Many persons living with dementia feel the urge to walk about and in some cases leave their homes. Though it is sometimes termed as “wandering”, it is rarely ever aimless. Persons living with dementia may simply not remember where they had set out to go, or what they had intended to do.
It is all right for persons living with dementia to walk around in a secure environment (for e.g., in their own homes or at day care centres), with supervision from others. However, wandering becomes a cause of concern when persons living with dementia meet with dangerous situations while wandering outside, about the neighbourhood alone. For example, they often experience problems with orientation, which causes difficulties in finding their way back home (getting lost). When the person living with dementia is away from home for an unusually long time, or when the caregiver is unable to locate him/her, then wandering becomes a problem.
Moreover, there is a significant number of older persons living with dementia, whose primary caregivers are seniors (for e.g., their spouse) as well. These seniors are more prone to falling and more susceptible to sustain fall-related injuries.
Possible Causes of Wandering Behaviours
Wandering behaviour can be caused by various factors including the following:
Boredom
Someone who is lacking in mental and physical stimulation may go out walking because they are simply looking for something to do.
Restlessness or a need to burn up energy
If your loved one used to have an active life and is suddenly stuck at home, they may simply have the urge to get out and about.
Memory problems and confusion
Your loved one may set off to a place and forget where he/she is going or why. Sometimes your loved one may tend to wander and forget how he/she got into that room in the first place. This can happen a lot more often in persons living with dementia. Your loved one may be trying to ‘retrace’ their steps. Likewise, if they do not remember an area, they may wander off until they find something familiar.
Confusing night with day
Your loved one may suffer from sleep problems, or wake in the early hours and become disoriented. He/she may think it is daytime and decide to go for a walk.
Looking for familiar persons / items / places
Your loved one may wander off in search of someone, something, or a place relating to their past when he/she becomes confused. Wandering may occur because they suddenly decide they need to find an old friend they have not seen for a long time. They could also be wondering where they parked their car, even if they have not driven for quite some time. Confusion about time and place is one of the symptoms of dementia.
Continuing with a habit or routine.
If your loved one had a very specific routine or habit that they used to follow, they may want to carry on with it. Your loved one who is used to walking long distances may simply wish to continue doing so. They may also head out to attempt to go shopping or back to their old workplaces if this was something they used to do in the past.
An attempt to get away from something
If the situation or place they are currently in is stressful or unpleasant in any way, they may simply walk off to get away. Likewise, if the environment is noisy, they may walk off to find somewhere more quiet and peaceful.
Change of environment
Your loved one may feel uncertain and/or disoriented in a new environment such as a new home environment or daycare centre.
Physical discomfort or pain
Your loved one may walk to ease discomfort that is caused by uncomfortable clothes, excessive heat or the need to go to the toilet.
Night Wandering
Always be aware that wandering can happen at any time, including the middle of the night. If a person who lives with dementia gets easily confused with what time of the day it is, you may find them wandering at 2 a.m. because they think they have to be somewhere and do not understand that they are supposed to be asleep.
Some Ways to Manage Wandering Behaviours
The tendency to wander is common amongst persons living with dementia. Depending on your loved one’s personality, how well they can cope, their reason(s) for wandering and the safety of the surrounding environment, you may use the following strategies to manage your loved one’s wandering behaviour:
Carry out daily activities
Having a routine can provide structure. Try to create a daily routine for your loved one with dementia.
Install locks out of the line of sight
Install either high or low exterior doors and consider placing slide bolts at the top or bottom.
Identify the most likely times of day or situations that wandering may occur
Identify your loved one’s wandering behaviour patterns by keeping records or a diary. Plan activities at that time. Activities and exercise can reduce anxiety, agitation and restlessness.
Use devices that signal when a door or window is opened
Use devices that signal when doors or windows are opened. For example, doors can be placed over bells, and electronic home alarms can be used.
Reassure the person if they feel lost, abandoned or disoriented
If your loved one wants to leave to “go home” or “go to work”, use communication focused on exploration and validation, and refrain from correcting them.
Provide supervision
Do not leave someone living with dementia unsupervised in new or changed surroundings. Never lock them at home or leave them in a car alone.
Keep car keys out of sight
If the person is no longer driving, remove access to car keys — a person living with dementia may try to drive. If the person is still able to drive, consider using a GPS device to guide them if they get lost.
Redirect attention elsewhere with activities
Engage your loved one through a simple and quiet activity that is familiar to them from their earlier days.
Ensure all basic needs are met, and that your loved one is not experiencing any illness, pain or discomfort
Has your loved one gone to the bathroom? Is he or she thirsty or hungry? Go for his/her regular physical check-ups, which help to identify the presence of any illness, pain or discomfort.
Avoid busy places that are confusing and can cause disorientation
Shopping malls, grocery stores or other busy venues.
Remove objects that may encourage wandering
Objects that may prompt wandering, such as handbags or keys, can be removed from sight.
Remove any obstacles to allow your loved one to wander about safely – ensure supervision is available and he/she has steady gait at all times.
Carry identification
Have your loved one carry identification such as the CARA Membership Card (which replaces the Safe Return Card). This can be helpful when he/she is found by others or the police. Find out more about the CARA Membership Programme.
ForgetUsNot Initiative: Don’t Go Missing
Source: LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore
Hear what care specialist Lily Teh from Homage has to say about helping the community and persons living with dementia find their way home.
When Your Loved One Goes Missing, You Should:
- Remain calm.
- Make a thorough search of the house and familiar places.
- Try to remember what he/she was wearing.
- Walk or drive around the vicinity and/or to any places he/she may visit regularly. Have someone stay at home in case he/she returns home, or to answer any phone calls.
- Contact the police if immediate searches yield no result. Tell them the person has dementia and any concerns you have for their safety.
- For CARA members, use the CARA app to notify members of the public to keep an eye out for your loved one living with dementia who is lost.
- If your loved one lives in the Sembawang-Woodlands community, you may reach out to the Dementia Search Activation Network (DSAN). DSAN is a Telegram channel run by AWWA Community Resource, Engagement and Support Team (CREST) for persons living with dementia and caregivers within the area. The Telegram channel will be activated upon receiving information about lost seniors within Woodlands and Sembawang from national apps such as CARA. Upon activation, the channel’s chat function will be activated for 48 hours to allow participants to share critical information to help locate the lost individual. Those interested to join the channel can click here.
When your loved one returns home:
- Notify the police immediately.
- Do not scold them or show anxiety as this may confuse or frighten them.
- Provide reassurance and get back into their regular routines as quickly as possible.
William’s Story
CNA Insider: My Grandpa Has Dementia
Source: Channel News Asia
At first, William’s dementia symptoms included forgetfulness and confusion, but then the wandering and getting lost began. William’s dementia makes him sneak out in the middle of the night. He even found a way out after the family padlocked the gate.
Watch how Bethany and her mother, Geraldine (William’s daughter and main caregiver), coped until they finally realised they needed help.
Tell us how we can improve?
- Changi General Hospital. (2020, October 5). Managing agitation and aggression in dementia. HealthHub. https://www.healthhub.sg/live-healthy/843/managing-agitaton-and-aggression-in-dementia