Wandering and getting lost are serious problems for people with dementia, especially since it happens so unpredictably. A person can wander off unexpectedly – even when you think they’re safe – and then can’t remember the way back home. Or, one day, out of the blue, they’re out the door, off to a job that’s no longer there or searching for someone they truly believe is still in their care, like a late parent or a grown up child. And sometimes they leave home desperately searching for their “real” home because they no longer recognize where they’re living.
Sometimes they get lost, just looking for a familiar place, like the bathroom. Or the person may pace and constantly move about, increasing their chances of getting lost. And finally, they may get agitated and storm off: for example, they may be bored, disturbed by too much noise, or upset by side effects from certain medications.
What makes wandering difficult is that we’re all so accustomed to leaving home whenever we want – and people with dementia are no exception. But at some point in the disease, the person you care for will get lost if they go out alone and we cannot say when that moment will come.
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Night Time Wandering
Sleep problems are also common in people with dementia. And if the person is up at night, you may be concerned that he will have a fall, use the stove or toaster when it’s no longer safe to do so, or wander outdoors. If you live with the person, one solution is to use a motion sensor with a remote alarm. This can alert you when the person gets out of bed, even if you’re in another room. Some models allow you to prerecord a message, such as “Victor, please don’t get out of bed. Please wait for me.” This can give you the time you need to be at his bedside to offer assistance. Keep in mind that some alarms only sound at the person’s bedside, which can be upsetting to him or her.
There’s a lot you can do to help the person sleep better, though at times you’ll need to creatively address his or her nighttime wandering.
Choosing a Strategy
There has been very little research on what solutions work best in different situations and environments, so it can be overwhelming trying to find the best strategies to deal with wandering. How well any intervention works depends on a lot of things, including the person’s temperament, the stage of the disease, their environment, and, of course, the product or strategy employed.
For example, a person may become very agitated by locked doors or refuse to carry a tracking device like a cell phone or wear a special monitor on their wrist. Further GPS and other tracking devices do not work in all environments. Since no single strategy will work in all situations, it’s best to try several to see which ones work best for you. For example, combine several strategies for extra safety, like ID bracelets and some kind of monitoring device.
Keep the Person Pleasantly Engaged
Activities can be powerful tools in redirecting a person’s attention from leaving home to a favorite pastime. And going for daily walks outside when the weather permits can also reduce “cooped up” feelings and help reduce agitation.
Here are five simple but powerful activities caregivers have told us that kept their loved ones engaged at home. Keep in mind you’ll need to start the activity as dementia causes one to lose the ability to initiate.
- Listening/singing favorite old songs
- Watching short videos (nature, music, babies, art, etc.)
- Looking at large print or picture books
- Reminiscing over family albums
- Doing light chores (folding colorful scarves/socks or preparing a meal together
Put Away Any Triggers
Putting away any triggers that can cause wandering is crucial. Reminders like hats, boots, handbags, coats or even mail for posting, may all give out signals that it’s time to go outdoors.
Camouflage the Door
For some, it they can’t see it, it doesn’t exist. However, people who have been living in their residence for many years may remember the location of the door, regardless of any camouflage. This intervention is usually most effective when a caregiver is nearby to provide redirection as the person could become agitated if they cannot find or open the door. Also, you’ll want to make sure this intervention is in compliance with your local fire codes; some towns may not allow this type of strategy.
Put Up Signs
Some caregivers have noted that a “Do Not Enter” sign has shown to be more effective than using a “Stop” sign on the door.
Door Locks
Some caregivers install locks higher and/or lower than normal, as the person may not look for locks in these unexpected locations. Make sure you monitor all doors to the outside, including the basement and the deck. How the person will react to a locked door is very individual. Some will simply walk away when they cannot open the door, but others will become agitated, if they feel trapped or are used to coming and going on their own.
Here are a few examples of things to say to help redirect the person to an activity indoors- ” I need your help with lunch” or ” Your favorite show is on TV”etc.
If they insist on going out the door – you may want to go with them instead of trying to hold them back. Along with extra locks, consider using a remote chime alert to let you know the person is trying to leave home. For some individuals, you’ll need to monitor the windows as well.
Monitors
When possible, consider using a two piece monitoring device. For example, a monitor sends a signal that sets off a chime alert in another room every time the person opens an outside door. Depending on your situation, you may want to combine a monitor with a lock on the door (installed high or low) or with a voice reminder unit that tells the person to wait for you – which you can learn about in the next frame.
Automatic Voice Reminders
You can record a personal message that will play if the person is at the outside door, telling the person to wait for you and not to leave the house alone. This can give you the time you need to be at the person’s side to either accompany him or her outdoors or redirect them to an activity inside. Some voice reminders have clearer audio than others and if the person is a bit hard of hearing, the muffled sounds could be a problem.
If you have a large house, you’ll need to use this device along with a remote door alert to let you know the person is at the door and a set of sliding locks, installed high or low on the door.
Alzheimer Friendly Trained Dogs
A new and promising intervention is using trained Alzheimer’s dogs to help keep a person from wandering. For example, the dog can help lead the person back home when lost if the person can remember to say “Home” to the dog. The dog will even wake you or another caregiver up when the person gets out of bed.
You’ll need a dog with a gentle personality who has both basic obedience and specialized Alzheimer’s training. And you’ll need a stable, loving environment where you, the caregiver, are the responsible party for taking good care of all the dog’s needs.
The only U.S. organization that we know of that trained Alzheimer’s dogs is no longer in existence, but be sure to check back frequently as we continually post new services as we are made aware of them.
