In
Part One of Wandering Behavior we discussed
who might be affected by the compulsion to
wander from home and risk getting lost. In this
section we present ways to anticipate the need
to wander and simple steps that can sometimes
help reduce the wandering urge.
People in the middle stages of dementia are
generally no longer able to manage their
impulses well. They may not be able to tell us
why they feel the need to move around or to go
outside. We must rely on observation and
understanding their individual "patterns" in
order to better predict when they may have these
impulses. If we can predict the impulse to
"roam," we can often head it off.
Experts have identified seven primary
"triggers" for wandering behavior:
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1. Medication Side Effects: Some
medications can cause increased anxiety,
physical discomfort such as nausea, flushing,
dizziness or lightheadedness, even
hallucinations. An individual who is
experiencing unpleasant side effects may be
walking restlessly and trying to escape
something that can't be articulated. A caregiver
who notices changes in behavior that can be
related to having started a new medication, or
the time of day that a particular medication is
taken, should immediately contact the
prescribing physician. Reviewing all medications
and making adjustments may help to resolve the
problem.
2. Stressful Environment: At times when
the environment is more noisy or active a person
with dementia can become overwhelmed. At the end
of the day when family members are returning
home, the evening meal is being prepared, the
television is on and the phone is ringing, the
need to escape the hustle and bustle can be a
cause of wandering attempts. Providing a place
where the patient can have restful quiet can be
beneficial in reducing this stress.
3. Needing The Toilet: A person who can
no longer connect an uncomfortable feeling with
the need to use the toilet, or who can't find or
properly use the toilet, will often want to
escape the uncomfortable feeling by leaving the
scene. Be sure to leave bathroom doors open so
that the patient can see the facilities inside
the room. Use a night light or leave the light
on in the evening and on gloomy days. If this is
not sufficient, assist the patient to the
bathroom on a regular schedule, whether he
indicates that he needs to go or not.
4. Boredom: Like all people, those with
dementia need something interesting to do.
Boredom will lead them to explore and wander
into places that can be dangerous. Meaningful
activities at which they can succeed will reduce
the need to go looking for something to do.
5. Historically Active Individual: A
person who has had a life pattern of always
being active and on the go will not change
simply because of a dementing illness. Sitting
in a chair is not their "style." These
individuals need lots of activity options and a
safe area where they can roam, such as a
well-fenced and gated yard. These patients will
especially benefit from an excellent adult day
program with lots of activities.
6. Feeling Lost: Even the home of a
lifetime can be a strange place to someone with
dementia. When they want to leave these patients
are usually looking for something familiar.
These are often the most difficult wanderers to
divert, particularly in the evening when
"sundowning" symptoms can worsen. Offering a
snack "before you go," or a familiar and
comforting object to hold can sometimes help.
Sometimes a short walk or ride around the block
is sufficient. Be wary of offering a walk to
someone who will be difficult to bring back into
the house. Often entering and leaving through
the garage and taking a short car ride is safer.
7. Environmental Cues: Some dementia
patients seem to be "cued" to want to leave when
certain objects remind them that this could be
an option. Coats and hats hanging near the door
can invite going outside. Sometimes simply the
sight of the door itself is enough. Keep outdoor
gear in closets or rooms far away from outer
doors. Many women will not leave without their
purse. Keep purses out of sight if possible.
Disguise the door by painting it the same color
as the wall or by hanging a mural over it. Use
alarms if necessary.
The above suggestions are offered as a guide to
observing your own loved one with dementia who
may wander. Keep notes about the behavior you
observe. Try to identify triggers to restless or
anxious behavior. These are the potential
triggers for wandering, as well. Look for
activities, diversions and rewards that work.
Write these down in your notes so you don't
forget what worked in the past. Have one or two
of these ready to grab quickly, if necessary
(Hint: A well-wrapped dish of ice cream in the
freezer and ready to go can often be a lifesaver
when you need a quick diversion). |
