Not all people afflicted with Alzheimer’s disease seem to need to wander, but according to the Alzheimer’s Association three out of five of them will do so at some point. And most of those wanderers will do it repeatedly—anecdotal evidence suggests six to eight times—before family members or caregivers recognize the behavior as the problem it poses. Those who wander may face the perils of inclement weather, traffic, and people who may prey on the vulnerable found in their midst.
The reality of wandering is made worse by the fact that Alzheimer’s—with its plaques that accumulate in the brain and affect memory, thinking, and behavior—is also unpredictable and varies from person to person. People in the early stages of the disease tend to wander because they are beginning to feel more disoriented and unsure of themselves in general. Those in the later stages tend to flee their surroundings if they become fixated on getting to another place and time: a childhood home in a distant state, for example.
Causes of Wandering
Despite Alzheimer’s tricky signals, those caring for a person who has it and tends to wander are advised to do some sleuthwork to determine whether there is a pattern to the behavior—and then get to the root cause of it. Doing so may help uncover ways to soothe the underlying physical or mental discomfort that’s causing the person to wander and prevent the behavior from occurring in the future.
But first, it’s essential to note that not all wandering should be prevented. Some of that movement may even be helpful as a form of exercise or a way for the person with Alzheimer’s to keep socially connected with others. The key is to make sure a wanderer is in a safe environment.
A number of the triggers for wandering have been identified, which also suggest possible ways to understand and curb the behavior.
Some of the most common triggers include:
- Disorientation. People in all stages of Alzheimer’s may become disoriented in time and place. A 90-year-old may believe he or she is a teen, for example. Or someone who’s moved to a new residence in the last 10 years may seek out a former home. Experts recommend that caregivers gently reassure people who seem disoriented that they are in the right place at the right time—and to redirect their focus to something small in the present, such as a favorite plant or TV show, if the disorientation is making them anxious.
- Changes in routine. The honest among us admit that we’re creatures of habit—perhaps eating the same thing for breakfast every day, or unflaggingly taking the same route to work. However, routine is actually an essential reassurance for some people with Alzheimer’s, many of whom feel most safe and comfortable when living the same routine. Setting regular times for meals, sleep, and exercise every day helps make the days and nights more familiar. And paying attention to whether the person with Alzheimer’s tends to want to wander at the same time may reveal an underlying attachment to a routine remembered from the past: heading to work in the morning, calling a loved one at a particular time each day, preparing meals at mealtimes. Try to find a distracting substitute activity, instead.
- Delusions and hallucinations. People with Alzheimer’s may be deluded—and firmly believe that something is true when it’s not—for example, that a family member is stealing their money, or a stranger is spying on them. Or they may hallucinate: Their hampered brains may cause them to see or hear something that is not actually there. If the hallucinations are severe and persistent or actually life-threatening, some believe that a regimen of anti-psychotic medication under a doctor’s supervision may help provide relief. In less serious cases, it may be helpful merely to listen to the person and acknowledge his or her feelings, or again, switch the focus to another activity.
- Fatigue. Though not yet well understood, the reality is well documented: For many people, Alzheimer’s causes disruptions in sleep patterns—restlessness in the night or confusion about whether it’s day or night. And about one-fifth of the people who have Alzheimer’s tend to experience increased confusion or agitation in the late afternoon—a phenomenon dubbed “sundowning” early on.
Again, sticking to a regular sleep/wake schedule may be helpful in warding off sleep-deprived wandering. So can keeping consistent sensory signals, such as brightly lighting the rooms until bedtime. It may be helpful to limit daytime naps, or increase the exposure to the sun or full spectrum lighting. And as is true for any person, it’s wise to refrain from stimulants such as ingesting caffeine, exercising, eating, TV-watching or Internet-surfing too close to bedtime. Interestingly, the damaging effects of fatigue can even be contagious: Those with Alzheimer’s may pick up on a caregiver’s fatigue and become agitated or confused by it.
- Overstimulation. Having to process a great number of sights and sounds can also trigger wandering in a person with Alzheimer’s, who may attempt to escape when subjected to a noisy crowd. Spending time in smaller groups of people with familiar faces may be a good antidote for those with this tendency.
- Fear and frustration. Crossed brain signals in people with Alzheimer’s may cause them to become afraid of a longtime spouse or partner they no longer recognize, causing them to want to flee. Or frustration about the effects of the disease itself, especially for those in the early stages, may make them want to run to get away from it. In such cases, experts recommend offering soothing words of safety, or suggesting an activity to do together, such as taking a walk or a car ride through the park.
- Pain. People with Alzheimer’s may find it difficult to express their pain or physical or emotional discomfort, which may trigger their tendencies to wander off in search of relief or a cure. Check for things that can be easily remedied first: hunger, thirst, constipation, a full bladder, fatigue, skin irritations, or uncomfortable room temperatures. If you suspect that chronic pain is the culprit, seek help from a medical expert who is versed in treating people with Alzheimer’s and discerning their underlying ailments.
- Fleeing a facility. Finally, people with Alzheimer’s are at the highest risk of wandering off from a new facility within the first 72 hours of moving there. The motivation seems obvious: The surroundings and people are unfamiliar, and the staff is not yet familiar with the individual’s personal proclivities. If a family member or friend is currently in or will be entering a facility for memory care, be sure to quiz the administration about what specific measures are in place there to ward off wandering.
Where to Get Help
As researchers, medical personnel, and caregivers have all become more familiar with the connections between wandering and Alzheimer’s, a number of resources have emerged to help deal with the behavior.
Among them are:
- Help for Alzheimer’s Families, a website that maintains a roster of articles and advice on dealing with wandering behaviors
- Confidence to Care, a handbook for Alzheimer’s caregivers that details how to deal with unmet needs that may trigger wandering behavior, and
- The Alzheimer’s Association, which maintains a Web page dedicated to the issue of wandering and getting lost.
In addition, there are a few films featuring realistic portrayals of people with cognitive limitations who also have wandering issues. They include: