Wandering? Or walking about? When people with dementia leave the house unattended.

Recently one of my clients called me. I could tell by his voice that he was panicked and scared.  He was in the kitchen making dinner while his wife who is living with dementia, napped on the couch. Or so he thought.  When he called her for dinner she was no where to be found.  Gone from the house.

This is a real concern for many care partners. When a person with dementia walks out of the home it can be very alarming for their loved ones.  This action is often referred to as wandering. It is a common action associated with dementia that can occur at any time of the day or night. Although many people use the term wandering, I think term “walking about” is more of an accurate description of the actions of someone with dementia. “Wandering” that the person’s actions are aimless or purposeless, but that is often not the case. Although individuals living with dementia do become lost, there is typically a true purpose for walking or leaving the home.

Unfortunately, this activity can be dangerous when the person living with dementia becomes disoriented or lost. While everyone should have the opportunity to move about as freely as possible, but changes in the brain caused by dementia may mean that individuals are not able to exercise the judgment and reasoning to do it safely. So, as care partners, we need to balance the person’s desires and needs with our wish to keep them safe.  This can difficult.

One thing that I find helpful is to figure out the cause or trigger of the wanting to leave, so it can be addressed in a way that is helpful to the person, not restrictive.

First, ask yourself: Why is this behavior happening? Try putting yourself in their shoes…

Actions that we observe in people living with dementia may be in response to something going on around them that is difficult for them to handle. There are a number of reasons why a person with dementia may leave the home. You’ll need to rely on what you know about the person and their past and present habits to try to figure out a cause.

Here are some reasons a person might leave the home:

• If someone finds it difficult to concentrate, they may walk about as a way to focus their mind or get away from a distracting situation.
• The person may be too hot or too cold and not know what to do about it.
• The room may be too noisy or overstimulating.
• If the person is bored, he or she may walk as something to do.
• The person may be searching for something that he or she believes is lost. This item may or may not exist.
• The habit of preparing a meal for others may result in many trips to the kitchen or the want to leave the house to go shopping.
• The person may forget that their care partner told them that they were going out and would be right back and the set off in search of them.
• Walking about can be caused by a lack of exercise and a need to use up excess energy.
• The person may believe they need to leave the house in order to go to work or take care of their children.
• The person may not recognize their own home and may want to go somewhere that is more familiar.
• The person may be continuing a long-standing habit such as going to work, taking long walk with the dog, walking children to school, walking to the market, etc.

Next, try to figure out how to meet the person’s needs

 You may have to try several different things before you find the right fit for the person, especially if it isn’t clear was is causing the actions. Don’t give up, people don’t come with an instruction manual and what works for one person, may not work for another. Try to stick with until you find a solution that works.

Take frequent walks together.  Accompanying the person on a daily walk or enlisting the help of family, friends or volunteers to walk in a safe location such as a park or sidewalk is a simple solution that usually works very well. Build this into the weekly routine. If you live in a cold climate, daily walks can be problematic. If that’s the case for you, look for indoor opportunities for regular exercise such as a local YMCA, school or other facilities with an indoor walking track, even a shopping mall that opens for morning walkers. There are many websites that have free exercise videos, if you can’t leave the home to exercise try seated yoga classes or programs designed for older adults that are offered online. Since walking about is often caused by excess energy, this is an easy solution to try.

Schedule daily activities that the person enjoys.  Many people walk about out of boredom or because they are looking for something meaningful to do. If the person enjoys a certain type of hobby, try setting up a hobby table in a central location of the house where they can go and work on a project whenever they like.

Reduced excess stimulation.  What looks like a bit of clutter on the kitchen counter to one person could be overwhelming to someone with dementia. Individuals living with dementia have difficulty making sense of what is going on in their environment and find it hard to process information when there is a lot of stimulation. Try to keep the house neat and tidy.  Organized frequently used items in labeled containers so they are easy to locate.

Pay attention to when the leaving occurs.  It is common for an increase in noise to cause the person to want to get up and leave the area. Activity or noise that used to be easily tolerated or enjoyed such as the TV, radio, grandchildren are running about, or the dogs playing may now be overstimulating and uncomfortable.

Put coats, boots, briefcases and other possible triggers away.  A coat hanging near the door could serve as a cue to someone with dementia that he or she is going out of the house. A briefcase may remind someone about going to work. Look for clues in the person’s behavior that they might be responding to these cues or triggers and remove them from one’s line of sight.

Threatening, yelling or becoming angry with the person isn’t going to help the situation. They are on a mission, they have a purpose and they think they are doing the right thing. Offering to join them, inviting them to enjoy a cup of coffee or bowl of ice cream with you, or asking them to help you fold the clothes, can all be simple interruptions that redirect the person to something positive. In addition, playing music the person enjoys will often provide a relaxing distraction that will curb unwanted walking about.