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Wandering in people who have dementia is both common and exhausting. It leads to getting lost, but also to malnutrition, failures of medication, social isolation, and an earlier need to go into nursing care. Here are 10 ways to prevent it.

Wandering is one of the most common and one of the most exasperating features of dementia. The worries caused by wandering aren't limited to the patient's getting lost. People who have dementia who stray from home without their maintenance medications are prone to medical crises. They are easily injured. They lose contact with family, friends, and caregivers, and they are likely to be institutionalized sooner rather than later after even one incident of wandering away.

What is wandering? A formal definition of wandering from the journal of Aging and Mental Health treats it as a syndrome rather than as an event: A "syndrome of dementia-related locomotion behavior having a frequent, repetitive, temporally-disordered, and/or spatially-disoriented nature that is manifested in lapping, random, and/or pacing patterns, some of which are associated with eloping, eloping attempts, or getting lost unless accompanied." The bad news about wandering is that once it has occurred, it is likely to happen again.

Just how common is wandering? One study found that 40 percent of people who have dementia wander at least once during the first 10 months after their diagnosis. Another study found that from 21 to 67 percent of those in nursing home care wander at some time during their stay, and yet another study found that 80 percent of people who have dementia wander at some point in their disease. 

The causes of wandering are probably both neurological and psychological. One biological explanation for the syndrome is that there is progressive deterioration of the right parietal lobe. This affects spatial perception and memory. Combined with losses in executive function, the ability to make good judgments, there is a general inclination toward wandering.

The need-driven dementia-compromised behavior (NDB) model of wandering behaviors takes into account the social and psychological environment of the patient. "Proximal factors," which can be something as simple as whether the door is open, and need for stimulation and/or depression trigger the event. Anxiety and depression increase the likelihood of wandering. A satisfying environment reduces it.

If you are a family member who has had to put out an all points bulletin to find grandma or grandma, however, you are not so much concerned about why wandering happens as how to keep it from happening again. Some methods are more effective than others. Here are 10 approaches to the problem to consider.

RFID and GPS

RFID chips imbedded in clothing or the soles of shoes can locate a patient to within five meters (about 10 feet). GPS tracking devices can locate a patient who has taken off on a "trip". If the recipient of your care has access to the greater world outside the apartment, house, or care facility, then RFID will be more useful for locating them quickly. The challenge in using either RFID or GPS locators is maintaining the dignity of the patient. It is important not to make a show of "chipping or clipping" the patient's clothing. Don't demean the patient. Protect them emotionally as well as physically.

Surveillance alarms

It is possible to fit doors and windows so that they automatically lock in the presence of a radio signal from a device placed in the patient's clothing. The problem with this approach is that these alarms will lock you in when you are close proximity to the patient and the door. They are prone to false alarms from other kinds of electronics. Still, they offer freedom to move about indoors and stop escapes to the community.

Distraction wall

One kind of distraction wall is a little like the video screen at the end of some rides in amusement parks. You look up and see yourself on the ride. A camera and with a monitor screen at an exit may be enough to capture the attention of someone who has dementia long enough to intervene before they wander away. This approach has the advantage of maintaining the dignity of the patient. It is their decision to stay. Can't afford a camera and screen? Place a mirror at the door. One study found that mirrors at exits reduced rates of wandering by 50 percent.

Motion detectors 

Motion detectors don't have to be placed on the patient, and don't have to be prominently displayed in the home. They have the added advantage of being right most of the time. There are relatively few false alarms. They protect the dignity of the patient. However, motion detectors don't work unless there is someone to respond to the alarm. They require constant attention. 

Exercise

"If you don't want your patient to wander away, make sure they are too tired to exit the home," one expert advises. That is hyperbole, but regular exercise programs reduce wandering significantly (about 30 percent) but aren't a sufficient single intervention to eliminate the problem.

Visual disguises of exits

Another way to keep people from wandering is to cover up the door. One study found that a majority of people who wanted to get out (56 percent) could figure out that plantation shutters pulled down to cover a door could be lifted so escape was possible. However, placing a blackout curtain in front of an exit reduced wandering by as much as 96 percent. 

Signage

Signs ("You Need to Stay Here," "Don't Even Think About Leaving Here," "We Love Please Stay Here," "Don't Forget to Check Out at the Front Desk Before You Leave," and so on) are of limited value to people who have dementia who have lost verbal skills. Because people with dementia usually have a downward gaze, signs may not even be noticed.

Aromatherapy

Clinical trials with lavender, geranium, rosemary, and mandarin oils in lotions rubbed on the skin have found reduced agitation and less wandering. They may also be helpful from a diffuser.

Silver alert (in the US)

Different states have very different success rates. There are no locations where this can be primary means of dealing with the problem of wandering.

Differential reinforcement, also known as there's dessert if you stay

Studies have found that offering people with dementia their favorite foods (usually sweets; the author of this article had success with ice cream) outside of regular mealtimes reduces rates of wandering from 55 to 80 percent.

What about drugs? Alprazolam (Xanax), fasudil (Chuan Wei in China and Eril in Japan), and risperidone (Risperdal) have all been tested as single-drug interventions to stop wandering. They are less successful than most non-pharmaceutical interventions. 

  • Cipriani G, Lucetti C, Nuti A, Danti S. Wandering and dementia. Psychogeriatrics. 2014 Jun.14(2):135-42. doi: 10.1111/psyg.12044. Epub 2014 Mar 24. Review. PMID: 24661471.
  • Jeong JG, Song JA, Park KW. A Relationship between Depression and Wandering in Community-Dwelling Elders with Dementia.Dement Neurocogn Disord. 2016 Mar.15(1):1-6. doi: 10.12779/dnd.2016.15.1.1. Epub 2016 Mar 31. PMID: 30906332 .
  • Neubauer NA, Azad-Khaneghah P, Miguel-Cruz A, Liu L. What do we know about strategies to manage dementia-related wandering? A scoping review. Alzheimers Dement (Amst). 2018 Aug 31.10:615-628. doi: 10.1016/j.dadm.2018.08.001. eCollection 2018. Review.PMID: 30456289.
  • Photo courtesy of SteadyHealth
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6427960/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234917/

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