When an Alzheimer’s Patient Wanders

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By Lisa Esposito

Walking is one of the best ways for older adults to stay active. But purposeful walking can turn into restless wandering when someone develops dementia. Escaping the watchful eyes of caregivers is dangerous, exposing vulnerable seniors to hazards from street traffic, unfamiliar terrain and opportunistic strangers. Even when family members and caregivers are on constant alert, 24/7 vigilance isn’t always possible.

William Schiekler, 90, of Sarasota, Florida, is trying to cope with the risk of his wife wandering. Now 85, Shirley Schiekler was diagnosed with Alzheimer’s disease a few years ago. “We’ve had to call the police on one occasion,” he says. Fortunately, he noticed Shirley was gone almost immediately. He still doesn’t know where she went, just that the officers quickly found her and brought her home unharmed.

While wandering could refer to driving with dementia, the kind that provokes Silver Alerts on the highway, it usually refers to wandering on foot, says Lisa Milne, vice president of programs for the Florida Gulf Coast chapter of the Alzheimer’s Association.

When people are confused and looking for a place of comfort, they may wander to that place, whether it’s their current home or their home from 20 years ago, Milne says. “We’ve had several cases where they walked several miles,” she says. “People with this disease have a hard time recognizing hunger or thirst or that their body is getting tired. So they’ll just walk and walk and walk.”

Heat exposure and dehydration threaten seniors who wander in sunny Florida and don’t remember to drink, notes Milne. “And of course their access to water is a concern down here,” she adds. “We don’t want them to drown in the ponds or the ocean.”

Redirect, Redirect

“We really encourage redirection as a form of preventing wandering,” Milne says. “So when you know your loved one is going to be looking for a way out of the home, give them an activity that will keep them occupied.” Tailor the activity to the person, she suggests, such as giving a former homemaker towels to fold or coupons to clip.

“If you do have the person who is exit-seeking – the type of wandering where the person is going to find a way out, no matter what activity you give them – some simple tips are things like just putting a stop sign on the door sometimes can help,” Milne says. “Or disguising the door so that it doesn’t look like an entrance or an exit.”

Staying physically active helps those with dementia stay healthy, but with extra emphasis on safety. “Take your loved one for a walk, but early in the morning when it’s cool outside,” Milne suggests. If possible, find a suitable setting like a park with long walking paths that loop back around to where they begin, she says, and continue to keep your loved one within eyesight.

As a couple, the Schieklers remain active, taking long walks together and working out at the fitness center in their country club. But a few weeks ago, neighbors noticed Shirley alone on a golf course fairway – she had climbed out of a window at home. Her husband has since installed locks on all the doors and windows.

Shirley will be safe, Schiekler says: “I’m with her all the time.” He has a bit of a respite when he plays golf a couple times a week. On those days, he takes Shirley down to the Senior Friendship Centers in Sarasota, where constant supervision is available.

Staying Safe

Systems like mattress motion sensors, home alarms and high-tech wanderer bracelets that allow GPS tracking are just some of the methods caregivers use for peace of mind. The Alzheimer’s Association offers a low-tech, low-cost MedicAlert/Safe Return emergency response program, which includes stainless steel bracelets. The bracelet has a phone number that good Samaritans can call if they find a person who’s gone missing.

William and Shirley Schiekler both wear identification bracelets with contact information, including that of their son in Pennsylvania. The couple also attends a weekly session for families dealing with dementia, Schiekler says, hosted by their local Jewish center. Social workers hold sessions for caregivers, educating them about the disease. A separate class offers activities for the patients.

His wife’s wandering doesn’t make him anxious anymore, Schiekler says. “It’s like anything else,” he says. “After a while, you do adjust to these things.” But Shirley’s disease is progressive, and how long the current situation can last is uncertain. The time may come when she needs to stay somewhere else to meet her care needs. “I don’t really know yet,” he says. “It’s something we’ve got to play by ear.”

Space to Wander

Some long-term care facilities with memory care units are addressing the issue of balancing physical activity and the risk of leaving by giving residents secure spaces to wander safely, indoors or outdoors.

Smooth, flat cement pathways wind around landscaped gardens with multicolored flowering, he says, allowing residents to wander in a beautiful outdoor setting. Benches surround the pathways, along with picnic tables with built-in game boards, so residents and visitors can enjoy a game of checkers. A streaming water wall encourages calming interludes for residents and staff alike.

“There’s something about wandering, something about movement, that many of these individuals who are physically very strong, have no evidence of physical frailty, but obviously they have a cognitive decline and deficit – they just want to move and want to go,” Simon says. In many ways, that urge is positive and healthy, he notes. But dementia adds complications.

“The problem of wandering patients has been present for years now and increasingly so,” Simon says. “Our patients have wandered outside of our building, across our large campus, outside the confines of the campus. The dangers of their wandering are overwhelming. And we’ve had patients who ended up being found by police, [or] found by local citizens. Thankfully, to my knowledge, we’ve never had any tragedies. But they occur.”

If you have a family member with dementia living in the community who’s at risk of wandering, reach out to your local Alzheimer’s Association chapter or Area Agency on Aging for support. Caregivers “should know that they’re not alone,” Milne says. “There are other people going through it.”