Unfortunately, this issue is quite common among dementia patients. Any resident who can walk and has memory problems could be at risk for unsafe wandering. In fact, the Alzheimer's Association states that 6 in 10 individuals suffering from dementia will wander away from home. As a caretaker, it’s important to understand who is most at risk and to study various preventative strategies in order to keep older residents safe from harm.
In this guide, we will cover:
- An overview of dementia
- Why dementia patients wander
- Warning signs of potential wandering
- Tips for preventing wandering
- What to do when your patient has wandered off
While it isn’t possible to keep an eye on your patients 24/7, you can take active steps toward keeping them safe and out of danger. Read on to learn how to manage wandering in patients with dementia now!
Overview of Dementia
Reviewing the Basics of This Serious Disease
Dementia is a term for a group of diseases that negatively impact the part of the brain that controls memory. Due to abnormal brain changes, dementia patients start to lose their most recent memories as well as their spatial recall abilities. A decline in thinking skills and other cognitive abilities will also occur.
These symptoms typically appear during the early stages of the disease. But they will eventually decline enough to impact an individual’s ability to function independently.
Causes and Types of Dementia
Put simply, dementia is caused by damaged brain cells. Symptoms may vary between different patients, depending on the particular type of dementia and also which region of the brain has been damaged.
Different causes/types of dementia include:
- Alzheimer’s: Alzheimer’s is the most common cause of dementia. Alzheimer’s patients have plaques inside their brains that damage their neurons. Not all causes of the disease are known, but some cases are caused by gene mutations that can be passed down from parent to child.
- Lewy Body Dementia: Patients with Lewy Body Dementia also have abnormal clumps of protein in their brains. Like Alzheimer’s, it is one of the most common forms of dementia.
- Vascular Dementia: This type of dementia is caused by damage to vessels that supply blood to the brain. The resulting blockages can cause strokes. Mental issues like loss of focus and poor organizational skills are common signs of vascular dementia.
- Frontotemporal Dementia: Frontotemporal Dementia is characterized by the breakdown of nerve cells and their connection to the brain’s frontal and temporal lobes, which are associated with personality and behavior.
- Mixed Dementia: Patients with mixed dementia experience brain changes reflective of multiple types of dementia.
- Parkinson’s Disease: A great number of patients with Parkinson’s eventually develop dementia.
- Huntington’s Disease: Huntington’s is a genetic disease that essentially causes the nerve cells in the brain to deteriorate.
Signs of Dementia
Wandering is not the only symptom of dementia. If you are in charge of taking care of someone with dementia, you need to educate yourself on the various signs of worsening dementia in your patient. These include both cognitive and psychological changes, such as:
- Experiencing difficulty with finding the right words to say
- Having trouble with coordination and motor functions
- Displaying inappropriate sexual behavior
- Experiencing hallucinations
- Developing anxiety and/or depression
- Memory loss
- Having trouble performing routine tasks
- Misplacing objects
- Showing impaired judgment
- Becoming withdrawn and suspicious of others
Everything You Need to Know About Wandering
Learn How to Identify and Prevent Wandering in Residents
Wandering, also known as elopement, occurs when someone with dementia walks off or becomes lost and confused by their surroundings. All patients with dementia are at risk of wandering.
As the disease progresses and worsens, their risk of wandering also increases. Wandering puts patients at risk of injury, and almost 50% of patients will hurt themselves. If the injuries are severe enough, they may end in death.
Why Wandering Occurs
The Mayo Clinic writes that there are numerous reasons why someone suffering from Alzheimer's or another form of dementia might be prone to wander. Some of these include stress, boredom, searching, fear, or following past routines. Believing that they have obligations to fulfill or experiencing physical discomfort can also lead to wandering.
When one’s ability to remember certain locations and where they are in relation to other places deteriorates, they will have a difficult time remembering how to get to certain destinations, figuring out directions, or remembering why they left a particular location. This confusion can lead to wandering.
Discomfort: Messy desks, scattered floor items, and busy rugs can all cause discomfort and confusion. If your patient is in an uncomfortable or cluttered environment, they may leave the said environment in order to relieve those negative feelings. But because of their dementia, they could end up getting lost, even if they’ve gone somewhere they visited 100 times before.
Boredom: Inactivity can also lead to boredom. In an effort to combat boredom, your patient might start to wander around in pursuit of something to do. But after leaving the house, they may forget how to get back home.
Perceived Obligations: Someone with dementia may wake up in the middle of the night and believe they have to go to work. Or maybe they start searching for something, or someone, from their past. Wandering can even occur during regular activities like going to the bathroom or going on a long walk. After they leave, they may forget why they walked away in the first place and get lost.
Physical Problems: Wandering can also result from physical decline. Patients with poor eyesight or mobility can easily become disorientated. Impaired eyesight can cause someone to turn down the wrong street or fall off their intended path. During the later stages of dementia, seniors may lose their ability to walk or go up and down stairs without assistance. These issues can also cause disorientation, which increases your patient’s risk of wandering.
Unfulfilled Basic Needs: If your patient needs to go to the bathroom or grab food, they might wander away from your eyesight. Ensuring your patient’s basic needs are met is crucial for their health and for preventing wandering.
Warning Signs of Potential Wandering
Older adults who are in the late stages of dementia are not the only individuals at risk for wandering. Even those in the very early stages of dementia can become confused or disoriented for moments of time, leading to wandering or elopement. The Alzheimer's Association states that a few warning signs for wandering include:
- Wanting or attempting to go home, even while at home
- Making restless movements or pacing
- Asking where past friends and loved ones are
- Trying to go to a past job or location
- Appearing lost in a new environment
- Having difficulty locating familiar places, such as a bedroom or kitchen
- Acting as though they are doing a chore or hobby, but failing to actually get anything done
- Getting anxious in crowded areas
- Forgetting how to get to familiar places
- Talking about former obligations they need to fulfill like picking up someone from school or going to work
- Taking longer than usual to return from long walks or drives
- Experiencing spatial problems and having difficulty judging the distance between objects
Tips to Prevent Wandering
The best way to prevent wandering is to be prepared. While you can’t completely prevent wandering from occurring, you can take steps to reduce the severity of wandering patterns.
Keeping Patients Engaged: If you want to keep your older adults safe, you must learn to identify the times of day when wandering is most likely to occur and plan activities during those times that are likely to reduce anxiety, restlessness, or confusion. Engaging in fun activities during these times will keep your residents active and less likely to become agitated or disoriented and wander.
Follow a Daily Schedule: Encourage your residents to follow a daily schedule that will provide them with the structure they need to feel reassured about what they are doing. If they are used to eating at a set time, exercising afterward, and then socializing after that, they will know what to expect and might not grow as confused about what to do next.
Obscure Doorways: Obscuring entries and exits with floor mats, neutral door coverings, curtains, or paint that match the surrounding walls of a room can reduce the chances of wandering. You can also put up posters saying “Do Not Enter” or “Emergency Exit.”
Hide Triggers: Items like keys may trigger your patient and cause them to wander. Whenever you aren’t supervising them, you should keep these items out of sight or in hard-to-reach places. Just tuck them away in a place where you can quickly retrieve them later.
Add Extra Security: Adding alarms, extra locks, and motion-sensing devices can make it easier to monitor your patient and prevent wandering. Alarm mats can alert you when your patient has started walking out of the front door or has gotten out of bed. Warning bells on doors can also alert you to potential wandering.
Being Active Instead of Reactive: If you do notice a resident growing agitated or upset, refrain from correcting or just telling your residents what to do or how to feel. Instead, reassure them and emphasize that you will be with them and that they are safe. Be proactive with your residents about wandering prevention, not reactive should an incident occur.
Label Items: Labeling certain items can reduce disorientation in patients. You can label everything from the bathroom to a piece of furniture for your patient. Color coding also works!
Use a Tracking Device: Small, budget-friendly tracking devices like watches and in-shoe tracking systems can greatly reduce stress about wandering. Should your patient wander off, you will have a much easier time finding them thanks to their tracking device.
What to Do When Wandering Occurs
Despite your best efforts, your patient may still end up wandering off. Should this happen, you need to begin search-and-rescue efforts immediately. Most of the time, caretakers will find individuals within 1.5 miles of their original destination.
You should also search any areas your patient has wandered to in the past, such as a former home or a place of worship. Keep the numbers for these places saved on your phone. Dementia patients are sometimes found near ponds or fence lines, so make sure you check local landscapes too.
If you’re not able to find your patient within 15 minutes, you need to call 911 and file a missing person’s report. Make sure you tell authorities that your patient has dementia and give them an up-to-date health report. You’ll want to keep a recent photo of your patient to give to the police.
Dealing With Worsening Symptoms
Your patient’s dementia will get worse over time. The rate at which it progresses differs for everyone. For some patients, their dementia worsens rapidly while others experience worsening symptoms over a long period of time. Health professionals typically use the Reisberg Scale, which breaks down the disease into 7 stages:
- Stage 1 - No Cognitive Decline: Anyone who does not have dementia is in Stage 1. They have normal function and no memory loss issues.
- Stage 2 - Very Mild Cognitive Decline: At this stage, the patient does not have dementia, but they may forget names or misplace familiar objects. These symptoms won’t be severe enough to be evident to the patient’s loved ones or doctor.
- Stage 3 - Mild Cognitive Decline: Someone with mild cognitive decline may be slightly forgetful and have trouble finding the right words to say during a conversation. Their loved ones may also notice that their work performance is decreasing or that they get lost frequently. People in this stage may also have trouble concentrating. This stage can last from 2 to 7 years
- Stage 4 - Moderate Cognitive Decline: Patients with moderate cognitive decline are diagnosed with early-stage dementia. They may forget recent events, withdraw from loved ones, or have trouble managing their finances. Being able to concentrate or complete simple tasks has also become difficult. At this stage, patients are usually in denial of their symptoms. Stage 4 typically lasts around 2 years.
- Stage 5 - Moderately Severe Cognitive Decline: Mid-Stage dementia is marked by major memory issues. The patient may not know what the time or date is, or even where they are. It’s common for people in this stage to also forget things like addresses and phone numbers. They may also need assistance with everyday tasks like dressing or bathing. This stage lasts for about 1.5 years.
- Stage 6 - Severe Cognitive Decline (Middle Dementia): Severe Cognitive Decline occurs during the middle stage of dementia. Patients in this stage may forget the names of family members. They also cannot perform everyday tasks like dressing or bathing without help. Other signs that a patient is in Stage 6 include forgetting recent and major events from the past, suffering from incontinence, experiencing delusions, and having difficulty counting down from 10. Your patient may also develop anxiety from experiencing these symptoms. Patients stay in this stage for an average of 2.5 years.
- Stage 7 - Very Severe Cognitive Decline (Late Dementia): Patients with late-stage dementia experience a loss of motor skills. Some cannot walk or speak. They will also need help completing most activities. The average duration of this stage is 1.5 to 2.5 years.
Other common rating scales for dementia include the Functional Assessment Staging Test (FAST) and Clinical Dementia Rating (CDR). And while they differ in their terminology, all three rating systems display a progressing severity in symptoms as the patient continues to succumb to the disease.
Unfortunately, there is no cure for dementia at this time. But, as a caretaker, you can still take numerous steps to help make your patient more comfortable. Reducing clutter and stowing away unsafe objects can make your patient’s environment safer. Helping your patient break down simple tasks can also help them maintain autonomy over certain parts of their life and improve confidence.
Frequently Asked Questions About Taking Care of Dementia Patients
Do you still have questions about taking care of your dementia patient? We understand that taking care of a dementia patient can be a big job. Check out our FAQ section!
What are some fun and safe activities I can do with my patient to prevent boredom? There are plenty of fun activities you can do with your patient! Going on supervised walks, looking through family photo albums, playing music, completing crossword puzzles, and even dancing are all great activities!
How can I help my patient stay active? Going on supervised walks is a fun and easy way to keep your patient active. Restorative yoga and water aerobics can also be great for patients. However, these activities should be cleared by their physician first. If your patient has mobility issues, you can try simple chair exercises.
How can I help my patient maintain some form of autonomy in their life? Your patient doesn’t have to release all control of their life to you. You can help them write appointments and events in their calendar. Whenever they dress or bathe, you can try to let them do as much on their own as possible.
How can I take care of myself? It’s important to remember to take care of yourself. While being a caretaker is extremely rewarding, it’s also exhausting. Remember to eat nutritious foods, take regular breaks, and keep in touch with loved ones. Joining a caregiver’s support group or starting therapy can also help you manage this demanding job.
What can I do to keep my patient’s home safe? Maintaining a sparse, clean home is crucial. Try to clear away miscellaneous objects from tables and floors. Move away electrical cords so your patient doesn’t trip. Make sure all the rooms in your patient’s living space have good lighting. You can also add safety features like safety grips, colored tape, and cabinet latches for increased safety.
Realizing that your patient has wandered away can be extremely frightening. That’s why taking active steps to prevent wandering while also planning ahead should elopement occur is key for keeping your patient safe. And while we understand that you won’t always be able to keep your eye on your patient, we also know that prepping important materials like a recent headshot of your patient will be helpful in finding them should they wander off.
To learn more about providing quality care for your residents with dementia, take one of Mariposa Training's long-term care courses, such as "Elopement Prevention 10 Strategies for Preventing Wandering and Elopement," today! Mariposa offers 60+ classes and certifications for long-term care and nursing home professionals interested in cost-effective web-based training. Because they’re all online, it’s easy for you to take them during your free time!