Wandering can be a sign of dementia and can happen when someone no longer recognizes their surroundings. The Alzheimer’s Association reports that 6 in 10 people living with dementia will wander at one point.1
The many concerns about wandering include that it can:
- Make a person with dementia even more confused and disoriented
- Lead to injury from traffic, uneven terrain, extreme weather, or other hazards
- Significantly increase caregiver stress
Wandering safety for caregivers can involve prevention like locks, routines, and supervision. There are several ways to help reduce wandering, from identifying triggers and creating a safer environment to establishing routines and using tools such as medical alert systems. This guide includes tips and resources to help reduce the risk.
What is wandering in older adults?
Wandering is not the same as getting lost. Wandering is moving around without a clear destination, often away from a safe or familiar place. It can be common among those with dementia or cognitive impairment. These conditions can affect judgment and the ability to think or make decisions.2 Getting lost is only one of the possible negative outcomes.
Wandering can also cause frustration, agitation, and anxiety.1 A person without cognitive decline may be better able to retrace their steps, use GPS, or call for help after getting lost. A person with dementia or cognitive impairment may not be able to use these tools.
If you're a caregiver, you might wonder when to involve emergency services. When someone not experiencing cognitive decline is lost, the impulse might be to wait up to 24 hours before filing a missing person’s report. When someone with memory loss or dementia wanders, the Alzheimer’s Association recommends calling emergency services after a 15-minute search.1
Why wandering can be dangerous
Wandering can be dangerous for multiple reasons. Unfamiliar surroundings may make agitation, confusion, or anxiety worse. The places someone wanders to could also be dangerous. This is especially true if roadways or natural features (such as hiking paths, bike paths, woods, or water) are involved.
Even without an immediate danger, wandering for a long time can affect a person’s health. The longer someone wanders, the more likely they are to become dehydrated and more disoriented. Dehydration can cause confusion, cognitive dysfunction, and delirium.3 People with Alzheimer’s and other types of dementia are already prone to confusion.
Common causes of wandering behavior
There are many reasons someone might wander. Some common conditions and causes include:
- Alzheimer's disease and dementia—Alzheimer’s and dementia cause the loss of the ability to recognize familiar places.1 A person may keep walking while looking for something familiar. For a person with dementia, familiar surroundings may no longer feel recognizable—even in places they see regularly.
The “familiar” places lost to dementia aren't just the shopping center or park someone has visited for 15 years. Sometimes a familiar place might be the bathroom or kitchen of a home they live in. - Cognitive impairment and memory loss—Cognitive impairment is defined as a hampered ability to learn, remember, use judgment, or make decisions.2 If someone can’t remember where they are, they may walk around with the goal of heading somewhere they do recognize. Memory loss and cognitive impairment can worsen confusion. This can affect judgment and lead the person farther astray.
- Confusion and disorientation—Disorientation may be triggered if someone with dementia is left unsupervised. Confusion and disorientation may cause wandering in search of something familiar. When recognizable surroundings don’t appear, confusion can deepen, and the wandering continues.
- Unmet physical needs—Hunger, pain, or the impulse to use the bathroom may cause someone to wander. Someone with Alzheimer’s or dementia might get up to go to the bathroom or get a snack. Then find they don’t recognize their surroundings.
- Changes in medication—Medication changes can affect how a person with dementia responds to their surroundings. This can be a particular risk with these medications:4
- Benzodiazepines (used to treat anxiety, seizures, and sleep problems)
- Polypharmacy (taking multiple medications regularly)
- Antipsychotics
- Opiates (often prescribed for pain management)
How caregivers can assess wandering risk
Signs that a person may be at risk for wandering aren’t always obvious. They can be subtle, such as unsupervised drives or walks going longer than usual, or returning from the store without the items on their list. Increased restlessness might also be an early indicator of wandering.
Here are some other signs you can look out for to assess wandering risk:1
- Frequent talk of completing tasks for a job they no longer hold
- Questions about family members who have passed
- Increased nerves in crowded places
- Forgetfulness regarding familiar places
- Difficulty locating bathrooms and bedrooms in the home they live in
- Restless or repetitive movements
When to discuss concerns with a health care provider
Occasional forgetfulness can happen at any age. But frequent confusion or other changes in thinking may be worth discussing with a doctor. Discuss dementia concerns with your health care provider as soon as you notice them. Early dementia detection means that the person in your care can participate in crafting their own care plans.
What to do if a person in your care goes missing
When someone in your care goes missing, start the search as soon as possible. The Alzheimer’s Association says that many people who wander are found within 1.5 miles of their last known location.1 Getting help with the search can be useful. If you can’t find the person in your care within 15 minutes, call 9-1-1.
If you’re worried someone may wander, there are steps you can take ahead of time. Consider keeping an updated photo of them on your phone to show the authorities. You should also scope out their neighborhood for hazard areas (pipes, woods, tunnels) so you can begin the search there. If they’ve wandered before, search the areas they were found previously.
“Time matters tremendously in emergencies," said Tina Sadarangani, ANP-C, GNP-BC, PhD, RN, a board-certified geriatric nurse practitioner and creator of The Enlightened Caregiver in New York. "Quick access to help can mean the difference between a minor injury and a life-altering one, or between recovery and long-term disability.”
Resources for caregivers concerned about wandering
- Sign up for a wandering response service: Look to organizations like Wandering Support or Project Lifesaver. These programs may help locate people who wander and help them return safely. If you can't find a chapter in your city, you can even start one.
- Call dementia helplines: The Alzheimer’s Association’s helpline is 24/7. Reach them at 800-272-3900.
- Visit the site for safety resources: Head to www.alz.org/safety for guides on how to handle wandering.
- Invest in a medical alert system: A GPS-enabled medical alert system is another option for helping locate a person who wanders. Many of the best medical alert systems these days are equipped with GPS.
Technology and tools that may help improve safety
When it comes to wandering, GPS can be a useful tool for managing the risk of wandering. GPS trackers can help you find someone with dementia who wanders. While you could use an AirTag to help track the person in your care, there are better solutions: Medical alert systems.
GPS-enabled medical alert systems can track the location of the person wearing them. They can also be a tool to call for aid. Medical alert systems have help buttons a person can press to contact a monitoring center or emergency services.
Medical alert system brands like Medical Guardian and LifeStation have multiple GPS-compatible wearables. There are also stylish and discreet options, such as medical-alert smartwatches.
Consider a medical alert system with a caregiver app. This can allow you to help if the person in your care won’t think to press the help button when they get lost. That way, you can call emergency services on that person’s behalf. Medical alert systems like LifeFone and Lively have caregiver apps.
Frequently asked questions
Is wandering always a sign of dementia?
Wandering is not always a sign of dementia, but people with dementia and Alzheimer’s are the most at risk for wandering.1
When should I be concerned about wandering behavior?
You should be concerned about wandering behavior if it becomes a habit. Look for signs like repeatedly coming back late from walks or errands, or struggling to find bathrooms and bedrooms in familiar areas. These may signal it's time to put precautions in place.
When should I call emergency services for a missing wandering adult?
The Alzheimer’s Association recommends starting the search immediately. After about 15 minutes without finding them, call 9-1-1.1 There are wandering response services and helplines, and you can mobilize your community.
What are wandering triggers?
A change in medication can trigger wandering, as can the time of day (usually the late afternoon or early evening). Busy or overstimulating places can also be triggers for wandering.1
Sources
1. Alzheimer’s Association. Wandering. Found on the internet at https://www.alz.org/help-support/caregiving/stages-behaviors/wandering
2. National Cancer Institute. Cognitive Impairment. Found on the internet at https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cognitive-impairment
3. Faraco G., et al. Water Deprivation Induces Neurovascular Cognitive Dysfunction Through Vasopressin-Induced Oxidative Stress. Journal of Cerebral Bloodflow and Metabolism. February 2014. Found on the internet at https://pmc.ncbi.nlm.nih.gov/articles/PMC4013763/
4. Agrawal A., et al. Approach to Management of Wandering in Dementia: Ethical and Legal Issue. Indian Journal of Medicine. Sept. 21, 2021. Found on the internet at https://journals.sagepub.com/doi/10.1177/02537176211030979
