One of the more common behavior problems associated with persons who are in the middle to latter stages of dementia is that of wandering. A person who wanders may roam incessantly around his environment, not really trying to get to any one place in particular but just having a compulsion to move. Or, the person may try to leave his home or the facility where he resides, trying to get to some location remembered from his past. This may be a former home, a workplace, or some other place of presumed safety. In order to help prevent or limit such behavior, it may be helpful to understand why it is happening. Here are a few possibilities to consider:
1. Stress and anxiety. People with dementia have a harder time dealing with these things than most of us. It’s harder for them to think things through, and figure out ways of dealing with what causes anxiety, or produces feelings of stress. They may not even be able to think through what it is that is causing them to feel uncomfortable. This generalized feeling of discomfort, and even fear, can lead them to seek out someone or something that can help them understand.
2. Restlessness. A person who is used to staying busy may not be able to adapt to a more sedentary lifestyle. I can think of one woman in particular, whose daughter told me that she worked two jobs to help support her family, and even then was always busy taking care of her home and children as well as helping others in her church or community. After so many years of this kind of life, she just couldn’t adjust to a lifestyle where everything was done for her.
3. Confusion. A person in the middle to latter stages of dementia may not be able to recognize where he is, or remember why he is there. He may have a vague awareness that this is not his home, and will try to get back to a place of familiarity. If he is prevented from doing so, he may become agitated and even combative.
4. A desire to fulfill former obligations. A person may continue to answer that life-long inner alarm clock that tells him to go to work every morning. Or she may sense that the house needs to be cleaned, or meals need to be prepared for her children. In an earlier post, I related the story of a women I met who had spent years working as a nurse who worked at night, and who persisted in making her rounds to check up on her “patients.” Once the staff realized this, and understood that she had no desire to wake people up or to disturb their belongings, they allowed her to resume her “duties,” and then help her back to bed with a smile on her face.
5. Medications and their side effects. Some medications used to treat concomitant physical problems may have the unwanted side effects of producing restlessness or agitation, or may decrease inhibitions.
6. Difficulty recognizing familiar places and things. Even if a person is in the home he has lived in for years, he may wake up in the night and not recognize where he is. He may become fearful, and go off in search of someone or something that he knows.
7. Fear arising from the misinterpretation of sights and sounds. As dementia progresses, a person’s brain will perceive things differently. For example, photographs on the wall may appear to be strangers looking in through a window. A moving shadow caused by cars going by on the street may look like something unrecognizable and threatening.
It may not always be possible to determine what it is that causes a person to feel the need to wander. But it is important to understand that the vast majority of behaviors exhibited by the person with dementia are a form of communication, and if we can learn what the person is trying to tell us we may be able to better deal with the behavior. For example, it may be that all that is necessary is to remove frightening photographs or mirrors, or to put a night-light in the person’s bedroom. Or, perhaps finding more to keep a person busy during the day might help, or a change in medication. Unfortunately, often the only way to deal with wandering, however, is to find a way to keep the person safe by preventing them from leaving their home or injuring themselves in some way.
(This is adapted from, and inspired by, a list found here.)