Not All Those Who Wander Are Lost

Wandering behavior is a common phenomenon among those that are diagnosed with dementia. Approximately 60%-67% of those with a diagnosis will exhibit wandering behavior over the course of their illness. Despite the prevalence of wandering, it remains a difficult issue to tackle and the consequences of a wandering incident can be dire. However, there are benefits to wandering, if done is a safe, supervised environment.

What is wandering?    

Wandering has proven difficult  to define because it is an inherently broad concept. In fact, a US Department of Veterans Affairs study (1985) concluded that its imprecision “defies definition”. Although there is not consistent agreement on what constitutes wandering some definitions include:

  • Behavioral problem of AD patients that involves cognitive impairment affecting abstract thinking, language, judgement, and spatial skills
  • Disorientation and difficulty relating to the environment
  • Aimless or purposeful motor activity that causes a social problem such as getting lost, leaving a safe environment, or intruding in inappropriate places
  • Meandering, aimless or repetitive locomotion that exposes the individual to harm; frequently incongruent with boundaries, limits, or obstacles

Wandering statistics

  • Up to 67% of those with dementia will wander.
  • 45% of wanderers will perish if not found in the first 24 hours
  • 83% have wandered before
  • 95% are found within 1.5 miles

Why does wandering occur?

The reasons why wandering occurs are as varied as the individuals that exhibit this pattern of behavior. Although it may not be readily apparent why the person with dementia is exhibiting wandering behavior, it likely originates from a physical, mental, or social need.

Determining Risk

  • Consider premorbid personality and lifestyle
  • Sleep disturbances sometimes predictive of wandering
  • Increased cognitive impairment correlated with increased likelihood of wandering behavior
Other Indicators:

  • Returns from a regular walk or drive later than usual.
  • Tries to fulfill former obligations, such as going to work.
  • Tries or wants to “go home,” even when at home.
  • Is restless, paces or makes repetitive movements.
  • Has difficulty locating familiar places like the bathroom, bedroom or dining room.
  • Asks the whereabouts of current or past friends and family.
  • Acts as if doing a hobby or chore, but nothing gets done.
  • Appears lost in a new or changed environment.

One interesting theory suggests that wandering in outdoor or woodland settings is a natural, human impulse and should be embraced rather than stymied. In Mape’s (2012) study, researchers piloted the idea of facilitating controlled wandering in a woodland environment in their study Wandering in the Woods. Researchers found after participants were exposed to outdoor exercise, subjects exhibited improved sleep, improved dietary intake, multi-sensory engagement and associated joy, increased verbal expression, and improved memory.

Where do they go?

Picture1

Evidence-Based Interventions

Environmental Modifications

  • Provide safe place for person to wander, such as walking path or ‘man cave’.
  • Enhance visual appeal of environment with interesting décor.
  • Maintain safety by removing clutter and dangerous objects.
  • Remove ‘triggers’, such as car keys, from the environment.
  • Place locks out of the line of sight. Install either high or low on exterior doors.
  • Subjective barriers, such as camouflage doors and doorknobs, and dark floor mats.
  • Use devices that signal when a door or window is opened.
  • Use confounding locks on doors to prevent exit/entry.
  • Provide supervision. Never lock the person with dementia in at home or leave him/her in a car without supervision.
  • Use large print signs/photographs to assist in finding key areas.
  • Ensure pathway to bathroom is clear and accessible, especially at night. Restrict fluids an hour or two before bed to avoid nighttime wandering.
  • Avoid environments that are confusing and can cause disorientation, such as grocery stores, shopping malls, or large holiday gatherings.

Physiological and Psychosocial Interventions

  • Having a routine can provide structure and reduce restlessness.
  • Encourage regular exercise, such as walking after meals.
  • Identify the times of day that wandering may occur. Plan activities at that time.
  • Ensure all basic needs are met. Has the person gone to the bathroom? Is he/she thirsty or hungry?
  • Assess for and treat depression.
  • Provide social interaction and engagement.
  • Encourage the person to engage in meaningful activities.
  • Reassure the person if he or she feels lost, abandoned, or disoriented.  Validate feelings.
  • Engage person in stress relieving activities, such as music, art, massage, etc.

References

Bushnell, R., & Collins-Fadell, C. (2012, September 1). For those who wander. The Best of Aging(11).

Futrell, M., Melillo, K., & Remington, R. (2010). Evidence-based guideline: wandering [corrected] [published erratum appears in J GERONTOL NURS 2010 Mar;36(3):1p]. Journal Of Gerontological Nursing36(2), 6-16. doi:10.3928/00989134-20100108-02

Lai, C., & Arthur, D. (2003). Wandering behaviour in people with dementia. Journal Of Advanced Nursing44(2), 173-182.

Mapes, N. (2012). Have you been down to the woods today? Working with Older People18 (1), 7-16. doi:10.1108/13663661211215105

Robinson, L., Hutchings, D., Dickinson, H. O., Corner, L., Beyer, F., Finch, T., Hughes, J., Vanoli, A., Ballard, C., & Bond, J. (2007). Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review. International Journal of Geriatric Psychiatry22, 9-22. doi:10.1002/gps.1643

US Department of Veterans Affairs (1985) Dementia Guidelines for
Diagnosis and Treatment. Author, Washington, DC.

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1 Comment »

  1. […] shorter days, less sunlight, and disruptions from a normal routine. He/she may also exhibit “wandering” behavior which includes walking or pacing about and trying to leave a safe environment. […]

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