time is of the essence.

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.