Dementia - How to Handle Wandering with Alzheimer Patients

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Sally Smith: Welcome to Age to Age. I'm Sally Smith. Let's talk. Today we have Rhonda Weichsel with us. And Rhonda is an occupational therapist and as such has dealt with many families who are dealing with Alzheimer's and Dementia issues. She also is in charge of the Alzheimer's Research and Clinical Programs here at MUSC in the Department of Psychiatry and Behavioral Sciences. Thank you so much for joining us today Rhonda.

We're looking forward to talking to and asking your advise about ' wandering' and patients with dementia. I understand wandering is very common and frequently a serious symptom of Alzheimer's and dementia because it can make it hard to people, loved one at home. It can be frustrating and sometimes can actually keep them from being in unassisted living home or nursing home. They won't take someone who wanders continually. Why has wandering happens so frequently in these patients?

Rhonda Weichsel: Many times the patient is agitated and they're looking for a focus or looking for a loved one or they believe that something is missing and are trying to find it. Many times individuals wander because they are looking for someone. They're looking for maybe their child. They're looking for their loved one and they start to wander. Or they're merely going to work. They believe that they're going to work. And they need to get on with their day.

Sally Smith: Someone brings sense like it's positive and that they're happily going to wander. But some wandering sense the agitated can sense upsetting and would be upsetting for people around. Because I understand it's not necessarily something that's brief. Sometimes these patients are wandering repeatedly during the same sort of thing for several hours which can be stressful for them and stressful for a caregiver.

Are there strategies when they have this agitated looking for somebody that obviously may not be there in their life anymore? How does a caregiver divert them from this agitation or is it just something that they're going to do regardless?

Rhonda Weichsel: Wandering is not limited just to walking. It may also be driving a car. They may be wandering and not knowing where they are going but they do have a purpose. So when they're agitated and they're wandering whether it's ambulating or whether it's driving a car.

Approaching them and asking them where they want to go and what is their purpose and keeping a very low tone. Not agitating them purposely or confronting them or being condescending. But asking them how can you help them find what they're looking for.

If they're wandering, you'd want to address their needs. Are they thirsty? Do they need the toilet? Do they need to change their clothes? Are they too hot? Are they looking for something? Are they hungry? So there may be many reasons why they will start wandering or they may just be the type of individual that wants constant attention. There may be fear. There may be some sort of protection involved. They don't want to let go of their caregiver. They want to follow them around the house a couple of steps behind them.

Sally Smith: That shows the complication of how many different ways that could present and how hard it could be. I like your approach of the calm and then how they can help you and non-threatening. Do patients tend to wander more when they're in strange and new surroundings.

Rhonda Weichsel: Yes, absolutely. If they're not comfortable with their immediate environment. They're looking for the kitchen. They may be looking for their loved one or a comfortable area or someone who is familiar to them. Anytime you get them out of their routine, it is distressing to them.

Sally Smith: Do they panic? Is that what you're trying to avoid with the calm approach. You're trying to stop it before they escalate into a panic, fear, real fear situation?

Rhonda Weichsel: It is very disconcerting when they are disoriented and they're looking for that someone or for that something. And yes, you do want to take an approach of comforting and reassuring and affirming that they are in a safe place. And that their loved one is only temporarily gone for a moment. They've gone to the car or they've gone to work. So you just want to put them in a very safe emotional place.

Sally Smith: I knew of a man one time, his wife had early dementia. And she would get very agitated and want to go home. And he would say, "Okay, let's get in the car." And they would get in the car and they'd drive around two or three blocks. And then come home she would be perfectly calm. So I guess everybody has to find their unique way of wandering.

Are the patients open to substitute repetitive motions like could you say, " Well we can't go wandering out in the street today but we can sweep this kitchen." Or we can stacks this books. Or will they switch off to another or it is just every case is different.

Rhonda Weichsel: Actually that's a really good question because re-direct is what you're doing. Often times people will say, "I want to go home. I want to go home. I want to go home. When are we going home?" And what you say to your loved one is, "Before we go home, let's eat dinner. Let's go wash the dishes." Or since she definitely want to go home, "That's fine mom, let's get in the car and go home." And you ride around the block and you divert their attention.

Sally Smith: If this sort of constant motion and wandering goes on and you're may be in an area that could be quite dangerous. If they got it, obviously you've got to deal with locks. That sort of thing, double-bolt locks. And I think you mention this in an earlier interview that we had about importance keeping the outside doors open to you but locked for everybody else. Is this an issue, you just hang a key nearby where everybody knows where it is except for one person that shouldn't get out?

Rhonda Weichsel: That's right. Actually, you want to address several issues. You want to let your law enforcement know that you have an individual in the home that has Alzheimer's or some sort of memory loss. So in case there is a fire, in case there is a problem, they will be a first responder. And they'll be able to help you.

Yes, you do want to put a key in an appropriate place where everyone knows where it is except for the person with memory loss. In case they're wanting to get out and you don't want them to leave. For example, in the middle of the night. Some people actually have alarms on their doors when it opens and they'll know when the person's trying to get out. But you also want to let your neighbor's know that a person may be wandering. And if they see that person to bring them on home.

The Alzheimer's Association has a identifier where it's a separate option where you can get ID bracelets. And they can bring the person home. It's available 24 hour a day, seven days a week. And it's an option where you wear an ID bracelet, your loved one wears an ID bracelet and they're called if they're ever missing.

Sally Smith: That's so cool because if you think of an older person wandering, say you're someone who doesn't know that's an older person wandering and that he might have issues with his clear thinking. It could be scary.

Rhonda Weichsel: We just need to use our good manners. "May I help you? Can I help you? Are you lost? May I help you find your loved one?" So using your good manners even out in the public are a great thing.

Sally Smith: Is the reason that the wanderers are not accepted in the assisted living homes, is this just because they wander in on the other people and disrupt?

Rhonda Weichsel: That often does happen, yes. Many times in the assisted living in nursing homes, the doors are not locked. And often times people feel intruded when a wanderer enters their home or enters their space, if you will. And so many times the doors are not locked and they have wanderers. But there are locked units for Alzheimer's patients where they can roam freely but they're in a secure area.

Sally Smith: Well that's fantastic. I must say that the idea of someone who wanders quite a bit, especially when you're the caregiver in the home, I can see how it could be relatively stressful. Rhonda, thank you so much for talking with us about 'wandering' and patients with dementia and Alzheimer's. I thank you for coming and doing that for us.

I also want to thank my producer Betsy Reeves, web administrator Sujit Kara. Thank you to all of our listeners too for joining us today. We welcome your suggestions and invite your comments on our website. This is Sally Smith, Age to Age, saying goodbye and wishing you courage and joy on your journey. We are all connected.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or you'd like to schedule an appointment with one of our physicians, please call MUSC Health Connection at 1-843-792-1414.

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