Alzheimers and Wandering

When he was in the middle stage of Alzheimer’s disease, 63-year-old Jim Hembree wandered away from his home in suburban Atlanta and got lost in the woods. He had occasionally wandered off before, when his wife was in the back of the house. When she realized it, panicked, she’d run outside and find him talking with the amiable young men at the local fire station on the corner. But this time it was night, and he never made it to the station.

As the temperature dropped into the forties, emergency calls and a search of the neighborhood yielded nothing. Hours later, his frantic wife received a call from a married couple who were startled to find an elderly man in their back yard. He was bleeding from numerous scratches and had a large gash on his foot; he also wore a metal bracelet with his phone number. The couple described him as “very nice but obviously confused and frightened.” When his wife arrived, he was elated and shook the couple’s hands graciously before returning to his home. “I can’t stand to think what might have happened if they hadn’t found him,” his wife said later.

Wandering is indeed a problem for Alzheimer’s patients and caregivers. As the disease progresses, your loved one may experience increased disorientation with regard to time and space. He or she may slowly lose the ability to recognize places and even familiar faces.

According to studies, nearly 60 percent of people with AD living at home tend to wander away from their house or their caregivers. Some researchers attribute wandering to a combination of memory impairment and disorientation. Other studies have looked at wandering as a way of reducing stress. To caregivers and family, wandering can be frightening or simply exasperating, but this behavior can almost always be traced to an underlying cause.

The Alzheimer’s Association says wandering may occur because the person is seeking out familiar people and surroundings — and gets lost even in his own neighborhood. Often he will wake up in the night, not recognize where he is, and wander out to find “home.”

What causes wandering?

Theories for the causes of wandering are legion. Experts say the causes may include the side effects of medications that cause confusion or restlessness. The person with AD may be trying to avoid an isolated and seemingly dangerous spot, or trying to escape noise, tension, or stress inside the home or residential setting. He may be acting on past routines, such as going to work and seeing friends, or trying to escape from something frightening, whether real or imagined. He may be trying to escape pain. He may be looking for something that is lost, trying to find the bathroom or get something to eat, or — like many of us — feeling the need to move around and get some fresh air. He may feel useless and abandoned, or be trying to make sense of his new surroundings. He may feel frustrated or upset with a caregiver; he may also be suffering from delusions, agitation, or paranoia. Or he may simply be bored and want to see something new.

The best approach to wandering is not to discourage it, but to control it as best you can. If, for example, a circular wandering path can be created in the home, this can help control a loved one’s restlessness and should be encouraged. And much wandering is not aimless; in some homes and residential settings, a person who appears to be wandering may actually be following the same path each time, taking the opportunity to look out the window, get water, and seek social contact. With this in mind, many of the new communities being developed for patients with dementia include circular paths specifically designed for patients who wander, according to Peter Pompei, a geriatrician at Stanford University.

However, because wandering can be dangerous — and even result in death due to exposure or accidents — caregivers shouldn’t become complacent. Wandering can begin without warning, and experts recommend the following “do’s” to manage this difficult behavior:

• Be prepared for wandering, even though it may not happen.
• Try to figure out why the person is wandering: Did anything happen just before the episode that could have caused it? Is there a time-of-day pattern to it? Does the loved one appear to have a goal?
• Get your loved one a thorough medical evaluation, particularly if wandering begins abruptly.
• Let your loved one wander where it is safe, but keep an eye on him.
• Take your loved one for walks around the neighborhood to satisfy the urge to move about.
• Set a structured program of exercise and movement as part of a daily routine, especially if your loved one was active before AD. Some people with AD enjoy gardening or just digging in the soil.
• Use double-key locks and other simple devices affixed to doors. In some cases, placing a towel over door handles is enough to deter someone from wandering; due to brain damage from the disease, the person will not know a doorknob with a towel over it is part of a door.
• Install door alarm systems that sound an alarm if the person opens the door.
• If you’re deprived of sleep because the patient routinely gets up to walk around at night, consult your doctor or a specialist about ways to control the wandering.
• Look around your home for hazards such high balconies, steep stairways, dense foliage, and nearby freeways; you may want to install fences inside and out to reduce risks.
• Install night lights and gated stairwells camouflaging at all exits.
• Affix clothing labels and an identification bracelet or necklace that display your home phone number.
• Reassure your loved one frequently about where she is and why.
• Buy an electronic bracelet that provides a long-range tracking alert.

Here are some “don’t’s” in managing wandering:

• Don’t argue with your loved one or physically restrain him, as these may lead to further agitation and aggression.
• Don’t secure the home with bolts you can’t readily open.
• Don’t panic when you can’t find your loved one; the majority return on their own.
• Don’t rush out on your own; call the police. If the wanderer returns and you aren’t home, she may go out again.

Emergency alert systems

Many products on the market today help families monitor and track loved ones at risk of getting lost. The Alzheimer’s Association “Safe Return” program helps to locate missing people who have AD. In this program, individuals are registered in a private national database by age, name, address, physical description, and medical conditions. The names, addresses, and phone numbers of up to three contact people are also listed. Program members receive a bracelet or necklace with an identity number, clothing labels, and wallet cards that indicate memory impairment. You may also buy a device with a long-range tracking alert system.

If a loved one wanders away, caregivers can call the toll-free number to report the situation; then an alert is sent to some 20,000 law enforcement agencies around the country. Experts recommend notifying police and neighbors that a memory-impaired person lives at your residence, and giving police a photo to keep on file.

Wandering can be managed to a good degree, experts say — it simply takes careful planning and education. And no matter how scared you are when the person disappears, don’t get angry with him when he returns. He’s probably already frightened. Jim Hembree’s wife, who began using double locks at night after her husband got lost in the woods, recalls her feelings upon his return. “I had been so worried I felt sick. But when I found him, I just hugged his neck.”

Resources

Alzheimer’s Association Safe Return
P.O. Box A-3956
Chicago, IL 60690
800/272-3900

National Association for Search and Rescue
4500 Southgate Place, Suite 100
Chantilly, VA 22021
703/222-6277

Care Electronics
800/916-3794
“WanderCARE” system provides caregivers a long-range tracking alert when a loved one walks away.

Medic Alert Foundation
800/432-5378
Members get an ID bracelet or necklace and are registered through a central monitoring system that immediately contacts family and other emergency personnel.

Senior Technologies
800/824-2996
Wander Guard bracelet, worn by loved one, triggers alarm if selected door is opened.

All rights reserved. This article first appeared at Consumer Health Interactive.

Beth Witrogen McLeod