Dementia and Wandering: Causes, Prevention, and Tips You Should Know

“If a person is confused because of memory changes, and the environment becomes uncomfortable, they may attempt to leave the situation to get away from the discomfort,” says Andrea Denny, outreach, recruitment and engagement core leader for the Knight Alzheimer Disease Research Center in St. Louis, Missouri. “This desire to escape the overwhelming stimuli may cause what we call wandering.” While people with dementia often leave with a goal or destination in mind, they may forget directions, encounter an obstacle in their planned route, or realize the place they’re trying to reach is imaginary or inaccessible.

Wandering — sometimes called elopement — can be dangerous. Nearly 50% of seniors who wander will suffer a fall, fracture, injury, or some type of elemental exposure, according to a 2016 assessment of wandering behaviors in the International Journal of Geriatric Psychiatry. Fortunately, research suggests certain strategies and technologies can help decrease dementia wandering. Learn who’s at risk of elopement, potential causes, 12 tips to reduce wandering, and how to be prepared if dementia wandering occurs.

Alzheimer’s disease and other types of dementia affect cells in the part of the brain that controls memory. Recent memories and spatial recall — or the ability to remember different locations or where something is in relation to something else — are two of the first things seniors with cognitive decline lose, according to the National Institute on Aging. These challenges make it harder to remember a destination, determine directions, or recall the reason for leaving in the first place.

Seniors with dementia may want to escape a situation because they’re confused or disoriented. But as they depart, they can forget what happened, become unexpectedly lost, and begin to wander. Emotional distress, medical conditions, and a perceived need to complete tasks can all cause dementia wandering.

Everyday activities can lead to wandering

Seniors with dementia may become disoriented trying to follow old routines and complete daily tasks that were once common for them. Some activities that can lead to wandering include:

• Following past routines. With Alzheimer’s and other forms of dementia, people may cognitively revert to times past. Trying to follow familiar routes like driving to work, going on long walks, or returning to an old neighborhood can result in disorientation and dementia wandering.
• Searching. A senior may be looking for someone or something not in their present environment — for example, a childhood friend or a room in a home they used to own.
• Navigating the home. Sometimes, a trip to the mailbox, restroom, or kitchen can lead to disorientation.
• Attempting former chores or responsibilities. Responsibilities like caring for a child, cooking dinner for the family, or gardening can lead to wandering. Trying to find a young child or go to the grocery store can put seniors in unfamiliar environments.

Emotional causes of dementia wandering

Wandering is a common response to overstimulation and overwhelming situations. Fear, agitation, and confusion commonly lead to dementia wandering outdoors or in public environments. Some emotional cues that can cause wandering include:

Stress or fear. Unfamiliar or crowded locations, like busy restaurants, sidewalks, or even family gatherings, may lead to confusion or fear in people with dementia — this could cause them to wander.

Overstimulation. Loud noises and quick movements can lead to anxiety. “Brain changes may cause them to interpret these stimuli differently than you and I might,” says Denny. While someone without dementia may tune out the conflicting sounds of television, conversation, and outdoor sirens, these noises may cause a person with dementia confusion and fear. The overstimulation may make seniors want to escape a situation in favor of a quieter, calmer place.

Frustration. Inability to communicate can lead to frustration. When someone can’t remember or ask for the things they need, they’re more likely to try to complete tasks by themselves.

Physical causes of dementia wandering

Sometimes, wandering is the result of physical decline. In addition to memory, dementia can affect eyesight, mobility, and spatial reasoning.

Visual-spatial problems. Dementia affects the parts of the brain that process visual and spatial cues. Even in a familiar setting, someone may not be able to find objects like keys, navigate grocery store aisles, or understand the layout of rooms.

Poor eyesight. Dementia changes the way eyes see and the way the brain processes visual information. Impaired peripheral vision can leave seniors unable to see alternate paths or signage, while incorrect depth perception — the ability to see how far away something is — can lead to seniors turning earlier than intended, or wandering from a designated path.

Poor dimension perception: In the late stages of dementia, vision may become limited. This can make it difficult to distinguish between two-dimensional and three-dimensional pictures or objects. For example, a rug’s pattern may come across as something physically blocking a path or hallway, forcing a senior to navigate around it and become lost or confused.

Let our care assessment guide you

Mobility. Seniors with late-stage dementia may gradually lose their ability to walk, go up and down stairs, and transfer themselves from bed to wheelchair. They are also more likely to fall. Mobility issues can lead to disorientation — if someone needs to sit or to avoid potential obstacles, they may forget their original intentions or become lost on an unfamiliar path.

Causes of dementia wandering at night

As dementia progresses, people often spend more time sleeping during the day and awake or restless at night. “Sleep itself is often a major stressor for caregivers, and when you add wandering, it’s really a challenge,” says Denny. “No one is happy or able to provide their best care when they’re waking up multiple times a night —  especially when they’re fearful that their loved one getting up will wander.” Some causes of dementia wandering at night may include:

Physical discomfort. Someone may wake because of a physical need, like hunger, thirst, or a bathroom trip. While searching for a solution, they may become disoriented and leave the room.

Being too hot or cold. Alzheimer’s patients’ bodies may regulate temperature differently, according to a study in the American Journal of Geriatric Psychiatry. This is because the frontal and temporal lobes — the parts of the brain where people process temperature and pain sensations — have begun to deteriorate. A natural drop in body temperature also occurs with age. Someone could leave bed to find blankets and become lost, or be unable to fall asleep due to extreme heat.

Boredom. Circadian rhythms — the natural, internal processes that tell us when to go to sleep and wake — often change as people age. Seniors with Alzheimer’s and other types of dementia generally experience more drastic changes than others. Because of the disruption in circadian rhythms, it’s common for people with dementia to feel wide awake during the night. Lying in bed can be boring when you aren’t tired, and people may get up to find something to do.

Perceived obligations. Someone may wake up and think they need to get to work or complete some other imagined duty, says Denny. When they try to fulfill the task, they may leave the bed and become disoriented.

Wandering can happen to anyone experiencing dementia who’s mobile, whether they walk or use a wheelchair. It may begin in the early stages of dementia, even before a diagnosis. “Many caregivers I speak with doubt that their loved one is at risk for wandering,” says Denny. “But it’s good to be at least aware this is an issue early on, so appropriate precautions can be taken.” Monitor these warning signs if you believe your loved one’s at risk. They may be:

• Discussing former obligations, like going to work or caring for a child
• Trying to “go home,” even when at home
• Pacing, making repetitive motions, or repeating phrases
• Behaving oddly or acting nervous in public or crowded areas
• Taking longer than usual completing regular walks or drives
• Forgetting directions to familiar places, or insisting on repeating directions throughout a trip
• Having trouble finding familiar places, like the bedroom or bathroom
• Failing to complete a full activity or chore — for example, getting out multiple pieces of bread without making a sandwich, or repeatedly opening and closing a book
• Incorrectly judging the distance between objects
• Perceiving two-dimensional objects as three-dimensional

Dementia wandering isn’t entirely preventable — but you can reduce the severity and danger of wandering patterns through behavioral changes, preparation, and technology-based solutions. Follow these 12 guidelines to help avoid dementia wandering.

1. Provide supervision. In the early stages of dementia, it may be okay for someone to be alone for short periods. As dementia progresses, continuous supervision will likely become necessary. Always stay with your loved one in new or changing environments, including stores, parks, and restaurants. If you’re a primary caregiver, consider hiring in-home care for respite to run errands, work, or spend time with family.
2. Obscure doors. Neutral door coverings and floor mats in front of doorways reduce exit-seeking behaviors, according to a 2014 clinical trial by the Department of Veterans Affairs. Use removable curtains, paint, or wallpaper that matches the surrounding walls to obscure entries and exits. Alternatively, you can use posters that say “Do Not Enter” or “Emergency Exit.”
3. Hide signs of leaving home. During unsupervised times, keep “trigger items” out of sight, says Denny. “Don’t leave car keys by the door, or anything else that might prompt someone to think they’re supposed to go out and do something.” Consider keeping keys in hard-to-reach places, or on your person, especially if your aging relative no longer drives.
4. Plan meaningful activities. The more engaged a person is, the less likely they are to wander. Seniors who are bored throughout the day are more likely to be restless at night, so provide opportunities for exercise and mental and creative stimulation. Note what times of day your relative is most likely to wander, and plan engaging activities then.
5. Prepare your home. Alarms, locks, and motion-sensing devices can alert you when your aging relative moves unsupervised. Other monitoring devices and modifications can keep them safe when dementia wandering occurs. Some helpful home preparations include:
   • Installing pressure-sensitive alarm mats at doors and bedsides
   • Attaching warning bells to doors
   • Using child-proof covers on doorknobs, outlets, and cabinets with any hazardous contents
   • Fencing the yard or using a hedge to block line of sight
   • Installing sliding bolts above eye-level, if they tend to unlock doors
6. Redirect and validate. Rather than correcting your loved one, use redirection to prevent wandering with dementia. For example, instead of telling them they aren’t allowed to go to work or drive, suggest a different activity that’s safe and calming. Or use validation to help them feel secure. For example: “We don’t need to run errands today; everything’s already here. We’re safe and have plenty of groceries.” Denny suggests exploring emotional connections related to where they’re trying to go. “You might ask, ‘what is your favorite part of work?’ or ‘what do you want to do first when you get home?’” she says. “Open-ended questions allow them to share memories or thoughts connected to the places they’re thinking about, which may prevent the urge to wander,” she says.
7. Reduce confusion. Loud noises, over-stimulating environments, and new places can lead to confusion and agitation. Try to provide a calm environment, especially during times your loved one is prone to wandering.
8.  Label and remind. Verbal reminders may limit disorientation in familiar settings. Consider signs for common areas — label the bathroom, bedrooms, and even clothing or favorite furniture. When possible, use your relative’s name. For example, a clear sign for “Rose’s favorite chair” can eliminate Rose’s stress and discomfort from finding and selecting seating.

How to reduce dementia wandering at night

Dementia wandering at night is a common problem, especially in conjunction with sundown syndrome. Denny suggests taking these steps to reduce the likelihood and hazards of nighttime wandering:

1. Talk to your loved one’s doctor. They can discuss helpful sleep hygiene tips. If behavioral approaches don’t work, the doctor may prescribe melatonin or another sleep aid. Denny notes that many over-the-counter sleep medicines can increase cognitive issues, so always talk to a physician before giving your elderly relative a sleep aid.
2. Create a safe environment. Night lights and arrows or signs posted around the house can help your elderly loved one remain oriented, while a clear path to the bathroom can help prevent falls.
3. Take preventive measures. Devices like bed alarms can alert a caregiver if a loved one gets up in the night. Consider placing locks and latches to prevent wandering from a safe space — but be sure your relative has access to a restroom, water, and a snack. Consider leaving a tablet with favorite games next to the bed, to provide safe distraction in case they wake and feel bored.
4. Regulate sleep. Try to limit naps throughout the day and reduce fluids in the hours before bedtime to eliminate bathroom trips during the night.

Some wandering is likely — even with preventive steps. Making a plan and knowing what to do in advance will help you find your senior loved one more quickly in case of dementia wandering. Follow these four steps to ensure you’re ready for an emergency.

1. Prepare important documents. Make copies of these documents and share them with home care aides and other family caregivers:

• A recent, close-up photo of your relative
• Up-to-date medical information to give police in case of emergency
• A list of people to call for help, like friends and neighbors
• A list of places your loved one with dementia may wander — former homes, jobs, favorite restaurants, or places of worship
• A list of places and people they’ve mentioned while experiencing dementia symptoms
• A wandering information sheet tracking your loved one’s symptoms and behaviors over time

2. Don’t be afraid to ask for help. Having all possible resources available can be necessary in case of emergency.

• In advance, ask family, friends, and neighbors to call if they see the person alone.
• Enroll your relative in a dementia wandering response service. MedicAlert’s Safe Return program has a 24/7 caregiver hotline in case of dementia wandering at night.
• Tell the local police or sheriff’s department your loved one has dementia and may wander, says Denny. “I’ve heard really good feedback from caregivers about the responses from their local precincts,” she says. Officers will keep your loved one’s information on hand to easily identify them, in case someone reports a senior who seems to be lost, confused, or in danger.
• Call 911 sooner rather than later: Survival rates of dementia wanderers fall to just more than 34% after 24 hours, according to the Alzheimer’s Association. Search your immediate area for 15 minutes — if your loved one isn’t found, call 911 or your local senior services hotline to report a missing person. Let them know your loved one has dementia, and share your on-hand documents.

3. Be aware of your surroundings and your loved one’s condition. Knowledge of your neighborhood and your aging relative’s wandering habits can save time in an emergency.

• Pinpoint obstacles and dangerous areas in your neighborhood, such as tunnels, heavily trafficked roads, and bodies of water.
• Be aware of any transit options near you, like taxi stands or bus stops. Police can contact bus and cab companies if your loved one isn’t found in the immediate area.
• Know if your relative is left or right-handed. Dementia wandering patterns often follow the dominant hand.
• Keep track of places they regularly ask to go, and have the phone numbers available.

4. Use tracking technology. GPS devices and other tracking systems are one of the most effective ways to reduce caregiver stress about dementia wandering, according to a year-long study of 45 caregiver/senior pairs from the University of Alberta, Edmonton. Many GPS tracking devices for seniors are available — watches, in-shoe tracking, and small, budget-friendly devices that attach to clothing are all popular options.

As cognitive decline increases, it may become unsafe for your relative with dementia to live at home — especially if they’re at risk of wandering. Memory care provides housing and 24-hour care for seniors with Alzheimer’s and other forms of dementia. These communities offer stimulating activities and therapies to reduce the likelihood of dementia wandering, and also provide a protected environment for seniors who do wander.

Talk with a Senior Living Advisor

Some memory care amenities to keep protect against wandering risks include:

• Specially designed memory care hallways and neighborhoods to allow unrestricted walking and pacing
• Outdoor wandering gardens for secure exploration
• Color-coded walls and signs
• Concealed doorways to reduce agitation
• Alarmed entry and exit doors to alert staff of dangerous situations
• Well-labeled rooms, furniture, and areas
• 24/7 supervision to assist with dementia wandering at night

To learn more about memory care communities near you, reach out to our local Senior Living Advisors.

Sources:

Administration on Aging. “Responding to the Wandering and Exit-seeking Behaviors of People with Dementia.”
https://acl.gov/sites/default/files/triage/BH-Brief-WanderingExit-Seeking.pdf

Alzheimer’s Society. “Mental and Physical Activities in the Later Stages.” 
https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/mental-and-physical-activities

American Journal of Alzheimer’s Disease and Other Dementias. “A framework for managing wandering and preventing elopement.”
https://pubmed.ncbi.nlm.nih.gov/19357378/

American Journal of Geriatric Psychiatry. “Disturbance of endogenous circadian rhythm in aging and Alzheimer disease.”
https://pubmed.ncbi.nlm.nih.gov/15879584/

Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring. “What do we know about strategies to manage dementia-related wandering? A scoping review.”
https://pubmed.ncbi.nlm.nih.gov/30456289/

International Journal of Geriatric Psychiatry. “Risk assessment of wandering behavior in mild dementia.” https://pubmed.ncbi.nlm.nih.gov/26223779/

Neurocase Journal. “Visual Spatial Cognition in Neurodegenerative Disease.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028935/

University of Alberta, Edmonton. “Acceptance of Global Positioning System (GPS) Technology Among Dementia Clients and Family Caregivers.”
https://www.tandfonline.com/doi/abs/10.1080/15228835.2016.1266724

US Department of Veterans Affairs. “Home Evaluation of Exit Barriers in Wandering.”
https://clinicaltrials.gov/ct2/show/study/NCT00997425