People with dementia are likely to walk or pace aimlessly at some point during the disease. This wandering behavior can occur both indoors and outdoors, and it may have several causes. It may be the result of memory loss and disorientation. It may be a sign of curiosity, restlessness or boredom. Or it may be an attempt to express an emotion, such as fear or loneliness, or basic need, such as hunger or thirst. Here are some tips to help cope with this challenge, determine which ones work best for you and adapt them to your specific situation. To help reduce or manage your loved one’s tendency to wander:
- Understand the disease process. People with dementia often have deteriorating communication skills. When language is gone, behaviors may be the only way your loved one can communicate. By wandering, your loved one may be trying to share feelings of fear, isolation, loneliness or confusion. Provide comfort with a hug and a reminder that he or she is safe and in the right place.
- Make sure your loved one is getting enough food, drink, rest and opportunities to use the bathroom. If your loved one has trouble expressing wants, wandering may be the only way he or she can tell you that these basic needs aren’t being met.
- Take a daily walk or engage in exercise with your loved one, if possible. This may reduce anxiety, agitation and restlessness and reduce the tendency to wander.
- Allow your loved one to wander in safe areas, such as a fenced yard or looping set of hallways, with supervision. This can be a natural way to explore and adapt to surroundings.
- Maintain a quiet environment. Wandering can occur when there’s too much stimulation, such as multiple conversations or a loud television.
- Keep your loved one engaged in daily chores and activities. Restlessness and boredom can lead to wandering.
- Make your living space safer by removing throw rugs, moving electrical cords and possibly rearranging furniture. Use night lights and install gates at stairwells in case your loved one wanders at night.
- Install childproof doorknobs or latches mounted high on doors or post a stop sign on your home’s exit doors. This may deter outdoor wandering.
- Keep a family photo album handy. Your loved one’s wandering may indicate a desire to look for family members or something familiar.
- Post signs that say “Bathroom,” “Bedroom” and “Kitchen” on the corresponding doors in your home. Your loved one may forget where he or she is and may have difficulty finding these rooms without guidance.
- Keep car keys out of sight. Wandering doesn’t always occur on foot.
- If your loved one tries to leave the house, do not stop him. Forcefully trying to restrain a person set on leaving can result in injury and a catastrophic reaction (severe distress). Rather, go with him or her for a “walk”, go on an outing (even if it just for a drive around the block), or let them go and then follow them to ensure safety. Even if it is the middle of the night, the few minutes you go for a walk is better than the hours of distress (and possibly injury) associated with trying to stop a person with dementia from leaving
- Enroll your loved one in the Alzheimer’s Association’s “Safe Return” program. This is a nationwide identification system designed to assist in the safe return of people who become lost when wandering. Caregivers pay about a $40.00 registration fee. In return, they receive an ID bracelet, name labels for clothing, ID cards for a wallet or a purse, registration in a national database with emergency contact information, access to a nationwide alert system and a 24-hour toll-free number for reporting lost persons. To register someone, contact a local chapter of the Alzheimer’s Association or call 800-272-3900.
PREVENTING OR DEFUSING AGGRESSION OR CATASTROPHIC REACTIONS
When people with dementia become frustrated, scared or unable to communicate, they may become irritable or angry. Sometimes a person may experience a catastrophic reaction. This may occur in response to variety of occurrences including: loud noise (radio, TV, person), multiple questions, “why” questions, feeling insecure, feeling left out, small accidents, being reprimanded, arguments, a tense or irritable caregiver, or tasks that are too difficult. Try to see the situation from the patient’s point of view.
- Make sure your loved one gets enough sleep. Fatigue can cause combativeness.
- Reduce loud noises and physical clutter in your home. Loud noises and clutter can over stimulate your loved one. Limit guests to one or two at a time, and use television sparingly.
- Don’t expect too much. Don’t try to teach new information or ask your loved one to perform tasks he or she has been unable to complete in the past. This only results in frustration.
- Include exercise and light housekeeping chores in your loved one’s daily routine. This may reduce the restlessness that can lead to agitation and aggression.
- Don’t argue with or quiz your loved one to test his or her memory. This can lead to agitation. If you need to ask your loved one questions, make them easy to understand and ask them one at a time.
- Keep your loved one’s routine and environment consistent and simple. Changes, even small ones, can cause agitation. If you need to make changes, make them gradually.
- Try to be pleasant. If you’re feeling angry, stressed, irritated or impatient, try not to let it show. Respond to your loved one in a calm, reassuring way. That doesn’t mean you should deny your feelings, however. Just try to deal with them at a later time, and it may be a cue that it is time to obtain additional assistance, so you can have some respite from caregiving responsibilities.
- If your loved one becomes frustrated, provide reassurance and distract him or her with another activity. After some time has elapsed, you can return to the original activity if necessary.
- Don’t panic. If your loved one becomes agitated or aggressive, don’t resort to physical force. Try instead to soothe your loved one by holding hands, gently patting his or her back. Some people do not like to be touched when they are feeling agitated, and for those individuals it may be best to leave the room or to sit quietly a safe distance from him or her.
- Consider the 5 “R”s in handling catastrophic reactions: Remain calm, respond to feelings, reassure the person, remove yourself, return later.
- Check out the reality of a situation; maybe what the person says or thinks is true.
- Remember that whispering or laughing around the person may be misinterpreted.
- Consult a physician. Sometimes agitation is caused or aggravated by physical symptoms of pain, discomfort, physical illness or a co-occurring depression.
BENEFITS OF EXERCISE FOR PEOPLE WITH DEMENTIA
Exercise may not be high on your list of care-giving priorities. But you should consider it. There are many well-documented benefits of exercise for people who have dementia — benefits that also may make it easier for you to cope.
Consider the benefits of exercise. Helping your loved one stay active may:
- Improve strength, endurance and cadiovascular health
- Reduce risk of falls and fractures
- Improve energy, circulation, stamina and mood
- Improve sleep
- Promote regular bowel and bladder function
- Help maintain flexibility and balance, reducing the risk of serious injury from falls
- Help sustain the ability to perform self-care activities, such as grooming and dressing
- Impart a sense of belonging, purpose and contribution
- Create a calming effect through familiar activity.
Getting started: If you’re interested in making exercise part of your loved one’s daily routine, consider these tips:
- Consult your loved one’s doctor first. Other medical conditions that your loved one may have, such as high blood pressure or heart disease, may affect the type of program you can establish.
- Offer support and encouragement but not pressure. Pushing your loved one beyond what he or she is comfortable doing may cause frustration.
- Go with the familiar. Plan safe, supervised activities your loved one has enjoyed in the past, such as walking, swimming, golf or tennis. These offer the best chances for success.
- Exercise with your loved one. This may even help you manage the stress of caregiving.
- Adapt activities to your particular situation. If your loved one was once an avid golfer, for example, hitting chip shots in the backyard still may provide enjoyment.
- Establish a regular routine. Exercise at the same time each day, if possible, and keep the sequence of activities the same each time. If you and your loved one walk together, for example, use the same walking path each time to minimize confusion. When it rains, walk inside a mall or in your home.
- Ask your loved one to follow your lead while exercising. Offer simple instructions or directions. Or use an exercise videotape as a guide for some light stretching or calisthenics.
- Look to outside resources. If your loved one enjoys exercising with others, contact your local senior citizen’s center for information about group exercise programs.
- Look for creative options. Walk outdoors and watch birds as you go, or dance to music that your loved one enjoys. If outdoor gardening is no longer an option, plant and tend an indoor container garden or take a walk in a local nursery.
- Wear loose-fitting clothes and comfortable shoes. If you’re exercising outdoors in cool weather, wear layers of clothing appropriate to the temperature. This is especially important if your loved one has lost the judgment required to solve everyday problems, such as knowing what to do if he or she gets too cold.
- Remember to warm up. Before any activity, walk for a few minutes and then do gentle stretching exercises for the upper and lower body.
- Watch for changes in your loved one’s capacity for exercise. As dementia progresses, his or her capacity for exercise decreases. If you see this happening, cut back or try less strenuous activities so that your loved one can stay active as long as possible.
- Never ignore comments about pain, dizziness or shortness of breath. Consult a doctor if your loved complains of these symptoms.
- Keep it fun!
When factoring exercise into your care giving goals, aim to help your loved one remain as independent as possible while providing exercise options that offer purpose, meaning, pleasure and fun. In the process, exercise may even enhance your relationship.