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Managing and Preventing Wandering
Wandering is a common behaviour among individuals with dementia. Due to cognitive decline, individuals with dementia may have difficulty recognizing familiar places, which can lead to confusion, wandering, or getting lost.
It is estimated that 60% of older adults living with dementia wander at least once.[1] Wandering behaviour is associated with falls, injuries, and fractures.[2] In fact, nearly half of older adults who wander will experience a fall or an environmental hazard.
When family members and caregivers are not able to locate individuals with dementia who wander, the situation can quickly become dangerous. Therefore, it is important that caregivers are aware of the signs of wandering and know how to support individuals with dementia who wander.
Managing and Preventing Wandering
Wandering is a common behaviour among individuals with dementia. Due to cognitive decline, individuals with dementia may have difficulty recognizing familiar places, which can lead to confusion, wandering, or getting lost.
It is estimated that 60% of older adults living with dementia wander at least once.[1] Wandering behaviour is associated with falls, injuries, and fractures.[2] In fact, nearly half of older adults who wander will experience a fall or an elemental exposure.
When family members and caregivers are not able to locate individuals with dementia who wander, the situation can quickly become dangerous. Therefore, it is important that caregivers are aware of the signs of wandering and know how to support individuals with dementia who wander.
Wandering generally falls under two categories: Direct wandering and Random wandering.[3]
Direct wandering is goal-oriented and purposeful. It can happen when the individual is trying to address a specific concern or follow a routine from their past, such as going to work or picking up their children from school.
Random wandering refers to moving around without a clear purpose, usually because the person feels anxious or restless.
Signs of Wandering
Some common signs of wandering among individuals with dementia include:[4]
- Taking a longer time than usual to get home.
- Forgetting how to get to familiar places that they regularly go to.
- Wanting to go home even though they are already at home.
- Feeling anxious in crowded areas, such as grocery stores and restaurants.
- Being confused about the location of the washroom, bedroom, or living room at home.
When caregivers notice signs of wandering, they should look into measures to prevent their loved ones from wandering and getting lost.
Useful Resources
- Yee Hong Centre: Yee Hong CARE-Learning: Prevention of Missing Incidents (video in Mandarin)
- Yee Hong Centre: Yee Hong CARE-Learning: Prevention of Missing Incidents (video in Cantonese)
- A Place for Mom: Dementia and Wandering: Causes, Prevention, and Tips You Should Know
- Daily Caring: 8 Ways to Prevent Alzheimer’s Wandering
- Alzheimer Society of British Columbia: Wandering and dementia
- Chuxin Elderly Care, P.R.C.: Wandering, pacing and restless issues of seniors with dementia and how to tackle (Chinese)
- Alzheimer Society of British Columbia: Wandering and dementia: A guide for caregivers
- Finding your Way® (an informative website for people with dementia and wandering)
Signs of Wandering
Some common signs of wandering among individuals with dementia include:[4]
- Taking a longer time than usual to get home.
- Forgetting how to get to familiar places that they regularly go to.
- Wanting to go home even though they are already at home.
- Feeling anxious in crowded areas, such as grocery stores and restaurants.
- Being confused about the location of the washroom, bedroom, or living room at home.
When caregivers notice signs of wandering, they should look into measures to prevent their loved ones from wandering and getting lost.
Useful Resources
- Yee Hong Centre: Yee Hong CARE-Learning: Prevention of Missing Incidents (video in Mandarin)
- Yee Hong Centre: Yee Hong CARE-Learning: Prevention of Missing Incidents (video in Cantonese)
- A Place for Mom: Dementia and Wandering: Causes, Prevention, and Tips You Should Know
- Daily Caring: 8 Ways to Prevent Alzheimer’s Wandering
- Alzheimer Society of British Columbia: Wandering and dementia
- Chuxin Elderly Care, P.R.C.: Wandering, pacing and restless issues of seniors with dementia and how to tackle (Chinese)
- Alzheimer Society of British Columbia: Wandering and dementia: A guide for caregivers
- Finding your Way® (an informative website for people with dementia and wandering)
Wandering Causes and Contributing Factors
There are several causes and contributing factors that can lead to wandering behaviour in individuals with dementia, including:
Disorientation and Confusion
Cognitive decline can lead to disorientation and confusion. Individuals may not recognize their surroundings, leading them to wander in an attempt to find familiar places.[5]
Unmet Needs
From a psychosocial perspective, wandering behaviour is conceptualized as the expression of needs.[6] Wandering can be triggered by unmet physical or emotional needs, such as hunger, thirst, pain, depression, or a need for social interaction. If an individual is unable to communicate these needs verbally, they might express them through wandering.
Restlessness and Agitation
Some individuals with dementia experience restlessness or agitation due to sensory overload, discomfort, or an inability to sit still. Wandering can be an outlet for this restlessness.[7]
Routine Disruptions
Changes in daily routines or environment can cause distress and prompt wandering. Individuals with dementia often rely on familiar routines, so disruptions can lead to confusion and the urge to search for a familiar setting.
Sundowning
Many individuals with dementia experience increased confusion and agitation during the late afternoon and evening, a phenomenon known as sundowning.[8] The increased confusion and agitation can lead to increased wandering during these hours.
Memory Triggers
Certain stimuli, such as seeing a specific object or hearing a particular sound, can trigger memories from an individual’s past. This might prompt the individual to wander in search of a place or person associated with that memory.
Wandering Causes and Contributing Factors
There are several causes and contributing factors that can lead to wandering behaviour in individuals with dementia, including:
Disorientation and Confusion
Cognitive decline can lead to disorientation and confusion. Individuals may not recognize their surroundings, leading them to wander in an attempt to find familiar places.[5]
Unmet Needs
From a psychosocial perspective, wandering behaviour is conceptualized as the expression of needs.[6]
Wandering can be triggered by unmet physical or emotional needs, such as hunger, thirst, pain, depression, or a need for social interaction. If an individual is unable to communicate these needs verbally, they might express them through wandering.
Restlessness and Agitation
Some individuals with dementia experience restlessness or agitation due to sensory overload, discomfort, or an inability to sit still. Wandering can be an outlet for this restlessness.[7]
Routine Disruptions
Changes in daily routines or environment can cause distress and prompt wandering. Individuals with dementia often rely on familiar routines, so disruptions can lead to confusion and the urge to search for a familiar setting.
Sundowning
Many individuals with dementia experience increased confusion and agitation during the late afternoon and evening, a phenomenon known as sundowning.[8] The increased confusion and agitation can lead to increased wandering during these hours.
Memory Triggers
Certain stimuli, such as seeing a specific object or hearing a particular sound, can trigger memories from an individual’s past. This might prompt the individual to wander in search of a place or person associated with that memory.
Lowering the Risk of Wandering
There are several measures caregivers can take to reduce the risk of wandering, including:
Engaging Individuals with Dementia in Meaningful and Structured Activities
Involve individuals with dementia in daily activities and household chores during the times of day when they are most likely to wander. Encourage them to do regular exercises as an outlet for their energy.[9]
Modifying the Home Environment
Consider installing alarms or motion-sensing devices at entrances to alert you when your loved one goes out. Store away items that could trigger individuals with dementia to go outside, such as coats, purses, car and house keys, and wallets.
Ensuring Their Basic Needs Are Met
Wandering can be triggered by unmet needs, such as searching for food, a washroom, or simply wanting to get some fresh air. Ensuring these needs are met can reduce the likelihood of wandering.[10]
Helping the Individual Wear Accessories that Contain Identification and Emergency Contact Information
This helps pedestrians and passersby identify the individual and contact their family immediately if they become lost while wandering.
Using Tracking Technologies
Tracking devices, such as GPS smart watches and pocket-sized GPS trackers, can help locate the individual when they go missing.[11]
Ensuring Important Documents Are Ready and in a Convenient Location
Having the individual’s identification photos and medical information handy can assist police in searching and caring for the missing individual.
Notifying Friends, Neighbours, Staff of Nearby Stores, and Building Security Guards
Let your friends and those in your community know about your loved one’s wandering behaviours. Ask them to contact you immediately if they see your loved one walking alone.
Lowering the Risk of Wandering
There are several measures caregivers can take to reduce the risk of wandering, including:
Engaging Individuals with Dementia in Meaningful and Structured Activities
Involve individuals with dementia in daily activities and household chores during the times of day when they are most likely to wander. Encourage them to do regular exercises as an outlet for their energy.[9]
Modifying the Home Environment
Consider installing alarms or motion-sensing devices at entrances to alert you when your loved one goes out. Store away items that could trigger individuals with dementia to go outside, such as coats, purses, car and house keys, and wallets.
Ensuring Their Basic Needs Are Met
Wandering can be triggered by unmet needs, such as searching for food, a washroom, or simply wanting to get some fresh air. Ensuring these needs are met can reduce the likelihood of wandering.[10]
Helping the Individual Wear Accessories that Contain Identification and Emergency Contact Information
This helps pedestrians and passersby identify the individual and contact their family immediately if they become lost while wandering.
Using Tracking Technologies
Tracking devices, such as GPS smart watches and pocket-sized GPS trackers, can help locate the individual when they go missing.[11]
Ensuring Important Documents Are Ready and in a Convenient Location
Having the individual’s identification photos and medical information handy can assist police in searching and caring for the missing individual.
Notifying Friends, Neighbours, Staff of Nearby Stores, and Building Security Guards
Let your friends and those in your community know about your loved one’s wandering behaviours. Ask them to contact you immediately if they see your loved one walking alone.
Responding to a Wandering Incident
When wandering occurs, caregivers should stay calm and search for the individual with the support of the police and community.[12]
Call 911
Caregivers should contact emergency services immediately. If the individual has taken anything with them that can be tracked, such as credit cards or vehicles, provide this information to the authorities as this can aid in the search.
Conduct a Neighbourhood Search:
Search the area near the individual’s home and where they were last seen. If the individual cannot be found after 15 minutes, caregivers should ask friends and neighbours to help search or keep an eye out for the individual who has gone missing. Search in places they wandered, lived, worked, or visited frequently before.
Use Social Media
Caregivers can also get help from social media and services that help locate individuals with dementia who wander and get lost.
Stay at Home
If possible, it is recommended to have someone stay at home while the search continues, in case the individual returns home on their own.
How the Public Can Help
Community members can help older adults who seem lost on the streets[13]. Since individuals with dementia usually have cognitive decline and feel nervous in an unfamiliar environment, you should reassure them that you are here to help.
Here are some tips for creating a comfortable atmosphere:
- Maintain an appropriate distance from the individual to facilitate communication and a sense of security. It is important to use relaxed, open tones and gestures to help the individual feel safe.
- Patiently speak and listen to the individual. Individuals with dementia may have cognitive decline and may not understand complicated expressions, so you should use simple questions and sentences when communicating. If the individual does not understand what you are saying, it may be helpful to use non-verbal communication, such as hand gestures or writing in a notebook.
- Contact the police for assistance once you have gathered sufficient information. Stay with the individual in a safe place until help arrives.
Responding to a Wandering Incident
When wandering occurs, caregivers should stay calm and search for the individual with the support of the police and community.[12]
Call 911
Caregivers should contact emergency services immediately. If the individual has taken anything with them that can be tracked, such as credit cards or vehicles, provide this information to the authorities as this can aid in the search.
Conduct a Neighbourhood Search:
Search the area near the individual’s home and where they were last seen. If the individual cannot be found after 15 minutes, caregivers should ask friends and neighbours to help search or keep an eye out for the individual who has gone missing. Search in places they wandered, lived, worked, or visited frequently before.
Use Social Media
Caregivers can also get help from social media and services that help locate individuals with dementia who wander and get lost.
Stay at Home
If possible, it is recommended to have someone stay at home while the search continues, in case the individual returns home on their own.
How the Public Can Help
Community members can help older adults who seem lost on the streets[13]. Since individuals with dementia usually have cognitive decline and feel nervous in an unfamiliar environment, you should reassure them that you are here to help.
Here are some tips for creating a comfortable atmosphere:
- Maintain an appropriate distance from the individual to facilitate communication and a sense of security. It is important to use relaxed, open tones and gestures to help the individual feel safe.
- Patiently speak and listen to the individual. Individuals with dementia may have cognitive decline and may not understand complicated expressions, so you should use simple questions and sentences when communicating. If the individual does not understand what you are saying, it may be helpful to use non-verbal communication, such as hand gestures or writing in a notebook.
- Contact the police for assistance once you have gathered sufficient information. Stay with the individual in a safe place until help arrives.
References
[1] Alzheimer’s Association (2023). Wandering. Retrieved 08 May 2023, https://www.alz.org/help-support/caregiving/stages-behaviors/wandering
[2] Agrawal, A. K., Gowda, M., Achary, U., Gowda, G. S. & Harbishettar, V. (2021). Approach to management of wandering in dementia: Ethical and legal issue. Indian Journal of Psychological Medicine. Retrieved 08 May 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8543604/
[3] Dementia Solutions. (2019). Wandering & Dementia – Making Sense of It. https://dementiasolutions.ca/wandering-dementia-making-sense-of-it/
[4] Alzheimer’s Association. (n.d.) Wandering. https://www.alz.org/help-support/caregiving/stages-behaviors/wandering
[5] Alzheimer Society of Canada (2023). Wandering and dementia. https://alzheimer.ca/bc/sites/bc/files/documents/Wandering-for-Caregivers-print-2022-07.pdf
[6] Lai, C. K. Y., & Arthur, D. G. (2003). Wandering behaviour in people with dementia. Journal of Advanced Nursing, 44(2), 173–182. https://doi.org/10.1046/j.1365-2648.2003.02781.x
[7]Samuels, C. (2021). Dementia and Wandering: Causes, Prevention, and Tips You Should Know. A Place for Mom. Retrieved 08 May 2023, from https://www.aplaceformom.com/caregiver-resources/articles/dementia-wandering-causes-prevention
[8] Samuels, C. (2021). Dementia and Wandering: Causes, Prevention, and Tips You Should Know. A Place for Mom. Retrieved 08 May 2023, from https://www.aplaceformom.com/caregiver-resources/articles/dementia-wandering-causes-prevention
[9] Alzheimer Society of Canada (2023). Wandering and dementia. Retrieved 08 May 2023, from https://azheimer.ca/bc/en/help-support/programs-services/dementia-resources-bc/wandering-disorientation-resources/wandering-dementia
[10] Daily Caring. (2023).8 Ways To Prevent Alzhimers’s Wandering https://dailycaring.com/8-ways-to-prevent-alzheimers-wandering/
[11] Howes, J., Denier, Y., & Gastmans, C. (2022). Electronic Tracking Devices for People With Dementia: Content Analysis of Company Websites. JMIR aging, 5(4), e38865. https://doi-org.myaccess.library.utoronto.ca/10.2196/38865
[12] University of Pittsburgh Medical Center (2023). Wandering in Patients with Alzheimer’s Disease and Dementia. Retrieved 08 May 2023, from https://www.upmc.com/services/seniors/resources-for-caregivers/wandering-tendencies-patients-alzheimers-dementia
[13] Alzheimer’s Society (2019). How to help a stranger who seems lost and confused. Retrieved 08 May 2023, from https://www.alzheimers.org.uk/blog/what-to-do-find-someone-with-dementia-lost
