Changes in behaviour
When he has gone to a nearby shop and not come back, I have to go out searching. I keep my cool when I find him. Sometimes he smiles and says, “I’m glad to see you. I’ve had a long walk.” Other times he might refuse to get into the car, so I let him go. But I keep him in sight until he’s tired and agrees to take a lift home. My sister used to go out at all hours. I was worried because she’s forgotten how to cross the road safely. I put a big notice on the inside of the door to remind her not to go out on her own, and it seems to work most times.
Wandering is fairly common amongst people with dementia. Some people just wander around the home, whereas others try to go out and some wander around at night when everyone else is asleep. (Please see chapter on sleeplessness and night-time wandering.) Contrary to popular belief wandering is rarely aimless, but people with dementia may forget where they are going, what they set out to do or may be unable to explain it. Sometimes people with dementia wander off and become afraid when they realise that they are lost. There are a number of reasons for wandering such as boredom, discomfort, disorientation and memory problems etc. You may find it stressful and a physical strain to keep a constant eye on the person with dementia and feel concerned about their safety. The level of danger depends to a certain extent on whether you live in a quiet, relatively safe neighbourhood or a busy, dangerous town. But wherever you live you are faced with the problem of trying to avoid depriving the person with dementia of their independence, whilst at the same time making sure that they are not exposed to any risk.
How to prevent wandering
Make provisions for safe wandering and keep the person active
You should try to provide a safe environment in which the person with dementia can wander around. If you have an enclosed garden, this would enable them to profit from a little fresh air. Alternatively you could provide an area in your house or apartment where they could wander around in safety (please see chapter on safety). Wandering can sometimes be caused by excess energy. If this is the case, providing a safe place to wander may reduce its occurrence. Another solution might be to accompany the person on a regular walk or enrol the services of a friend or volunteer. You could even combine this with a daily task such as shopping or walking the dog. As many people with dementia seem to wander as a result of boredom, try to make sure that they have something to occupy their time (please see chapter on recreation, activities and exercise).
Look for a pattern to the wandering
It is a good idea to note down the circumstances and time when the person wanders. This might enable you to detect a pattern. If so, you may be able to prevent it from reoccurring, by distracting, reassuring or helping the person with dementia. A few possible causes are :
- Persisting memories from the past : Memories of old habits might be interfering with the present, e.g. the person may be concerned that the dog needs walking (even if you no longer have a dog). Alternatively, they might be looking for friends from the past or a previous home.
- Getting lost : The person may be looking for a particular room, e.g. the toilet. (Please see chapter on disorientation.)
- Confusion : As a result of confusion, the person with dementia might wander around in search of something (e.g. a suitcase or book) which might or might not exist.
- Hunger, thirst, discomfort or pain : People with dementia are not always aware of their feelings and sometimes cannot communicate their feelings to others. They may be hungry, thirsty, in pain or need to go to the toilet, but not understand what the feeling is. You might find out at some stage that the person has been in pain for some time without realising or being able to express it. If you cannot find a reason for the person‘s wandering and suspect that they are in discomfort or pain, it would be a good idea to consult a doctor.
Maintain a stable environment and provide assistance in unfamiliar surroundings
Try to avoid making too many changes to the person’s home. Even seemingly minor changes may be sufficient to render a room or building unrecognisable to someone with dementia. Wandering is a normal reaction to settling down in a new environment such as someone else’s home or a day care centre. If the person with dementia has recently moved, they may go through a transitional period, during which they feel confused, uncertain and disoriented. They may need reassurance and assistance to find their way around. But with time the wandering usually ceases.
Get help from friends and neighbours
It is a good idea to warn friends and neighbours that the person with dementia has a tendency to wander and ask them to keep an eye on them. This will reduce the possibility of the person wandering too far from home.
Identification and photos
Try to get the person with dementia to wear some form of identification (perhaps also a message or your address). This will be extremely useful if they wander and someone tries to help. You could put this information in a lady’s handbag or a man’s jacket pocket. But a lady might go out without her handbag and a man without his jacket. A possible solution is to sew a label into the person’s clothes. Alternatively you could get them to wear an identity bracelet with their name, address and telephone number (or your address and number if they live with you). Try to make sure that you have a recent photo of the person with dementia. This would help, should you need to contact the local police or ask people in your neighbourhood if they have seen them.
How to cope with wandering
Avoid being confrontational, using physical restraint or scolding
If the person with dementia tries to leave the building, it is best to avoid being confrontational or using physical restraint. Such an approach could lead the person with dementia to become aggressive or have an over-reaction. An alternative approach is to try to create a distraction. You could suggest doing something else such as having a cup of tea together. If the person insists on going out, go along with them and then once out try to distract them into returning.
If you realise that the person with dementia has slipped out unnoticed, don’t panic and don’t blame yourself. You cannot be expected to keep an eye on them twenty-four hours a day. Search your local area, enlisting the help of friends and neighbours where possible. If you don’t find the person with dementia straight away, contact the local police.
Avoid medication if at all possible. The dose necessary to reduce wandering is likely to cause side effects such as drowsiness, increased confusion and possibly incontinence. However, a doctor may be able to determine a source of discomfort or pain, which is causing the person with dementia to pace up and down. Many people do this when they are in pain.
Last Updated: lundi 18 janvier 2010