Three in five people with Alzheimer’s disease or another type of dementia will wander, according to the Administration on Aging. This potentially dangerous result of cognitive decline may occur when a senior with dementia is trying to find someone or something. It can also be the result of discomfort, anxiety, or fear.
“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.
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:
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.
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.
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.
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:
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.
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:
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:
2. Don’t be afraid to ask for help. Having all possible resources available can be necessary in case of emergency.
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.
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.
Some memory care amenities to keep protect against wandering risks include:
To learn more about memory care communities near you, reach out to our local Senior Living Advisors.
Administration on Aging. “Responding to the Wandering and Exit-seeking Behaviors of People with Dementia.”
Alzheimer’s Society. “Mental and Physical Activities in the Later Stages.”
American Journal of Alzheimer’s Disease and Other Dementias. “A framework for managing wandering and preventing elopement.”
American Journal of Geriatric Psychiatry. “Disturbance of endogenous circadian rhythm in aging and Alzheimer disease.”
Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring. “What do we know about strategies to manage dementia-related wandering? A scoping review.”
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.”
US Department of Veterans Affairs. “Home Evaluation of Exit Barriers in Wandering.”