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Wandering Risks With Dementia

Apr 10, 2019

A common question these days from families touring senior communities on behalf of a loved one is ‘What happens if mom (or dad) tries to leave?’ Whenever I’m asked this I can’t help imagining a pesky grandmother sawing off her GPS ankle bracelet and going ninja, shimmying under some infrared lasers on her way out the nearest exit. I usually respond however, that by providing a comfortable and enjoyable environment for our residents, they will have no reason to want to leave. I should mention that while we do not really use ankle bracelets (or lasers), the concern of wandering among residents with dementia is valid.

It is estimated that about 8 percent of the U.S. population over the age of 65 will develop dementia. That rate will increase to greater than 25 percent after age 85. About half of those with dementia will develop wandering tendencies. These statistics along with the aging of baby boomers are just part of the reason for the recent explosion of “memory care” communities.  At least twelve new memory care facilities have been built within a 10 mile radius of my home within the last five years. But before labeling one who wanders as a memory care candidate, it’s essential to determine the motivation behind the behavior.

Anyone with memory problems is at risk for wandering, but few are likely to do so without a specific cause.  Recognizing these causes isn’t always easy as they frequently occur when caregivers are busy with other responsibilities. Causes may also go unnoticed when unfamiliar with the wanderer’s history or personality. For example, highly sensitive or emotional individuals may react much stronger to environmental stress and thus more likely to exit seek.  Stress, however, is not always a factor for those who wander.  Most causes of wandering usually fall into one of four general categories:

     Overstimulation- Excessive noise, unorganized activity, clutter, oversize windows and frequently used doors may all drive individuals to seek calmer areas or entice them into unsafe surroundings

     Under stimulation- Lack of consistent activity whether physical exercise, puzzles and games or social interaction may lead to boredom and the desire to find stimulation in other areas

     Conflict & Tragedy- The recent death of someone familiar, an argument with a family member or a recent health scare may all create an imbalance in one’s daily routine, triggering abnormal behavior

     Restrictive conditions- Many senior communities, whether for memory care, assisted living or sometimes independent living, close off rooms and areas dependent upon levels of care. Frequently, outdoor areas may be secured for the safety of those who wander. Restricting areas, while often for the safety of others, add mystery and may become the focus of conquest for those who feel “held back”

The challenges facing caregivers whether in a private or community setting are not to eliminate causes but to recognize where, when and how potential causes may affect behavior and trigger wandering.  Perhaps it is this ability (or effort) to recognize one’s living environment and its potential effect on individual behavior that separate living options that focus on life enrichment from those which simply provide food and shelter.  Addressing safety through restrictive conditions may be necessary, but if a living environment fails to provide positive stimulation it becomes little more than confinement.  For those transitioning from home to a community, outdoor spaces and activities should not be ignored. As weather permits, outdoor areas may help to reduce feelings of confinement and may even help to reinforce the perception of safety and security once returning indoors.

Most studies seem to agree that the more we know about an individual in our care the more effectively we can address their needs and help to establish a sense of ease within their surroundings.  Personal profiles which identify interests, likes and dislikes will not only help caregivers learn about specific individuals, but also help to uncover commonalities with others.  By cross referencing common interests, programs and activities that tap into them can then be developed and social interactions are able to flourish. When developing programs it is also important to maintain some consistency. Routine events, when communicated appropriately, help to provide structure for those with dementia by giving them reference points and thus helping to deter future wandering.

Resources

Responding to the Wandering and Exit-seeking Behaviors of People with Dementia, Jane Tilly, DrPH, Office of Supportive and Caregiver Services, Administration on Aging and Administration for Community Living, https://acl.gov/sites/default/files/triage/BH-Brief-WanderingExit-Seeking.pdf, May 2015

Wandering, Alzheimers Association, https://www.alz.org/help-support/caregiving/stages-behaviors/wandering

Braintest.com/Dementia Statistics-U.S. & Worldwide Stats, Krista Hillis, https://braintest.com/dementia-stats-U-s-worldwide/, 2013-2019