Alzheimer's and Wandering

Not only do Alzheimer's patients wander but they also easily become lost. It's a serious and troubling symptom of Alzheimer's disease.

Many people with Alzheimer's walk around or leave their homes. This can be worrying for their caregiver, and can, at times, put the person in danger. But it is important to find a solution that preserves the person's independence and dignity.

If the person with Alzheimer's starts 'wandering', the first step is to look at the reasons behind their behavior. Alzheimer's patients usually wander because they're disoriented, anxious, restless or stressed. Once you identify what the person is trying to achieve, you can start to find other ways to meet their needs, reducing their desire to walk alone.

It can be very troubling for a caregiver when the person they are caring for starts to walk about in an apparently aimless way. A person with Alzheimer's might get up and leave the house in the middle of the night. Or they might knock on the neighbors' doors at inconvenient times of the day. Occasionally, people get lost and are discovered, confused, miles from home. This can make the caregiver feel very anxious and concerned for the person's safety.

Some caregivers find it reassuring to know that this type of behavior does not last - it seems to be a phase of the condition that people go through. In addition, most people with Alzheimer's retain their road sense and are rarely involved in traffic accidents.

What can you do?

The first thing to consider is why the person might be doing this, so that you can find ways to deal with the situation. Think about why people generally choose to go for a walk:

• Walking helps us to keep fit and to sleep better at night.
• It is a good way to relieve tension and stop us feeling 'cooped up' inside the house.
• It can be an enjoyable way to see what is going on in the outside world.

For many people, whether they have Alzheimer's or not, walking is a lifelong habit. A person with Alzheimer's who has always walked a lot for the above reasons may find it very difficult to remain in one place for long periods of time.

The Mayo Clinic also suggests other reasons for wandering:

Too much stimulation, such as multiple conversations in the background or even the noise in the kitchen, can trigger wandering. Because brain processes slow down as a result of Alzheimer's disease, the person may become overwhelmed by all the sounds and start pacing or trying to get away.

Wandering also may be related to:

• Medication side effects
• Memory loss and disorientation
• Attempts to express emotions, such as fear, isolation, loneliness or loss
• Curiosity
• Restlessness or boredom
• Stimuli that trigger memories or routines, such as the sight of coats and boots next to a door, a signal that it's time to go outdoors
• Being in a new situation or environment

Retaining independence

It is very important that people with Alzheimer's are encouraged to remain independent for as long as possible. Some degree of risk is inevitable whatever choices you make as a caregiver. You need to decide what level of risk is acceptable in order to maintain the person's quality of life and protect their independence and dignity.

The steps you take to safeguard the person will depend on how well they are able to cope, and the possible reasons for their behavior. You will also need to take the safety of the person's environment into account. There is no such thing as a risk-free environment, but some places are safer than others. If you live on a busy main road with fast-moving traffic, or in an urban area where you don't know your neighbors, you might need to take a different approach to someone living in a peaceful rural area where the person is well known within the local community.

Feeling lost

If the person has recently moved home, or if they are going to a new day center or having residential respite care, they may feel uncertain about their new environment. They may need extra help in finding their way about. They may also be more confused about the geography of their own home when they return.

This disorientation might disappear once they become familiar with their new surroundings. However, as the Alzheimer's progresses, the person may fail to recognize familiar surroundings, and they may even feel that their own home is a strange place.

Memory loss

Short term memory loss can lead a person with Alzheimer's to go walking and become confused. They might embark on a journey for a specific purpose, with a particular goal in mind, and then forget where they were going and find themselves lost. This can be particularly distressing.

Alternatively, they may forget that you have told them that you are going out, and set out to look for you. This may lead to extreme anxiety, and they will need plenty of reassurance. In the earlier stages, it can help to write notes reminding the person where you have gone and when you will be back. Fasten these securely in a place where the person will see them, such as near the kettle or on the inside of the front door.

Sources:

• U.S. Office on Aging - Alzheimer's brochure, 2007.
• Alzheimer's Association: Steps to Understanding Challenging Behaviors: Responding to Persons with Alzheimer's Disease, (2005).
• Alzheimer's Society - UK, Carers' advice sheet 501, Nov. 2005