Wandering can be defined as moving in circular patterns; moving back and forth between two points; moving in no fixed pattern; moving to a chosen place.  The duration and rate of wandering may vary and carry a risk of harm. 

A person with dementia may become disorientated or distracted when out, so although not classed as traditional wandering, there is a risk that thy will become lost.  While the risk of wandering increases with advancing dementia, clients in an early stage of dementia may wander and get lost even when walking in familiar areas.

Dementia Australia assesses the triggers or causes of wandering.  Causes may include looking for a familiar person or environment or routine; trying to escape perceived risk of harm; habitual walking; forgetting the reason for starting to walk; hunger.  Other causes e.g. reaction to medication; stress, anxiety, depression; pain, infection, constipation, dehydration or other health issues may require a health professional review.  A big reason for wandering is also boredom.  Engaging the person in meaningful activity may reduce the need to wander.

Wandering can impact on the person negatively such as increased risk of falls, fatigue, inadequate food intake, getting lost and premature admission to a residential aged care facility.  For the carer sleep deprivation, social isolation, reduced physical, financial and social resources and loss of privacy may occur.  Support for carers is essential.

If frequent walking around is not associated with physical and psychological distress, wandering can have physical, social or psychological benefits e.g. exercise/mobility may benefit heart, muscles, lungs, bones, promote a sense of wellbeing, promote sleep and appetite, relieve boredom.

Aids such as motions sensors, safety bracelets and tracking devices, wallet with family phone contacts, carers securing door keys and being aware of outside hazards e.g. wooded areas, rivers, and having a search plan can improve safety.

 

Shadowing

Shadowing occurs when the person with dementia is constantly following the carer.

Major issues for cares include loss of privacy, reduced time out, lack of behaviour management skills, lack of insight into the impact of their own responses to shadowing behaviours.

Possible reasons for shadowing include:

• As the person with dementia loses their ability to perform tasks in the home, garden or community, they may walk around trying to complete tasks.
• They may feel vulnerable and need reassurance – wondering where they are, where the carer is, what they should be doing.
• Disorientation and feeling of insecurity
  • Provide memory prompts such as a white board with the messages for the day to replace more complex diaries or calendars.
  • Maintain predictable routines with meal times, hygiene, bed times.
  • Avoid change such as moving or replacing furniture or other familiar items.
  • Encourage regular interaction with friends, family or other people or pets.  Create a roster if needed and educate support network regarding the needs of the person with dementia.
  • Commence attendance at a day respite centre.
  • Planned/organised activities should be
    • At regular times and when most alert.
    • Individualised meaningful and reflect your loved one’s previous roles, interests, strengths.
    • Not overstimulating or creating fear of failure.
    • Performed in a well-lit area with minimal distraction.
    • Flexible and able to be modified as skills or cognition change.
  • Use recordings and head phones e.g. music, recorded familiar life stories spoken by familiar voices, film, sport, documentaries.
  • Repeat short simple phrases ‘you are safe and I am here with you’.

 

Support the Person with Dementia who wanders

For the person with dementia who walks constantly, additional support may be required in:

Good Sleep Hygiene 

• Maintain regular routine for sleeping and waking.
• Avoid day-time naps or nap early after lunch for ½ to 1 hour.
• Sunlight exposure but maintain sun safety.
• Get out of bed if not asleep in 20-30 minutes or try calming strategies – massage, music, light in toilet or sit in a chair in the darkened room.
• Have a warm shower 1-2 hours before bed.
• Toilet before bed.
• Block out distracting noise.
• Do not watch TV or read in bed.
• Avoid caffeine, alcohol, nicotine 4-6 hours before bed.
• Avoid large or spicy meals before bed.
• Drink a glass of warm milk before bed.
• Exercise regularly before 2pm.
• Avoid rigorous exercise before bedtime.
• Check temperature and comfort of the room and bed.
• Observe for signs of pain or discomfort.
• Remove clocks if the person is a clock watcher.
• A sleep chart may assist to monitor hours of sleep to track the sleep pattern.
• Dim lights in living areas prior to bed if this does not cause confusion.

 

Nutrition 

• Maintain usual food and drink preferences (this may change with stage of dementia), choice of eating companions, time and place of eating (preferably eat during low wandering period and when not fatigued).  Provide small frequent nutritious meals.
• Consider aids e.g. contrasting coloured, non-spill plates and modified eating utensils to enable independent eating skills to be retained.  Provide cues such as placing the fork in their hand, sitting opposite the person and eating with them.
• Observe for swallowing difficulty, painful teeth, dry mouth, constipation which will deter eating.  Trial finger foods which can be eaten while walking.
• The presence of weight loss, decrease in food intake over the previous 3months, reduced mobility, dementia and/or depression increase the risk of being malnourished or experiencing malnutrition.  Food supplements and other recommendations may follow an assessment by a dietitian, speech pathologist or doctor.

 

Personal Care

• Encourage participation at preferred time (but in low wandering period).  Prepare a place and equipment that is pleasant and familiar (odour, warmth, quiet, private – door closed, small covering towels for privacy during hygiene).
• Give full attention to the person and be flexible and responsive to both body language and facial expression that indicates consent and emotional response.  A full shower or sponge bath may not be needed or wanted and grooming may be completed in stages.
• Explain actions in a clear respectful tone.  Conflict will have negative outcomes for both the carer and the person with dementia.

 

Elimination

• Provide clothing that is simple and easy to put on and take off e.g. elastic waist instead of zips.
• Maintain usual pattern and privacy e.g. toilet after rising, ½ -1hour after meals for bowels, every 2-3 hours to prevent incontinence, before typical wandering time begins, during accompanied wandering.
• Orientate to toilet e.g. light at night, open door, signage/picture of toilet on door, dark contrasting coloured toilet seat.  Remove items of furniture that may be mistaken for a urinal e.g. large vases, pot plants.
• Provide music or distractions such as a book to read or pictures on the walls or door to encourage adequate time is spent on the toilet.
• Use aids that will support transfers on and off the toilet e.g. grab rails or over-toilet seats.
• Watch for indications for toileting e.g. agitation, shouting out, pulling at clothes or starting to undress.
• Do not rush.  Use positive terms, prompts and assistance that are familiar and culturally appropriate.
• Prompt good bladder habits including adequate fluids, avoiding stimulants such as caffeine, aerated drinks.
• Prompt good bowel habits including intake of fibre fruit, vegetables and fluids.
• Arrange medical assessment as infection, enlarged prostate, medication side effects, constipation, impaired bladder function, depression or anxiety may increase elimination problems.

 

Mobility

• Ensure safe and comfortable footwear.
• Remind to use mobility aids and sensory aids e.g. spectacles.
• Have uncluttered walkways.
• Avoid areas/rooms that cause distress e.g. cover doors and mirrors.
• Encourage rest in low wandering periods to reduce fatigue; sit down with the person for an activity; take for walk in wheelchair; walk with the person but walk more slowly.
• Ensure as a carer you receive manual handling training if you are assisting with transfers.
• If morning wandering occurs have long walk after breakfast. If night-time wandering occurs a walk before bed.
• As dementia progresses balance, gait, strength, endurance may be impaired but lack of insight may lead to the person standing, trying to walk and then falling.