An estimated 60% of people with dementia will wander. Wandering can be one of the most challenging behaviours experienced by the carers of people with dementia. The potential for danger when a person with dementia leaves their home makes it one of the riskiest behaviours. Other problems associated with wandering are accidents and falls, weight loss and malnutrition when a person is unable to sit for meals and because wandering can increase calorie requirements, sleep disturbance, and earlier institutionalisation.
Wandering comprises a range of behaviours:
- Aimless walking
- Walking with inappropriate purpose
- Night-time walking
- Attempts to leave home
There are many interventions to manage and prevent wandering, taking a person-centred approach means identifying which ones are most effective for the individual in your care. Wandering is more likely to occur in new or unfamiliar settings; having a daily routine can provide structure. Surrounding the person with familiar objects and photographs may help, especially if they have moved into a new setting. It is useful if you can identify patterns in the wandering, if there are times in the day when it is more likely to happen, so plans can be made for activities for those times of day. Offering clear tasks if they want to leave the house / care home at an inappropriate time can distract the person from wanting to go out.
Traditional methods of preventing wandering comprised physical barriers, such as locking doors, and physical restraint, however these are not necessarily practical or ethical. Some small physical changes to the environment may prevent wandering in some people. Covering door handles or locks with a cloth can be successful, as can placing a mirror in front of the exit door. Placing strips of black tape across the floor in front of the exit may also decrease attempts to leave. Having door and window alarms are useful for alerting if these are opened.
In your own home
For people caring for people with dementia in their own home, if the person is likely to leave the house, it can be useful to enlist the support of neighbours and local shopkeepers. Ask them to telephone if they see the person out alone. It is useful if the person wandering carries some form of identification; ID alert bracelets are readily available, and can contain useful information such as name, address, emergency contact and any known allergies or medical conditions.
In care homes
Recently, and more controversially, electronic tagging has been used for people with dementia, particularly in care homes. This has proven to be effective in virtually eliminating the risks of getting lost, and enabling a degree of independence and control to the individual with dementia. Furthermore, medications are often used to manage wandering in care homes, but these can have unpleasant side effects, so electronic tagging may be preferable. However there are considerable ethical issues related to electronic tagging. This technique is associated with objectification and dis-empowerment. There is a risk that surveillance technologies may reduce human contact for the person with dementia, by reducing staff involvement. They may also provide a false sense of security. There is currently little evidence to suggest that electronic tagging is more effective than identity bracelets in preventing people with dementia from going missing: identity bracelets are certainly less costly.
In care homes, there are simple changes that staff can make to reduce wandering. Increasing the social interactions between staff and residents is effective in reducing wandering behaviours. Providing people with dementia with the optimum level of stimulation is important; people may become anxious, confused and disoriented when overstimulated, but under stimulation may increase wandering behaviours as well as decrease sleep.
Organisational changes can also help, establishing a caring climate where social relationships are valued, and the approach is person-centred, not-task oriented. Opportunities for staff to receive ongoing support and training in dementia care, and providing a safe space for discussion of ethical issues and conflicts that arise, should be embedded within the culture of the care home.
When is it a problem?
Finally it is important to consider whether the wandering is actually a problem, and if so, who it is problematic for. Going for a walk with someone can be an enjoyable and sociable experience; many people walk for pleasure. Joining the person in their wandering can be beneficial for both parties. Safe wandering may be more beneficial for some people than attempts to prevent the wandering altogether.
Alzheimer Scotland provide useful information for carers in their information sheet When people with dementia walk.
An initiative that has come from Germany, and is spreading, is the idea of creating fake bus stops at care homes and hospitals. The rationale is that often people with dementia will leave the care home because they want to go home, so they go to the bus stop and wait for a bus.