Nice weather brings early morning walks and after supper strolls, but when walks become wandering, it causes concern for people living with dementia and those who care for them.
Wandering can take a variety of forms. It might be a misdirection when on a regular route. It might be getting turned around when looking for the bathroom. It might be trying to get home before the school bus arrives or to make supper before a husband comes in from the field.
“An important part about wandering is that it’s not necessarily someone unaware of what they’re doing or where they’re going,” said Lisa Groon, Senior Health Systems Director with the Alzheimer’s Association. “They usually have a very intentional reason—I’m walking home or I’m leaving the hospital to find my car because that’s how I always leave the hospital.”
According to the Alzheimer’s Association, six out of ten people living with dementia will wander.
Sometimes referred to as “purposeful or intentional wandering,” people living with dementia know where they are going, but do not understand the context of safety in the reality of getting to their destination. Accepting that the person living with dementia may be reliving a different time can help the caregiver understand and better relate to the situation.
“It’s person-centered care,” said Beth Olson, Regional Care Consultant with the Alzheimer’s Association Minnesota-North Dakota. “How well do you know the person? We want to join their reality to find the best way to respond to them and work through an unmet need.”
Olson stressed the importance of becoming a part of their truth of the moment, even if it requires a ‘therapeutic fib.’ Meeting the person where they are at can alleviate the stress and frustration of repetitious explanations.
“What’s typical is often purposeful,” Olson said. “If it’s that banker who is wandering at eight in the morning—he needs to get to work—so, what can we do to help him? One option may be to lay out a ledger at about 7:30 while he’s eating his breakfast and get him working and distracted before he thinks he needs to walk to the bank because the work is already there.”
Alzheimer’s affects the hippocampus portion of the brain where we learn new memories and other memories are stored. Alzheimer’s literally refines or shrinks the hippocampus. New memories stop forming, but old memories remain.
“You can ask somebody what they had for breakfast, and they don’t know if they ate breakfast,” Olson said. “But if you ask them what they did on July 4, 1976, they might respond, ‘it was the bicentennial, and we went to the lake, and we had fried chicken, and we were fishing all week.’”
Care and safety are primary concerns for people living with dementia who wander. Recommendations include having the person carry an ID or wear an alert bracelet; informing neighbors and authorities about the situation; keeping updated photos or videos in an accessible place. Home safety can include door and window alarms or cameras to monitor movements within the house or in the garden.
With those tangible precautions, Olson recommends focusing on the individual living with dementia and understanding not only the present in which they are now, but also the past from where they have been.
“One of my favorite stories—not necessarily about wandering, but it makes sense about how to respond to questions,” Olson said. “There was a lady who was always asking for her husband who had passed away. Her son told her the truth that ‘dad died,’ so when she asked the question and he gave that answer, it didn’t upset her, but it wasn’t the answer she was looking for. She was concerned about when she needed to have supper ready because it was the time of day when he [the husband] would have been coming in from the farm. Once they figured out why she was asking, they came up with a different response: ‘why don’t you both stay here for supper tonight?’ That reassured her, and she was no longer worried that she had to leave to make supper.”
A simple story with a powerful problem solved with a purposeful response.
Resources and guidance are available to anyone caring for a person living with dementia who has a tendency to wander. The Alzheimer’s Association Helpline is available to individuals and families 24/7 for around-the-clock care and support, resource and dementia information, speaking with a dementia expert or setting up care consultations: (800) 272-3900.
The Alzheimer’s Association is a worldwide voluntary health organization dedicated to Alzheimer’s care, support and research. The mission is to lead the way to end Alzheimer’s and all other dementia — by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. Their vision is a world without Alzheimer’s and all other dementia.®