Wandering is a common and concerning behaviour for people living with Alzheimer’s disease and other forms of dementia. Changes in the brain can affect a person’s ability to recognize familiar surroundings and as a result they can become lost or confused about their location. Wandering typically happens during the middle or later stages of dementia but can occur at any time during the disease.

This behaviour can create significant safety risks for dementia patients and be very distressing for caregivers. Understanding why wandering may happen, recognizing the early signs and reducing the risks can help caregivers manage wandering to keep their loved ones safe.

What Causes Wandering?

Everyone living with Alzheimer’s or dementia is at risk of wandering, which can cause people to leave their home or get lost in a public place. Wandering behaviours are believed to be caused by a combination of cognitive decline and other psychological and environmental factors, such as:

• Changes in daily routine or home environment
• Discomfort, unmet basic needs, pain or medical concerns (e.g. temperature control hunger, urinary tract infection)
• Delusions or hallucinations caused by prescription medications
• Loud noises, crowds or bright lights

What are Early Signs of Wandering Behaviour?

Recognizing the signs of wandering is critical for early intervention and prevention. Concerning behaviours that often occur before a wandering incident can include:

• Restlessness, pacing or repetitive movements
• Returning from a regular walk or drive later than usual
• Appearing lost or confused in familiar places
• Asking to ‘go home’ even when living comfortably in own home
• Becoming nervous or anxious in crowded places
• Trying to follow a routine they used to follow (e.g. going to work, caring for children)
• Increased activity and restlessness overnight

How Can the Risk be Reduced?

The precautions you take will depend on your loved one’s living space and the level of risk involved. The approaches you use will likely change and increase over time as the disease progresses. Here are some effective strategies to consider:

• Keep your loved one engaged in daily physical and mental activities.
• Review prescriptions with a primary care provider to discuss possible side-effects that can increase confusion or disorientation.
• Keep objects that are associated with leaving, like wallets, keys, jackets and shoes, out of view.
• Secure the yard around your home with a fence or locked gate.
• Use locks that are difficult to open or install them up high or down low out of typical sightlines.
• Consider purchasing door and window alarms or a pressure-sensitive door mat.
• Have your loved one wear a medical ID bracelet which displays their diagnosis and contact information.
• Update neighbours and close contacts. Let them know how to respond if they see your loved one wandering.
• Paint exit doors the same colour as the walls and trim, cover with posters, curtains or wallpaper, or add a sign that says, ‘Stop’ or ‘Do Not Enter’.
• Never leave a person with a history of wandering unattended.
• Use a GPS or another tracking device, depending on the risk and your comfort level.
• Have a recent, close-up picture of the person in your care and a list of identifiable features on-hand.

How Should I Respond?

If you do notice your loved one engaging in wandering behaviours, here are some strategies to keep them safe:

• Distract and Redirect: Look at old photos, reminisce together, have a cup of tea or go for a safe walk together.
• Stay Calm: Try your best to use a calm and relaxing voice and do not get angry or shout.
• Avoid Correction: Do not attempt to convince your loved one that they are ‘home’, that they don’t work anymore, etc. This often increases agitation and confusion.
• Acknowledge and Identify: If you think they are feeling anxious, scared or lonely, respond by identifying this emotion. Try, “I will keep you safe,” or, “Are you feeling lonely?”

What if a Wandering Incident Occurs?

If your loved one is missing, start search efforts immediately. Enlist the support of friends and neighbours but always keep someone at home in case the person in your care returns. Start in the surrounding area as individuals who wander are typically found close by. From there, check around local natural landscapes, favourite places, any previous homes or past jobs. If they aren’t found within 15 minutes, call 9-1-1 to file a missing person’s report. Let the responder know that the person who is missing has dementia.

Wandering and restlessness are common dementia-related behaviours and aren’t necessarily dangerous if they occur in a safe and controlled environment. Prevent unsafe wandering by identifying the warning signs, ensuring there are precautions in place and responding quickly in an emergency.

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If you found this article helpful, you may also want to read:

• Compassionate Care Strategies Using The 7 ‘A’s of Dementia
• Driving and Dementia: When to Give Up The Keys