Understanding Wandering and Elopement in Dementia Care
Cognitive Mapping and Its Decline
Cognitive mapping is our innate ability to navigate and orient ourselves in our surroundings. For example, you might not see your car from inside a shopping mall, but you can still find it based on memory and spatial awareness. In Alzheimer’s disease and other cognitive impairments, this ability deteriorates. Consequently, if a person with dementia wanders or elopes, they are at a high risk of becoming lost, unable to retrace their steps.
What is Wandering / Elopement?
Wandering and elopement represent significant challenges in dementia care. While wandering refers to aimless or disoriented movement within a safe environment, elopement is when an individual with dementia leaves a safe area, often leading to dangerous situations.
Risks and Statistics
While wandering can sometimes act as a stress reliever, it poses significant risks if the person is in an unsafe environment. Elopement can lead to injury or even death.
Consider these alarming statistics:
Cognitive mapping is our innate ability to navigate and orient ourselves in our surroundings. For example, you might not see your car from inside a shopping mall, but you can still find it based on memory and spatial awareness. In Alzheimer’s disease and other cognitive impairments, this ability deteriorates. Consequently, if a person with dementia wanders or elopes, they are at a high risk of becoming lost, unable to retrace their steps.
60%
of persons with dementia (PWD)will wander at least once.
$1,500
per hour cost of search efforts for missing PWDs.
50%
chance of survival if missing PWD is not found within 24 hours.
23 Action Steps to Prevent Elopement
1) Prompt Basic Needs Fulfillment:
Ensure that the basic needs of individuals with dementia are met promptly. This includes regular meals, hydration, and bathroom breaks. Addressing these needs timely can reduce restlessness and the urge to wander.
2) Empowering Daily Involvement:
Actively involve persons with dementia (PWD) in their daily routines. This empowerment can provide a sense of purpose and familiarity, reducing feelings of anxiety or confusion that often lead to wandering.
3) Targeted Interventions and Communication:
4) Medication Management Consultation:
Regularly consult with healthcare professionals regarding the side effects of medications or the necessity for medication adjustments. Proper medication management can play a vital
role in addressing behaviors that lead to wandering.
5) Behavior Charting:
Regularly map out the daily behaviors of individuals with dementiato identify patterns and trends. This proactive approach helps in recognizing potentialtrigger events, enabling caregivers to anticipate and mitigate wandering incidents.
6) Person-Centric Redirection:
Regularly map out the daily behaviors of individuals with dementiato identify patterns and trends. This proactive approach helps in recognizing potentialtrigger events, enabling caregivers to anticipate and mitigate wandering incidents.
7) Strategic Environmental Design:
Place intriguing items or distractions along corridors and in common areas. These can capture the attention of PWD and serve as points of interest, reducing the impulse to wander aimlessly.
8) Dedicated One-to-One Attention:
Ensure consistent
one-to-one interaction with staff and volunteers.
Personalized attention can provide a sense of
security and belonging, significantly reducing the
likelihood of wandering.
Case Study
Common Triggers
- Saw coat, hat, and keys and decided to leave
- Change in schedule or routine, often within the first week of moving to a newcommunity
- Change in medication
- Was left alone at home or in the car
- Placed in an unfamiliar environment
9) Soothing with Rocking Chairs:
Incorporate rocking chairs in common areas as theycan have a calming effect. The rhythmic motion of rocking can be soothing andcomforting, helping to alleviate restlessness that often leads to wandering.
10) Constant Supervision:
Never leave persons with dementia (PWDs) unattended. Forinstance, during activities or in communal areas, ensure staff or volunteers are alwayspresent to monitor and assist, preventing wandering due to disorientation or confusion.
11) Wandering Committee Oversight:
Maintain and regularly update WanderingCommittee Guidelines. This committee should assess and revise strategies, likeconducting regular staff training sessions, to ensure the latest and most effectivewandering prevention methods are in place.
12) Minimizing Auditory Distractions:
Eliminate or reduce noise disturbances,particularly overhead paging systems, which can cause confusion or distress. Creating acalm auditory environment is crucial in preventing disorientation and subsequentwandering.
13) Regular Sensory Checks:
Keep hearing aids and glasses in working order. Forexample, perform daily checks to ensure these devices are functioning correctly, asimpaired senses can contribute to confusion and wandering.
14) Tailored Activity Engagement:
Offer activities that align with the individual’sattention span. For instance, for someone who can focus for only short periods, providebrief, engaging tasks like sorting or simple crafts to keep them occupied and less proneto wander.
15) Incorporating Exercise:
Add exercise to the daily routine, such as a structuredwalking program or outdoor activities. Regular physical activity, like a morning walk inthe garden, can help reduce restlessness and the urge to wander.
16) Purposeful Small Tasks:
Provide
small jobs or projects for PWDs.
Assigning simple, manageable tasks
like folding laundry or watering plants
can give a sense of purpose and reduce
wandering behaviors.
17) Combating Boredom with Stimulation:
Eliminate boredom by
providing stimulating activities.
For example, interactive games or
music sessions can engage the mind
and reduce the likelihood of wandering
due to lack of stimulation.
Case Study
Behavior Profile
- More incidents in the morning & late afternoon
- Fewer incidents between midnight and 6 am (sleeping after an active day!)
- More cases in warmer months (inviting climate/doors & windows are open)
- Left no clues/will not cry out or answer May attempt to travel to a favorite/familiar places
- The more severe the dementia, the shorter the distance traveled
- They usually don’t realize they need help, nor will they ask for help
18) Camouflaging Potential Exits:
Hide or camouflage doorknobs, doors, windows, andexits. Using murals or curtains that blend with the wall can make exits less noticeable,thereby reducing the temptation to wander outside.
19) Clear Time and Place Indicators:
Use large clocks, calendars, and signs in day rooms,hallways, and bedrooms. These visual aids help orient PWDs to time and place, reducingconfusion and the associated wandering.
20) Personalized Wayfinding:
Place the resident’s name and photo on the outside of theirdoor. This wayfinding technique helps individuals recognize their own space, reducingdisorientation and wandering.
21) Structured Daily Routine:
Provide a written daily routine for PWDs. Having a clearschedule posted in their room, for example, can help them understand the day’s activitiesand reduce anxiety-induced wandering.
22) Safe Walking Paths:
Designate secure walking paths within the community. Thesepaths allow PWDs to wander safely within a confined area, reducing the risk of themgetting lost or leaving the premises.
23) Perimeter Security:
Install fences and hedges around the community. This not onlyenhances the aesthetic appeal but also acts as a natural barrier, preventing PWDs fromwandering off the property.
Case Study
Responses – What should you do if there is an elopement?
- A systematic search of residence (use a grid of buildings and grounds)
- Always check under the bed and in between the bed and the window. Check rooms that are locked
- Go to areas that PWD has been before/canvass neighborhood
- Search community again
- Use dog teams and ground sweep teams if necessary
- Use tracking systems
- Post flyers if necessary
