Wandering is a common and serious behavior in individuals living with dementia, representing an unplanned departure from a safe environment. Approximately six in ten people with dementia will wander at least once. This behavior is a significant safety concern, as individuals are at high risk of injury, exposure, or becoming lost. Proactive prevention strategies are necessary, and understanding the underlying reasons can significantly reduce the risk.
Understanding the Root Causes of Wandering
Wandering is rarely aimless; it is usually a behavioral expression of an unmet need or internal confusion arising from the disease process. Patients may attempt to fulfill a past routine, such as going to work, picking up children, or wanting to “go home,” even when they are already in their residence. Memory loss and disorientation can trigger a search for a familiar person, place, or object from a past time period.
Unmet physical needs are common triggers. The person may be searching for the bathroom, food, or water, or attempting to communicate pain or discomfort. Boredom, restlessness, or anxiety can also lead to pacing and attempts to exit the environment in search of stimulation or relief. Changes in medication or an over-stimulating environment can also initiate the urge to wander.
Home Safety Modifications and Physical Barriers
Adapt the environment to create a first line of defense against unsupervised exit. Securing doors with locks placed outside the typical visual range prevents easy manipulation. Deadbolts or slide bolts installed very high or very low on exterior doors are less intuitive and provide a moment of delay for intervention. Simple door alarms, such as pressure-sensitive mats or inexpensive chimes, immediately alert a caregiver when an exit is attempted.
Camouflage techniques can make the exit door visually disappear into the surrounding decor. Disguise the exit by painting the door the same color as the adjacent wall or hanging a curtain or poster over it. For doors leading to off-limits areas, such as workshops or basements, use a simple, non-obvious slide lock or cover the door handle with a child-proof cover. The goal is to redirect attention away from the door without causing frustration.
Exterior safety measures are important for those who spend time outdoors unsupervised. Secure yards with fencing and locked gates to create a safe boundary. Remove access to anything that facilitates unsupervised departure, such as car keys. Clear pathways and proper illumination, especially motion-sensor lights at night, help prevent falls and disorientation, as clutter or dim lighting increases confusion.
Behavioral Management and Routine Implementation
Addressing the internal drive to wander requires the implementation of a predictable, structured daily schedule. Consistency in waking, mealtimes, and bedtime can significantly reduce anxiety and evening confusion, a phenomenon often referred to as “sundowning.” A predictable routine provides a sense of security and reduces the feeling of being lost or disoriented, which are major motivators for wandering.
Structure the day with meaningful activities that engage the person and mimic former roles. Simple tasks like folding laundry, wiping a table, or gardening fulfill the need to be productive. These purposeful activities decrease restlessness and the compulsion to exit the home. When a patient expresses the desire to “go to work” or “go home,” use redirection: agree with the sentiment but suggest the activity is postponed (e.g., for a holiday) before introducing a distracting activity.
Proactive monitoring of basic physical needs can prevent wandering episodes before they start. Patients may begin pacing or moving restlessly because they are hungry, thirsty, need to use the restroom, or are experiencing pain. Checking for these needs and providing appropriate relief can de-escalate agitation and eliminate the wandering trigger. If pacing occurs, allowing a safe, purposeful walking path within the home or a secured area can satisfy the urge to move without the risk of an exit.
Utilizing Tracking Technology and Community Resources
When physical and behavioral prevention measures are in place, technology and community support serve as a safety net. Global Positioning System (GPS) tracking devices locate a missing person quickly and accurately. These devices are available in various discreet forms, including watches, pendants, clip-on units, and inserts that fit into the sole of a shoe.
Many GPS trackers offer real-time location monitoring and geofencing capabilities, allowing caregivers to set virtual safe zones around the home or neighborhood. If the person crosses this boundary, the caregiver receives an immediate alert on their phone, allowing for rapid intervention. Some advanced models feature an auto-answer speakerphone, enabling the caregiver to communicate with the person even if they are confused or unable to operate the device.
Simple identification systems are a low-tech yet effective safety measure. Wearing an ID bracelet, necklace, or clothing tags with emergency contact information and a medical alert ensures quick identification if the person is found by a stranger. Caregivers should also maintain a recent photograph and an up-to-date physical description to provide to law enforcement immediately in case of a missing person report.
Community programs offer external support and coordination. Registering the person with local police or sheriff’s departments, or with national programs like MedicAlert, provides critical information to first responders. These systems allow law enforcement to access medical history, wandering patterns, and emergency contacts, which is essential for a safe and timely return. Informing neighbors and local community members about the person’s tendency to wander creates a network of vigilance.