How to Handle Wandering Behavior in Dementia Patients

Wandering Behavior in Dementia Patients

Dementia is a progressive neurodegenerative condition that impairs one or more cognitive functionalities in a person, impairing their performance in some daily living activities. The occurrence and progression of dementia place the affected person at a great disadvantage, necessitating care from others to ensure the appropriate quality of life for the patient.

The impairment of the cognitive functions of the individual may result in some unusual and disturbing behavior patterns from the person, with wandering being frequent. Wandering among persons with dementia (PwD) refers to a movement pattern that is, frequent, repetitive, aimless, disordered, and/or random, and that is likely to result in the wandering person losing contact with their caregivers or losing their way from care homes or residencies, placing them at significant risk of harm. It is a challenging behavior in PwDs because it raises the rates of morbidity and mortality for the patients, which increases care burdens on caregivers, requiring dedicated preventive and management interventions.

In this post, we will discuss the problem of wandering behavior in dementia patients and what can be done to overcome the consequences of the problem.

What Causes Wandering Behavior in Dementia Patients?

Wandering behavior is one of the most frequent symptoms of dementia. The exact causes of this condition remain unknown, although research is ongoing in attempts to unravel underlying factors. Nevertheless, scientific studies have identified some potential explanations, and possible risk factors for wandering behavior.

Some researchers view wandering behavior in dementia patients as resulting from impaired visual functional disability and topographical memory, limiting the person’s ability to navigate their way back to their homes or places of residence, or the initial point of departure. Alternatively, other scholars have interpreted this behavior as part of the daily challenges that PwDs face as a result of the debilitating effects of the disease on their cognitive functions, while others suggest that it may be occasioned by the unusual interaction between these patients and their environments, resulting in misalignments between their desires, the environment and the responses that they give.

In addition, several risk factors contribute to the probability that dementia patients will exhibit these behaviors. These factors include exposure to antipsychotic treatments, the presence of externalizing behaviors like aggression, severe cognitive decline, and challenges with recent memory regarding time, geography and spatial orientation.  

What Causes Wandering Behavior

Major risks of wandering in Dementia Patients

While wandering can be healthy for the mind and body, in dementia patients, this is a behavior that can pose significantly severe risks to the patient and their carers. Firstly, wandering exposes these patients to injuries that can range in severity from minor injuries to fatal accidents. Falls, car hits, abrasions, animal encounters, and fractures are some of the common incidents arising from wandering into unsafe zones. The weak gait of these patients and their impaired cognitive functions may lead them into areas of grave danger, where they may suffer irreparable harm. Secondly, wandering patients who find it difficult to sit down for meals may suffer from malnutrition, exacerbating their health issues. This could be complicated by the presence of other conditions, such as high blood pressure and diabetes.

Thirdly, morbidity and mortality rates are high among frequently wandering patients due to the risks of injuries and accidents that may be life-threatening. Apart from the injuries that may be sustained, wandering may disrupt vital schedules such as medication times for existing conditions and/or diseases, raising the risk of negative health outcomes.

Major risks of wandering in Dementia Patients

Lastly, wandering impacts the cost and quality of care and distresses caregivers due to the negative emotions and attention associated with having to trace lost patients who wandered out of homes or care institutions. The distress can be especially overwhelming for carers when this takes longer than anticipated, or when this occurrence involves multiple patients at once. Surprisingly, wandering is a frequent occurrence among dementia patients, with an estimated 60% of patients experiencing it in the course of their illness. This calls for effective management strategies to enable patients to continue enjoying their autonomy and dignity from their interactions with their surroundings while minimizing the risks and costs of wandering.

Management Strategies of Wandering in Dementia Patients

While wandering is fairly common in the aged population, the risks, nature, and pattern of the behavior vary from patient to patient. Wandering is not necessarily extreme in all patients, and understanding the patient’s pattern of wandering can be a useful starting point in developing further strategies to manage the behavior and personalize these techniques for the individual.

The persistence of walking, overall health, frequency of wandering, history of falls, and other injuries while wandering are some of the items that should inform the risk score for the patient.

Management Strategies of Wandering in Dementia Patients

Psychoeducation can be used as a crucial component of wandering behavior management. Psychoeducation is the process of providing education and information to individuals and families about mental health conditions. It is a collaborative process that involves the therapist, the individual, and their family members or support system. The goal of psychoeducation is to increase understanding, reduce stigma, and empower individuals to make informed decisions about their treatment and care.

When implementing a psychoeducational approach to manage the wandering behaviour it should target both patients and caregivers, allowing them to understand the nature of the condition, the triggers, and the inherent risks and dangers. Psychoeducation can also entail instruction on better management strategies and informing patients on how to better maintain their security and safety at all times. Some patients can provide valuable insights into their behaviours, especially around triggers.

Tailored education should enable caregivers to study their patients more closely and identify their behavior patterns for further refinement of care plans. It may also entail educating patients on necessary behavior changes and patterns that minimize risks in cases of wandering or reduce unhealthy wandering.

Another useful management option is behavioral intervention. A behavioral intervention for managing wandering behavior in dementia patients is a non-pharmacological approach aimed at modifying the patient’s behavior or environment to reduce their desire or ability to wander. These interventions are often used in conjunction with other strategies like environmental modifications and medication management.

The use of physical restraints and barriers to managing wandering in behaviour is a traditional approach to wandering, although current research restricts this to a secondary role, and is only used when absolutely necessary. This is because physical restraints and barriers put patients at increased risk of injury and other medical conditions. Some people also consider them to be unethical and deprived of personal liberty and dignity.

Caregivers should emphasize fewer restraining techniques, with a focus on individualized management plans centers on behavioral interventions. Physical restraints can also lead to the deterioration of the health of the restrained person and are likely to compromise the safety of the patient. Confinement, which is a form of seclusion for the patient, is also discouraged.  Confinement, like physical restraints, adversely impacts the mental and physical health of the patient. It should be a short–term intervention and only used when necessary. Otherwise, patients would enjoy the freedom and liberty to walk around and interact with their surroundings, and the focus should be on ensuring a safe environment that minimizes the risks of wandering into unsafe zones.

Caregivers should emphasize fewer restraining techniques

While there is no single approved treatment for dementia, there are a number of drugs approved for the management of some of the symptoms and attendant conditions related to dementia. Psychotropic medications, antipsychotics, and behavior management drugs may be deployed to manage wandering behavior in patients who are not responding to non-pharmacological interventions. This should be based on clinical evaluation and recommendation. They must also be short-term and targeted to minimize potential tolerance. Clinical evaluation is fundamental because such patients may have compromised renal and hepatic functionalities.

Technology has emerged as a potential solution to preventing and managing wandering behavior in dementia patients, although this is not a panacea for human intervention, and no approved technologies have been listed yet. However, tracking technologies have emerged as valuable elements in this process, which can track the location and movement patterns of patients in real-time. This can help detect alarming wandering patterns, detect wandering out of safe zones, and detect risky movements such as falls, pacing, and hits. However, the deployment of such technologies is likely to raise substantial questions of law and ethics, including the violation of privacy and liberty for the affected persons. This requires cautious weighing and deployment of these technologies where the needs of the individual are at the core.

Conclusion

Wandering is a frequent behavior in dementia patients. It poses substantial risks to the health, safety, and well-being of the patients, besides increasing emotional stress and care burdens on the caregivers. Effective management strategies can maximize the benefits of freedom and liberty of the patients in interacting with their surroundings while keeping them safe and reducing the risks of wandering. Caregivers should recognize that the wandering behavior is part of the impacts of the disease and not a deliberate action of the patients to sabotage their care and wellbeing. Comprehensive management strategies should respect the exact peculiarities of each patient, and evolve with their needs. In addition, non-pharmacological interventions should take precedence over pharmacological interventions and other forms of restrictions unless absolutely necessary. Professional advice is useful in such scenarios.

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Cherie Voise

Cherie Voise

Cherie Voise, inspired by personal experiences and driven by her role as an advocate, founded Voise Foundation to improve the lives of those with dementia. As the foundation's key content creator and blog author, she draws on her deep understanding of the disease, advocating for respect, dignity, and creative therapy avenues such as VST Music© and other programs. Cherie's heartfelt writings, fueled by empathy, resonate with readers, offering insight and stirring action. Become a part of this journey and together with Cherie, let's make a meaningful impact in the world of dementia care.