• Karen McPhail, RN, MSN

Creating a Positive Care Environment to Deter the Challenge of Wandering & an Upcoming BV Event


Wandering is a common challenge experienced by many individuals with cognitive impairments. There is always a reason for all behavior and often times once you observe and determine the cause or trigger, effective interventions can be put in place to prevent recurrence and create a positive care environment. Of course triggers may change over time as the disease progresses so this process needs to be flexible and adaptable as things evolve.


Some common reasons why individuals may begin wandering:

  • Anxiety, stress, fear, or insecurity – the routine or environment may be over stimulating, have had recent changes and they may not recognize where they are, who people are, or what is happening.

  • They are in discomfort or frustrated- uncomfortable clothes, shoes, general discomfort, tooth pain, or the inability to communicate a need.

  • They have basic needs that need to be met - hungry, thirsty, needing to go to the bathroom, etc.

  • They are searching or unable to find something.

  • Restlessness or Boredom – they could be looking for something to do or not knowing what to do and needing guidance and cueing.

  • Attempting past activities – trying to go to work, to help a loved one, take care of children or pets, do chores, or even run errands like they used to.

Some common interventions to prevent wandering:


1. Observe closely to identify and trouble shoot triggers for wandering behavior.

Identify the causes for the individuals wandering behavior, as all behavior is purposeful and has a root cause. Make notes of the who, what, when, and where aspects of wandering and include what they were doing before events began to unfold in a challenging manner. Even the smallest detail matter and are essential in problem solving. A pattern will emerge! For example, they may wander at around the same time every day, when the private duty leaves, when they’re bored, when looking for the bathroom if not easy to locate, when hungry or thirsty, or uncomfortable. They may be sad, lonely, in pain, or seeking an old pattern. Finding the root of the behavior and connecting at their level is key to resolving.

If wandering is caused by boredom or a physical need, find meaningful activities to keep them engaged, make transitions seamless, encourage a holistic, proactive daily routine that supports comfort, hydration, etc. Engaging them in activity to carry them through and past more difficult times can be helpful to break the cycle and provide them with purpose.

Some individuals may be trying to return to an old routine, like going to the office in the morning or picking up a child from school in the afternoon.

To reduce this need, redirect them - “I would love for you to stay home with me today. Today is your day off lets do something fun. The office isn’t open today.”

Or mention that you have plans or a friend is coming over. Then, distract them with a favorite activity or snack to take their mind off of their old routine.

Some individuals frequently look for an individual, pet, object and wander because they’re searching. Think creatively to reassure them that everything is ok. You may say that the lost item is being repaired or in a safe place with a trusted friend until finding. Or you might say that the person they’re looking for called to say they were delayed, but would be there later, or would like you to wait at home for them. Encouraging them to tell you about the person or object can often lessen anxiety, distract, redirect, and reduce the urge to further search. Help them reflect back, engage, and connect at their level.


2. Next make some positive changes in their care environment! Install door and window alarms, locks, and other alarm and monitoring devices. Making it less easy for for the individual to get outside of the house is essential to preventing wandering.

Some simple home safety modifications can support safety and make it difficult for individuals to open doors to the outside, including:

  • Install an additional lock higher up on the door so they are out of the individuals line of sight. People with dementia often do not look above eye level so this can be effective.

  • Another effective technique is to put a large black doormat in front of the door. Some individuals with dementia perceive dark areas of the floor as holes and will not walk over them. This will discourage them from actually reaching the door.

  • Install door and window alarms to provide a strong alert to abatement attempts.

  • Add childproof door knob covers make it more difficult to open doors

  • Use pressure-sensitive alarm mats next to their bed to alert you if they get up at night. An alarm such as SafeWander that is triggered when a specific threshold is crossed can be helpful.

  • You may also try to camouflage doors that lead outside or add signage to deter using. Often, individuals with cognitive impairment won’t be able to find the door if you cover it up or will not open it if you place a large sign on it. This can be achieved by using a curtain rod above the door to hang a dark curtain or wall hanging to cover. Slide the curtain open and close as needed, taking care to not let your older adult see you do it. One can also place large signs saying simply - “STOP” or “DO NOT ENTER” on the door. Many people with dementia will not attempt to open a door with those types of common restrictions as these are often part of their long term memory.

  • It is important to also consider and be mindful however of fire safety needs for everyone in the house. Make sure all locks are easily accessible to people without cognitive impairment. Doors should be able to be opened quickly in the case of an emergency.

3. Create a positive and frustration free care environment!

Create contrast in number of ways to cue the individual to positive use! Guide them to the safe doors that you want them to use though visual cueing. When an individual is attempting to leave and trying the doors leading to the outside, they are often actually looking for an interior room, such as the bathroom, kitchen, or their bedroom. Make these positive rooms that you want used stand out with a contrasting color. Research indicates that color preferences for individuals with dementia are red, blue and green. The use of contrast is extremely important for those with dementia - marking edges of things, drawing attention to furniture or other tripping hazards and making it easier to locate appropriate doors and other items is key. Therefore, contrast should be used to help define objects such as doors more clearly, especially safe doors to use. Using a color that contrasts with the background draws attention and helps to cue to use. Green and especially lime green is often effective with individuals with dementia for visual attention, i.e., visual cues to bedrooms, bathrooms, etc. In a bathroom, having a green toilet seat can be helpful along with a green door to the bathroom to keep the cueing moving forward. Blues and pinks have been shown in many individuals with challenging behaviors to be calming and can also be used to create calmness in spaces.

Either way, using a color that contrasts with the background draws attention to key features within the home and draws the individual to safe spaces and deters them from unsafe areas (such as outlets) as they can easily blend into the background if not contrasting.

One can also make key safe rooms easier for individuals to find by adding large signs or pictures on these doors or leaving the bathroom light on at night or by having a photosensor light in bathrooms and hallways. Hallways can also have visuals themes along the way to guide and cue to locations.


4. Enroll them in a safe return program

In the event that they do get out of the house, make it easier to find them by enrolling in a program such as the Alzheimer’s Association’s MedicAlert Safe Return. Once enrolled, the individual will get a wearable ID that allows people and law enforcement to identify a found senior and contact you. You can also call a 24/7 toll-free support line if you need to report your older adult missing. You may also want to contact local law enforcement agencies to ask if they offer Silver Alert or similar programs that help caregivers locate missing older adults. Northern VA has a senior alert system.


5. Have the individual wear a GPS device at all times. Find something that is light, easy to put one, and that they seem to like to wear. It is best if possible if they wear a GPS tracking device at all times aside from showering. A wearable GPS device like a wristband sends out tracking signals that can be followed by rescue personnel.

Some local law enforcement agencies offer locator services such as Project Lifesaver and Safety net. If the individual will not accept a wearable tracker, consider the SmartSole which is a GPS tracker that’s hidden in shoe insoles.


7. Hide unsafe wandering items such as keys, door openers, purses, wallets! These items can result in issues faster than one realizes - if car keys are accessible, the older adult could drive off before anyone even realizes it! it can also serve as a deterrent as some people will not leave the house without their keys, wallet, etc. To proactively prevent issues, make sure all car keys are well-hidden, and consider adding a steering wheel lock to the car.


6. Plan ahead! Ensure that you have a plan in case your loved one wanders off:

  • have an up to date photo of them within the home or take a quick photo of them each morning with your cell phone. By taking a daily photo one always has an up-to-date photo with the clothes they’re wearing that day. Sometimes it is difficult under stress to recall what they were wearing or even key details. it helps to have something tangible to show to law enforcement / rescue personnel.

  • If comfortable, talk with your neighbors about their wandering behavior and share tips on how to distract or slow them down if they see them wandering. Make sure that all neighbors have your contact information.

  • Iron-on ID labels with contact information is helpful to have on all their clothes. The sew in labels can also be used if they will tolerate them.

Being proactive and prepared will give you piece of mind and help your loved one to remain safe at home! As always it is important to consider what that person needs, their safety, and previously expressed wishes to achieve the appropriate balance between protecting them from potential hazards and supporting their safe independence and comfort.

With a few simple and cost effective modifications safe, functional, frustration free, and supportive spaces can easily be achieved!


Reach out if you need assistance in setting up a positive care environment for your loved one!



Sources:

https://www.psychiatrictimes.com/view/dark-side-dementia-care

Alzheimers Association

https://www.enablingenvironments.com.au/colour-perception-and-contrast.html

https://www.enablingenvironments.com.au/colour-perception-and-contrast.html

https://www.theadvocate.com/baton_rouge/entertainment_life/health_fitness/article_922b136a-84d5-11e6-8c00-fbc8ac72b472.html


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