Alzheimer’s: Understanding and Preventing Wandering Behavior

In 2016, a woman who lives on the California coast wandered off while picking avocadoes in her family’s orchard. Because of her mental confusion and disorientation, she could not make her way back home. Rescuers found the woman three days later sleeping under an avocado tree with some brush over her.

“Hundreds of people searched the orchards for her,” says Phil Chandler, owner of Right at Home Ventura County, whose team now cares for the woman who has dementia. “When rescuers found her, she was tired and dehydrated but OK. She was lucky that she was found.” Besides directing his home care franchise from Camarillo, California, Chandler facilitates two support groups with the Alzheimer’s Association and speaks to community groups about dementia.

The Alzheimer’s Association reports that as many as 60% of people with dementia will wander and may get lost. Dementia is the broad medical category for individuals with a decline in memory or other cognitive or language abilities. Among the over 100 forms of dementia, Alzheimer’s disease accounts for 60% to 80% of all dementia cases. Other people with conditions such as head injuries, stroke, Parkinson’s disease, autism and Down syndrome may also stray from their homes and familiar surroundings.

Any individual who struggles with memory issues and is physically able to walk is at risk of wandering. With dementia, wandering can happen at any stage of the condition and at any time of day. A loved one who wanders is one of the most pressing concerns of caregivers, but wandering is preventable with the right safeguards and training in place.

Warning Signs of Wandering

For caregivers of an individual with decreased cognitive ability, it is important to recognize the warning signs of wandering, then to secure a personalized safety plan for the individual. Specific signs of wandering include:

• Restlessness, pacing or repetitive movement.
• Difficulty with locating familiar places like a bedroom or bathroom.
• A desire to “go home” even when already at home.
• Attempting to go to work or to fulfill former obligations.
• Returning late from a regular walk or drive.
• Inquiring about the whereabouts of past or current family and friends.
• Becoming anxious or nervous in crowded places such as restaurants and stores.

“A lot of people with Alzheimer’s or other cognitive challenges will get agitated and feel like they need to get up and do something,” Chandler explains. “It may be to go get the children from school, go to work, go out to the garden or go shopping. And it doesn’t matter what time of day. If they can get out of the house, they will just start walking. It is the agitation caused by the disease that drives people to wander.”

Chandler knows of a frail 85-year-old woman in a care facility who stacked up chairs to climb over a wall to get out. He tells of another woman with Alzheimer’s who wanted to get back home to Texas from California. She wandered from her house and convinced a neighbor to drive her to the bus station. But the bus station clerk realized she had no money or ID and called Adult Protective Services.

“Often what people with Alzheimer’s really mean is, ‘I want to go home where it’s safe and where Mom and Dad are, as well as brother and sister and the dog I grew up with,’” Chandler says. “‘That’s the environment I want to go to.’ Of course, that environment doesn’t exist anymore, but they don’t know that.”

Tips to Prevent Wandering

• Assess the time(s) of day when the person is most prone to wander. Plan extra activities or exercise during these periods to decrease the restlessness and anxiety of wanting to leave.
• Address the underlying cause of wandering. Often there is a motive behind wandering. Is your aging loved one wandering at night because of waking up hungry or thirsty? Are certain sounds triggering a need to investigate outdoors?
• Note if the individual is right- or left-handed. People typically wander in the direction of their dominant hand.
• Consider adding an electronic door alarm or indoor monitoring system. Many of the smart home tracking systems include motion sensors, cameras, and remote arm/disarm options. Or you may simply want to start with a bell over the exit doors.
• Make a list of possible places your wandering loved one may visit. Wander-prone individuals tend to return to former places of employment, a former home, a place of worship or favorite restaurant.
• Secure the home with hard-to-access door and window locks. Place locks high or low on exterior doors, or add slide bolts.
• Install a fence outside with secured gates. This allows the loved one to get some fresh air while still keeping them safe at home.
• Use specialized monitoring devices such as jewelry, bracelets or shoe inserts. Some tracking devices you control, while others require a service that charges a monthly fee to notify you if your loved one wanders, and if so, pinpoints their location. Local law enforcement and organizations like Project Lifesaver can be of additional assistance.
• Practice restful sleep habits. Some health issues lead to poor sleep and exacerbate wandering. Reducing daytime napping and caffeinated drinks can help lessen the urge to wander instead of sleeping.
• Involve neighbors. Introduce your aging loved one to neighbors and give them a phone number to call in case they see your loved one walking about in the neighborhood. Also, be sure your loved one always wears an ID bracelet or pendant, or sew identification tags inside clothing.
• Provide adequate supervision. Never leave a person with dementia and possible wandering issues alone at home or in a car.
• If wandering occurs, search the immediate area no more than 15 minutes before calling 911 to file a missing person report. Also, phone MedicAlert® + Alzheimer’s Association Safe Return® program at 1-800-625-3780, which first responders are trained to call when they find a missing vulnerable adult. Registering with this nationwide 24-hour assistance program for Alzheimer’s or related dementia can provide an additional resource for caregivers of patients with dementia.

Negotiating With a Wander-Prone Person

Chandler notes that tracking devices and products to help prevent wandering all have their pros and cons, so he recommends using a combination of them because some individuals will pull off their tracking bracelet or pendant, or leave without their GPS-wired shoes. To ward off the wandering behavior upfront, Chandler cautions against quarreling with the person with cognitive impairment or leaving them alone.

“Never argue with someone with dementia,” Chandler adds. “In my experience as the owner of a home care agency, even if someone says they don’t need help and tells our caregiver to leave, our caregiver will step into another room but will keep an eye on them. Or our caregiver may step out the front door, wait two minutes, then step right back in and say, ‘I’m here!’ and the care client usually forgets that they told the caregiver to leave. Or you can distract the person by going on a walk together. Sometimes you need to walk 10 steps behind them because they don’t want somebody to be there, but you want to have eyes on the person the whole time. To keep the person with dementia happy and safe, sometimes you need to do a little bit of creative manipulation.”

For additional information about wandering and prevention tips and tools, visit the Alzheimer’s Association’s web page on wandering or call 1-800-272-3900.