By Meredith Kimple
When a senior loved one is diagnosed with Alzheimer’s disease, we are suddenly barraged with a variety of new questions and concerns. How will they carry out their daily tasks as the disease progresses? How rapidly and to what extent will their comprehension be compromised? What medical care will they need, and should they enter an assisted living facility or move in with family?
What if they wander outside the home and become lost, or worse, hurt themselves?
An estimated three out of five people diagnosed with Alzheimer’s exhibit wandering behavior, and across all stages of the disease. We might have certain preconceived notions about what wandering entails. But people who suffer from Alzheimer’s are not necessarily on autopilot when they wander, and they do not always attempt to leave the house. As with other aspects of the disease, there has been no general consensus about what causes those with dementia to wander; it often begins as a result of boredom, perceived necessity, frustration, or stress.
What are the warning signs that your senior loved one might have a tendency to wander? The reality is that anyone with dementia has the potential, but the following are a few of the signs that usually precede wandering:
They might find it difficult to stay in one place; they might walk around the house without purpose, pace in the same vicinity for an extended period of time, or engage in repetitive movements.
Your senior loved one might become disoriented when entering an environment that is either new or altered in some way. They may get lost in areas that offer too much stimulation, like the grocery store or the mall. But they also may have difficulty in identifying familiar places, like the rooms in their own home.
3. Repetition of Tasks.
They may continuously perform the same task without actually completing it; for example, they may think they are organizing their room, but are only moving the same few items around over and over again.
4. Following an old routine.
A person with Alzheimer’s may try to return to a past residence or the site of a former job, or attempt to run unnecessary and irrelevant errands.
5. Delayed Return.
If they regularly go for walks, they may take longer than usual to arrive home; this might be a sign that they are starting to lose their way while walking, or forgetting the route that leads back to their house.
Wandering is not dangerous in and of itself; if it occurs within the safety of the home, under supervision, it poses few threats. However, when a person with Alzheimer’s wanders outside alone, they are rendered completely vulnerable to a number of risks. They might become confused and lose track of the way home, or they may not recognize their surroundings at all. Others may try to rob or take advantage of them while they are lost, and, worst of all, they may be seriously injured.
In order to keep our loved ones safe, there are several concrete steps we can take to limit their wandering:
- Establish a regular routine.
Structure can be very beneficial to people with Alzheimer’s. A daily routine may help combat boredom and stress, both of which can trigger wandering in those with dementia. If you notice that the wandering occurs at a certain time of day, plan activities to occupy their attention during that period.
- Provide security.
Anything we can do to assuage their fears and reassure them that they are not lost is very important. Make sure that they are never left unsupervised in the home or out in public, and try to avoid crowded, noisy places that might disorient them. Be patient if your loved one insists on going to an old residence or office, and instead of invalidating their desire, tell them that they should stay with you at home for the time being. Hide all car keys so that they can’t drive off.
- Adapt the environment.
Install alarms and locks that are either out of reach or out of sight. Obscure doorknobs by covering them in fabric or painting them to match the door. Hide the door behind a curtain. Reduce in-home dangers by blocking the stairs with a baby-gate and removing clutter from the floors.
- Help them meet basic needs.
Wandering may at times be motivated by the need to eat, drink, or use the bathroom. Ensuring that they meet these needs regularly may help prevent some of their wandering.
It’s best to have a plan in place in the event that your senior loved one does wander and become lost. Know your surroundings; make sure that you can contact your neighbors, and familiarize yourself with any physical dangers in the vicinity, like stairs, hills, busy roads, or bodies of water. Keep in mind any places that your loved one may try to reach, such as the site of an old job, a former residence, or their place of worship. Search for no more than 15 minutes before calling the police. Consider buying identification jewelry that includes your loved one’s name, address and your phone number; people with Alzheimer’s may not remember these details while lost.
A recent study published in the journal Neuron has helped to shed light on the biological origin of wandering behavior. Researchers found that course-plotting capabilities are compromised by the build up of tau protein in the entorhinal cortex (EC), a part of the brain largely responsible for memory and navigation. Within the EC, there are nerve cells called excitatory grid cells that fire as we move through a space; these grid cells form a map of the environment around us that enables us to find our way in any area.
They observed the impact a build-up of tau had on the excitatory grid cells of mice; the protein only damaged the excitatory cells, creating a severe imbalance in the mice’s internal grids. The findings support the theory that tau in the EC does contribute to wandering in those with Alzheimer’s disease.
Though further research is needed, the results of the study offer the possibility for treatment in the future; researchers believe that they may one day be able to correct the imbalance with the right therapy. Dr. Karen E. Duff, who co-led the study, even thinks that the results of the study may make it possible for navigation-based cognitive tests to be administered as a screening for early stage Alzheimer’s.
Wandering is a behavior that can make us, as caregivers and relatives, feel utterly powerless. Alzheimer’s can transform aspects of our loved ones in what seems like the blink of an eye; we make adjustments, and we do everything possible to create the semblance of order in the midst of constant, inexplicable change.
The truth is that we may not be able to keep our loved ones from wandering. Despite our best efforts, they may still slip away from us. But understanding where this behavior comes from can only help to prepare us for those terrifying moments. There are steps we can take to better ensure their safety, and in preparing for the worst, hopefully we can acquire some peace of mind.