Wandering, Confusion, Disorientation and Dementia
When meeting with patients and their families and listening to what symptoms have been occurring that may have led them to their neurologist or primary care doctor, there is often a story or theme of being confused, disoriented, or lost, even in familiar places or routines. This often becomes another piece of the puzzle that raises the likelihood of a diagnosis of major neurocognitive disorder or dementia (such as Alzheimer’s disease).
Much of this confusion, disorientation, or getting easily lost can be attributed to memory loss experienced in dementia. However, dementia can also cause changes in behavior and mood. Wandering is one example of these behaviors. When paired with failing memory, those impacted may find themselves in difficult situations where they do not remember where they are, their name, the names of their loved ones, or any of their contact information.
It can happen at any stage of the disease (although it tends to happen more often in the moderate and severe stages) and is often caused by the inability to recognize what was once familiar, as well as by the confusion and disorientation that is part of the disease.
When wandering occurs in a supervised setting it isn’t necessarily harmful but, it can lead to dangerous safety issues, causing a great deal of stress for caregivers as they try to manage and prevent this challenging behavior.
While wandering may seem random, it can be purposeful for the person with dementia. For example, the person with dementia may be searching for something or someone familiar from the past, following a familiar routine like going to work, or wandering as a reaction to stress or fear in a crowded and overstimulating environment.
Here are some warning signs that your loved one may be prone to wandering:
They begin to have increased difficulty navigating familiar places.
They talk about needing to do previous life tasks/obligations that were already previously completed.
Your loved one no longer recognizes their home and/or asks to “go home” when already there.
They do not remember returning home after being outside, or they return from a routine walk or drive later than usual.
They start to become extremely restless or begins to pace a lot, especially during the late afternoon or evenings.
They act nervous and anxious in crowds, particularly if this never bothered them in the past.
While these signs may not always indicate someone will walk off, they are good indicators that there is an increased risk for the person to wander.
Try the following tips to help reduce the risk of wandering and keep the person safe:
1. Structure their day with a consistent routine.
2. Provide activities (gardening, music, physical exercise, or movies) to reduce boredom.
3. Ensure that the individual is well fed, well hydrated and using the bathroom at regular intervals. Dehydration can lead to delirium and confusion, particularly on hot days.
4. Create a safe space for wandering at your home or go on a walk with the person if it seems like that is what the person needs.
5. Keep items such as keys, hats and coats, out of sight, as they may trigger a desire to leave home.
6. Try to provide continuous supervision especially in new surroundings or in unfamiliar places.
7. Use alarms or bells on bedroom doors and exterior doors so you are alerted when doors are opened.
8. Exercise appears to be beneficial for depressed mood, wandering, and agitation. It may also improve sleep quantity and quality.
9. Mark all non-exit interior doors. Decorate the inside of exterior doors so they are not easily recognized as exits or put a “STOP” sign on the door.
10. Avoid busy places. Try visiting these locations only when you can assume there won't be large crowds.
11. Make sure that the person wears an identification bracelet.
12. Talk to your neighbors, local police, and others in your area. Let them know you have a loved one with dementia who tends to wander. Offer a recent photograph of your senior so that they’ll be able to keep an eye out for her if she does wander outside.
13. Complete ALZNJ’s Always Safe® card and give to your local police department, so they will have it on file should your loved one become lost or missing. Call the Helpline at 888-280-6055 for more information.
14. Consider whether a GPS or tracking device would be helpful. Find your local Project Lifesaver program.
15. Because those with dementia tend to wander off, many states now issue Silver Alerts. This is similar to the Amber Alert system used to find missing children. When a senior (usually a senior with dementia per alert protocols) is missing, family members will contact the authorities who may issue a Silver Alert (or that state's equivalent) to find the missing person.
To prevent unsafe wandering, try to recognize the causes of the behavior and the time of day that wandering occurs. Intervene by engaging in meaningful activities and providing reassurance that the person is safe. If the person with dementia is searching for a relative or friend from the past, rather than trying to explain the absence, try to redirect the wandering by having a conversation about that person and/or that period of time.
Wandering can be a real challenge for family care givers. It can be impossible to provide a watchful eye twenty-four hours a day, so wandering behavior may be a significant trigger for seeking residential care or having a home health-aide come into the home to assist.
If these symptoms are occurring and the person hasn't seen a medical professional an appointment should be set-up to determine the cause of the symptoms. Typically, the first step is consult with a neurologist or primary care doctor. Afterwards, they may refer you to a neuropsychologist such, such as Dr. Burchette, who conducts the neurocognitive testing to determine the person's current cognitive strengths and weaknesses.