Alzheimer's: Understand and control wandering

Alzheimer's disease can erase a person's memory of once-familiar surroundings and make adaptation to new surroundings extremely difficult. As a result, people with Alzheimer's sometimes wander away from their homes or care centers and turn up — lost, frightened and disoriented — far from where they started, often long after they disappeared.

Three out of four people with Alzheimer's will wander at some point during the course of the disease. Wanderers who get lost outdoors may become injured or even die of exposure. This risk increases dramatically if the weather is very cold or very hot.

Why do they wander?

People with Alzheimer's wander for a variety of reasons. They may be searching for something, or trying to get away from a noisy or confusing environment. Some may even be trying to fulfill tasks from their former occupations.

Searching for something
Especially if they've recently moved to a new environment, wanderers may be searching for something or someone familiar. Or they may be trying to satisfy a basic need, such as hunger or thirst, but can't remember what to do or where the kitchen is located.

Many wanderers are looking for a bathroom. They may take medications that increase the amount of urine they produce. Elderly people are at a higher risk of developing bladder infections, which makes them feel the need to urinate more frequently.

Escaping from something
Too much stimulation, such as multiple conversations in the background or even the noise of pots and pans in the kitchen, can trigger wandering. Because brain processes slow down as a result of Alzheimer's disease, people can become overwhelmed by all the sounds and start pacing or trying to get away.

People with Alzheimer's often lose the ability to tell you when they're in pain. Instead, they may become restless or try to escape their pain by walking away.

Reliving the past
If wandering occurs at the same time every day, it may be linked to a lifelong routine. For instance, a woman who tries to leave the nursing home every day at 5 p.m. may believe she's going home from work.

This belief could be reinforced if she sees nursing home personnel leaving at that time. A planned activity at that hour could distract her from wanting to wander. Another option might be to have staff exit through a different door at the end of their shift. To reduce visual reminders of going outdoors, you may want to store coats and boots out of sight.

Tips to prevent wandering

Although it may be impossible to completely prevent wandering, changes in the environment can be helpful. For example, a woman who was a busy homemaker throughout her life may be less likely to become bored and wander if a basket of towels is available for her to fold.

People with Alzheimer's often forget where they are. They may have difficulty finding the bathroom, bedroom or kitchen. Some people need to explore their immediate environment periodically to reorient themselves. Posting descriptive photographs on the doors to various rooms, including a photo of the individual on the door to his or her own room, can help with navigation inside the home.

Offering a snack, a glass of water or use of the bathroom may help identify a need being expressed by wandering. Sometimes the wandering person is looking for family members or something familiar. In such cases, providing a family photo album and sharing reminiscences may help.

Keeping your loved one safe

Techniques for keeping your loved one safe may range from providing a safe place to wander — either indoors or out — to rigging your doors with alarms and hidden locks.

Reduce hazards
Remove tripping hazards such as throw rugs and extension cords. Install night lights to aid nighttime wanderers and put gates at stairwells to prevent falls.

A place to wander safely
If wandering isn't associated with distress or a physical need, you may want to focus simply on providing a safe place for walking or exploration. This could be a path through the rooms of your house or a trail through a fenced backyard. Some nursing homes have circular routes where wanderers can travel to their hearts' content.

Providing a safe place to wander may help your loved one get more exercise, which can improve his or her ability to sleep through the night.

Alarms and locks
A variety of devices can alert you that your loved one is on the move. Pressure-sensitive alarm mats can be placed at the door or at your loved one's bedside. Warning bells can be used on doors. Childproof covers on doorknobs also are helpful. Many people also install sliding bolt locks up high on doors, out of the average person's line of sight.

Camouflaging doors
Doors to off-limits rooms pose a different problem. Camouflaging a door with paint or wallpaper to match the surrounding wall may short-circuit a compulsion to wander into such rooms. Curtains over the door might also work. A mirror on or near the door stops some wanderers. Sometimes a stop sign on a door is enough.

Some people have had success with creating a visual abyss in front of exit doors, by laying down strips of black tape to form a 2-foot black hole at the threshold.

Help ensure a safe return

Despite the best of efforts, some people with Alzheimer's will still wander off and get lost. They can be difficult to find, because they often behave in an unpredictable manner. For example, they rarely call for help or respond to searchers' calls. Once found, they often don't remember where they live. Some can't remember their own names.

The Alzheimer's Association's Safe Return program is designed to help identify people who wander and return them to their caregivers. For a modest fee, you receive:

• An identification bracelet
• Name labels for clothing
• Identification cards for wallet or purse
• Registration in a national database with emergency contact information
• A 24-hour toll-free number to report someone who is lost

You can register someone by filling out a form online at the Alzheimer's Association's Web page or by calling 888-572-8566.