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Saturday, 15 October 2011

Wandering Behaviour: How to prepare for it and prevent it

Statistics say 60% of persons with dementia will wander as they lose their ability to recognise familiar places and faces.  Many people cannot even remember their name or address. They may become disoriented and lost, even in their own neighbourhood.  

Although common, wandering can be dangerous – and even life-threatening.  When people with Alzheimer’s and other dementias walk off (and this can happen very quickly) they don’t think they’re lost. They have a destination in mind and they think they are going there the right way. Sometimes they may even hide from those searching for them due to paranoia. So searching and getting them back is not easy.  Even when wanderers are found, by the police or friendly strangers, they may be unable to supply their names or addresses.   The best way is to be prepared for it and to prevent it.

Following are some tips given by The Alzheimer’s Association to help caregivers of Alzheimer’s patients with wandering behaviour.   

Wandering: Who’s at risk?
Anyone who:
            • Returns from a regular walk or drive later than usual
            • Tries to fulfill former obligations, such as going to work
            • Tries to “go home” even when at home
            • Is restless, paces or makes repetitive movements
            • Has difficulty locating familiar places like the bathroom, bedroom or dining room
            • Checks the whereabouts of familiar people
            • Acts as if doing a hobby or chore, but nothing gets done (e.g. moves around pots and dirt without planting anything)
            • Feels lost in a new or changed environment

Consider behaviour
            • Be aware of who is at risk for wandering.
            • Identify the most likely times of day that wandering may occur, and plan activities at that time.
            • Provide opportunities for activities and exercise, such as folding towels, listening to music and dancing.
            • When night wandering is a problem, make sure the person has restricted fluids two hours before bedtime and has gone to the bathroom just before bed. Limit daytime naps, if possible.
            • Monitor reaction to medications. Consult a physician, if necessary
            • Use communication focused on exploration and validation (not correcting) when the individual says that he or she want to leave to go home or to work.  (ie. Don’t just stop them, join them and show them that they are mistaken – so they lose the urge to leave at that time)
            • If wandering is in progress, use distraction to redirect the individual’s focus.

Consider the home environment
            • Night-lights: Place throughout the home or facility.
            • Locks: Place out of the line of sight. Install slide bolts at the top or bottom of doors.
            Door knobs: Cover knobs with cloth the same color as the door. Use childproof knobs.
            • Doors: Camouflage doors by painting them the same color as the walls. Cover them with removable curtains or screens.
            • Use black tape or paint to create a two-foot black threshold in front of the door.
            • Warning bells: Place above doors.
            • Monitoring devices: Try devices that signal you when a door is opened. Place a pressure-sensitive mat at the door or person's bedside to alert you to movement.
            • Hedges or fence: Put around the patio, yard or other outside common areas.
            • Safety gates or bright colored netting: Use to bar access to stairs or the outdoors.
            • Furniture: Consider providing a recliner or geriatric chair for the individual to sit and rest. It is comfortable and yet restrictive to the body. Use round-cornered furniture, placed against the wall. Remove obstacles.
            • Noise levels and confusion: Reduce excessive stimulation caused by movement or noise.
            • Common areas: Develop indoor and outdoor areas that can be safely explored.
            • Clothing: Provide the person with brightly colored clothing.
            • Labeling: Label all doors. Use signs or symbols to explain the purpose of each room.
            • Secure trigger items: Some people will not go out without a coat, hat, kerchief, keys, wallet, etc.
            • Avoid leaving a person with dementia alone in a car.

Planning ahead
            • Keep a list of people to call when feeling overwhelmed. Have their telephone numbers in one location.
            • Ask neighbours, friends and family to call if they see the person alone or dressed inappropriately.
            • Keep a recent, close-up photo on hand to give to police.
            • Know your locality.  Pinpoint dangerous areas near the home, wells, ponds, open stairwells, dense foliage, tunnels, bus stops and roads with heavy traffic.
            • Is the individual right or left-handed?  Wandering generally follows the direction of the dominant hand.
            • Keep a list of places where the person may wander to, like past jobs, former homes or a place of worship or restaurant.
(Tips extracted from an official publication of Alzheimer's Association

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