Try to figure out why the person is walking about or leaving.

Why is this behavior happening? Try putting yourself in their shoes…

Behaviors or actions that we observe in people living with dementia are in response to something going on around them that is difficult for them to handle. Since it is problematic for them to communicate feelings or needs verbally, people often react by yelling, withdrawing, hitting, sleeping, or leaving the area. There are a number of reasons why a person with dementia may walk about. Each of us are unique individuals and therefore experience the symptoms in dementia in many different ways, but there are common causes that may result in someone leaving the home or spending a lot of time moving about the home. You’ll need to rely on what you know about the person and their past and present habits to try to figure out a cause. It is helpful if you keep a journal for several days in a row to note when the walking about occurs and what is going on at home when it happens.

Here are some examples of what journal entries might look like:

Amy’s Journal

September 14 At 10 AM Jeff was pacing in the kitchen and then left through the side door into the garage when I was in the bathroom. I asked him what he was doing and he said, “looking for something.” When I asked him to come inside, he became angry. What might help? Jeff liked to fix things, he may be looking for his tools. He may be bored and need a simple project to work on.

Henry’s Journal

June 2 Marjorie was up three times last night to go to the bathroom and each time went down stairs to the kitchen instead of back to bed. What might help? I’ll check with the doctor because Marjorie may have a urinary tract infection. Once she is awake, she may think it is time to cook breakfast for the family. A large clock in the kitchen and a note telling her to go back to bed, that I will wake her when it is time to cook breakfast may help.

Here are some reasons for walking about that may shed some light on the situation:

• Pain.  The person may be in pain and not be able to express the pain.
• Attention.  If someone finds it difficult to concentrate, they may walk about as a way to focus their mind or get away from a distracting situation.
• Temperature.  The person may be too hot or too cold and not know what to do about it.
• Medication.  The person may be experiencing medication side-effects that cause agitation.
• Noise.  The room may be too noisy or overstimulating.
• Boredom.  If the person is bored, he or she may walk as something to do.
• Toilet.  The person may be searching for toilet and is not able to find it.
• Infection.  Frequent trips to the bathroom may be caused by a urinary tract infection, even if the person does not complain about one.
• Lost item.  The person may be searching for something that he or she believes is lost. This item may or may not exist.
• Hunger.  The person may be hungry and not realize that he or she needs to eat.
• Routine.  The habit of preparing a meal for others may result in many trips to the kitchen or the want to leave the house to go shopping.
• Memory.  The person may forget that their care partner told them that they were going out and would be right back and the set off in search of them.
• Exercise.  Walking about can be caused by a lack of exercise and a need to use up excess energy.
• Confusion.  The person may not recognize their own home and may want to go somewhere that is more familiar.
• Sleep distruption.  Restlessness or changing sleep patterns can lead to confusion between night and day. People who suffer from insomnia or wake early the early hours may become disoriented and think it is daytime and time to leave the house or go for a walk.
• Habits.  The person may be continuing a long-standing habit such as going to work, taking long walk with the dog, walking children to school, walking to the market, etc.
• Purpose.  Seeking a sense of fulfillment and purpose by doing something meaningful such as going to work, tending the yard, or participating in a hobby.

Put a plan into place to meet the person’s needs.

Many people simply walk about because they have a need (such as to be free of pain, to have exercise, or to eat) that is not being met. Once you have identified the cause or suspected cause of the behavior, you can try some solutions. You may have to try several different things before you find the right fit for the person, especially if it isn’t clear was is causing the actions. Don’t give up, people don’t come with an instruction manual and what works for one person, may not work for another. Try to stick with until you find a solution that works. Please do not try to keep the person seated all day in order to stop the walking about. This may cause anxiety, boredom, incontinence, poor circulation, constipation and overall weakness, thus increasing the risk for falls.

Take frequent walks together.

Accompanying the person on a daily walk or enlisting the help of family, friends or volunteers to walk in a safe location such as a park or sidewalk is a simple solution that usually works very well. Build this into the weekly routine. If you live in a cold climate, daily walks can be problematic. If that’s the case for you, look for indoor opportunities for regular exercise such as a local YMCA, school or other facilities with an indoor walking track, even a shopping mall that opens for morning walkers. There are many websites that have free exercise videos, if you can’t leave the home to exercise try seated yoga classes or programs designed for older adults that are offered online. Since walking about is often caused by excess energy, this is an easy solution to try.

Talk to your doctor.

Share your journal entries with your doctor and describe the walking about and any solutions you have tried in as much detail as possible. Ask the physician to help determine if the person is in pain, has a urinary tract infection, or is experiencing side effects of medications.

Schedule daily activities that the person enjoys.

Many people walk about out of boredom or because they are looking for something meaningful to do. If the person enjoys a certain type of hobby, try setting up a hobby table in a central location of the house where they can go and work on a project whenever they like. Involve the person in the household chores and meal preparation on a daily basis. Encourage socialization with friends in or out of the home and look for free programs offered through the local senior centers, park service, museum, library or county department on aging. The more the person engages in life, the less likely they will walk about as a result of boredom.

Reduced excess stimulation.

What looks like a bit of clutter on the kitchen counter to one person could be overwhelming to someone with dementia. Individuals living with dementia have difficulty making sense of what is going on in their environment and find it hard to process information when there is a lot of stimulation. As a result, a home with significant amounts of clutter can be overstimulating and create difficulties locating a desired item, focusing on an activity, or remembering the sequence of tasks. Try to keep the house neat and tidy. Organized frequently used items in labeled containers so they are easy to locate. Pay attention to when the walking about occurs. It is common for an increase in noise to cause the person to want to get up and leave the area. Activity or noise that used to be easily tolerated or enjoyed such as the TV, radio, grandchildren are running about, or the dogs playing may now be overstimulating and uncomfortable.

Put coats, boots, briefcases and other possible triggers away.

A cue is something in the environment that gives us information or tells us what to expect. A coat hanging near the door could serve as a cue to someone with dementia that he or she is going out of the house. A briefcase may remind someone about going to work. Look for clues in the person’s behavior that they might be responding to these cues or triggers and remove them from one’s line of sight.

Provide information about the time of day.

People with dementia often wake throughout the night and becomes confused about time. They may wake up in the middle of the night and get dressed. Having a large digital clock that shows AM and PM may help with the time confusion. Leaving a light on in the bathroom and the hallway may help reduce disorientation at night. Avoiding day time napping and spending time outdoors will also help encourage normal sleep patterns. You can read more about sleep disruption and dementia here.

Distract the person with something they like.

Threatening, yelling or becoming angry with the person isn’t going to help the situation. They are on a mission, they have a purpose and they think they are doing the right thing. Offering to join them, inviting them to enjoy a cup of coffee or bowl of ice cream with you, or asking them to help you fold the clothes, can all be simple interruptions that redirect the person to something positive. In addition, playing music the person enjoys will often provide a relaxing distraction that will curb unwanted walking about.

Make it easier to see and find things.

Well-lit areas can help people to see what is around them, find needed items, see others’ faces during conversations and participate in daily activities. Poor lighting in the home can result in falls, other types of accidents, confusion and the desire to get away or walk about in individuals living with dementia. Improving lighting in the home results in renewed interest in activities and meals, a better mood state, and increased mobility. There are very simple changes you can make to the home to help your loved one function more independently and avoid walking about caused by frustration. Click here to learn more.

Never leave a person with dementia in the home unattended with the doors locked. This could be very dangerous in the event of a fire, fall, or other accident.

Be prepared if the person does leave the home unattended.

There is no way that we can predict and be prepared for every single event that may happen. It is also not humane to keep someone inside all day long because of the fear they may walk away. As care partners, we need to support our loved ones with dementia in living the life they want to lead, while understand that it may involve some risk. The choices we make on a daily basis, all involve some degree of risk. We cannot stop someone from living just because we are afraid of what might happen. If they do leave, here are some tips to help locate the person safely and quickly.

Inform others.

Visit the neighbors, local fire department and nearby shops. Provide them with the name and a picture of your loved one, include your address and phone number. Explain that your loved one has dementia and is at risk for leaving the home and getting lost.

Provide identification.

Purchase an ID bracelet for you loved one with their name and address and important medical information. In some emergencies, the person with dementia may not be able communicate or may be unresponsive. A medical alert bracelet can inform medical personnel of the disease and who to contact for more information. Sew fabric name and address labels into coats and shirts as an additional form of identification.

Use sound alerts.

Low cost modifications such as attaching bells to door or adding an additional small lock out of sight at the top of the door can either alert the care partner that someone is leaving or prevent the person from leaving altogether. There are also security systems that beep or announce an alert such as “kitchen door open” when a door is ajar. Again, please do not restrict the person from going outside. Build time outdoors into the schedule every day, even if it is just a walk around the block or down to the mail box.

Create an identification kit.

An identification kit can help organize vital information about your loved one. If the person goes missing, you will have valuable information on hand to assist police. Include the person’s name, address, height, weight, diagnoses, medications, a recent photo, a list of assistive devices used such as hearing aids or glasses, and care partner contact information. If the person may leave in the family car, add the make, model, color, and license plate number of the care to the emergency information kit. Make a list of any triggers that cause the person to become anxious or overwhelmed and any strategies the police can use to diffuse a difficult situation.

Location Devices

Location devices are electronic tools that can be used to track a person’s movements or identify a person’s location. There are many that are available on the market and can be used on conjunction with a care partner’s cell phone, tablet, or computer. Locating devices can be an important part of the overall strategy to keep the person safe, while supporting their independence. Devices have different ranges and some have monthly fees associated with them because they are linked to services that will connect the person to an operator when he or she pushes a button on the device. Some devices allow you to create a geofence so that the device will trigger a response when the person leaves a pre-set area.

Other Devices

Other devices simply allow you to look at an online map and identify the person’s location. Some maps refresh every few seconds, minutes, or longer, so make sure you ask for all of the details.

Pros and Cons

Have a discussion about the pros and cons of locating devices with the person as soon as possible after a diagnosis in order to plan effectively for the future. Some people may think a locating device increases personal freedom and safety, while others may feel it is an invasion of privacy. This can be a difficult decision, so consider having a discussion with the person living with dementia as early as you can. Research the options together.

Here are items for consideration if you are thinking about using a locating device:

• When is a good time to start using a locating device?
• During their life, what value has the person living with dementia placed on their freedom and independence versus their safety security?
• Is the device comfortable to wear?
• What does it look and feel and like?
• Is two-way communication needed with the person who is lost?
• How much does the device cost? Are there monthly fees, service calls, or replacement batteries?
• How often does the battery need to be recharged or replaced?
• Does the technology require other equipment such as a computer, internet or cell phone?
• Can the device be easily removed, lost or forgotten by the person?
• Will this device work if the person is in water, out of a specific range, or out of the building?
• Who needs to locate/track the person (e.g. agency, call center, police, caregiver)?