by Dr. Shelly Sternberg
"Missing: 84 year old woman with Alzheimer’s disease." This headline makes my heart sink as I envision another older woman wandering off, getting lost and endangering herself. Why do people with dementia wander and what can be done to prevent it?
Wandering is a common phenomenon in the early and middle stages of dementia occurring in 15-60% of dementia sufferers.(1) This behavioral disturbance is a major cause of hospital admission, physical harm, institutionalization and even death. It is considered one of the least manageable behavioral problems of dementia by caregivers. Less than 4% of people with dementia who wander away from home are able to return on their own. Alzheimer’s patients have difficulty determining whether they, or the objects around them are actually moving in the environment.(2) This problem with “optic flow” can lead to disorientation, wandering and getting lost.
Wandering in people with dementia has many triggers. Sometimes, it is simply meeting a need for exercise or social stimulation. In other cases, the person may be searching for something from the past like an old home, companion or place of employment. Wandering at night may be related to increased confusion or day/night reversal. Finally, the dementia sufferer may be leaving an environment that does not feel safe or secure.
Many different interventions have been developed to treat and prevent wandering. If the wandering is accompanied by agitation, then medications may be used. Non-drug interventions, although not supported by rigorous scientific studies, are used frequently by many carers and families. Exercise and distraction can be helpful. Camouflaging the door or placing a mirror near the doorway may prevent exiting through the door. Multisensory environments and music have been used to calm the need to wander. Safe and secured wandering paths or accompanied regular walks may be a useful solution for repeat wanderers. Changing locks on doors and informing neighbors and local police about the person’s condition may prevent a wandering episode. Physical restraints should be avoided as they may increase agitation and accidents. Recent electronic tagging and tracking devices, while showing potential, have raised ethical concerns. Recreational day programs such as those offered by Melabev, provide social stimulation in a safe,secure environment with staff specially trained to deal with the behavioral problems of dementia such as agitation and wandering.
In summary, wandering is a common and dangerous behavioral problem of dementia that can be prevented using drug and non-drug interventions in addition to increased family and caregiver awareness.
Dr. Sternberg is Director consultants' clinic for cognitive problems at Shaare Zedek medical Center; Senior consultant home care program for elderly with dementia, Melabev organization; Director of Geriatrics and homecare, investigator dividsion of Public health at Tel Aviv University affiliate, Jerusalem and Shfela region, Maccabi healthcare services.
