Possible causes physiological or medical causes a direct result of physical changes in brain b inability to identify or express hunger c reaction to sedatives…

Try: Possible causes physiological or medical causes a direct result of physical changes in brain b inability to identify or express hunger c reaction to sedatives tranquilizers or the interaction of medications d physical discomfort due to pain infection constipation bruises e seizures resulting in aimless confusing wandering f need to use bathroom g desire to exercise h dehydration contributing to confusion wandering i stress environmental causes j temperature uncomfortable too hot or too cold k can’t make sense of environment l sensory overload too many people or activities excessive noise m sensory deprivation too quiet boredom n poor lighting resulting in shadows which are misinterpreted or frightening o feels closed in trapped p friend or family member out of sight q desire to leave triggered by seeing outdoor clothing such as coat hats boots etc r acting out once regular routine such as leaving for workplace s lost sometimes people with dementia suddenly begin losing their way to familiar places and become lost t inability to recognize new unfamiliar surroundings perhaps attending new day care program u feels tension in the environment other causes v task too difficult w perceives activity as too childlike x feels useless helpless while watching others do task y inability to follow through on task z bored with activity or lack of activity aa clothing too tight or uncomfortable bb caregiver’s anger tension impatience sensed cc touching by caregiver frightening or misinterpreted dd caregiver speaking too quickly ee directions from caregiver not understood ff searching for home or people from the past nightime wandering gg inability to separate dreams from reality hh inactivity; too much sleep during the day ii adverse reactions to tranquilizers jj inability to differentiate day and night kk disorientation to time – upon awakening the older adult thinks it is time to get up coping strategies 1 have a thorough medical evaluation particularly if wandering begins suddenly 2 consider possible physical causes such as illness fever hunger pain swelling etc 3 allow person to wander if environment is safe and secure 4 place familiar objects furniture and pictures in surroundings 5 help direct person with clearly labeled rooms for example door decorations or name plaques may be useful for finding bedroom; a picture of a toilet or a brightly colored door may help person locate the bathroom 6 decrease noise levels and number of people interacting with wanderer at one time 7 go for a walk around neighborhood in a mall around home walking or other exercise often reduces agitation that leads to wandering and also helps person to sleep better 8 remove items that may trigger desire to go out shoes coat purse coat rack etc 9 take a drive in the car make sure the older adult is safely buckled in and doors are locked never leave a person with dementia unattended in an automobile the person may become frightened about being alone could wander away release emergency brake or fiddle with gear shifts 10 distract with conversation food drink or activity 11 try to involve the older adult in household activities such as folding laundry washing dishes which will help him her feel useful 12 limit activities to 20-30 minutes or less depending on level of impairment 13 consider past skills and interests when presenting activities is it possible to adapt activity to encourage participation is it possible for the wanderer to do one step of the activity 14 make sure the older adult isn’t wandering because he she needs to use the bathroom look for signals such as fidgeting with clothes at night be sure the bathroom or a commode is easily accessible 15 improve lighting throughout environment especially at night older adults need about three times as much light to see properly as younger people 16 try plastic a large digital clock by the bed to orient the older adult to time 17 try these communication techniques with wanders a reassure the older adult frequently about where he she is and why b speak in calm normal tone of voice c try written reassurance for mildly impaired person d try not to confront or argue with the older adult e limit number of people to redirect wanderer if more than one person is needed for safety second person can remain out of sight or in background behind other caregiver f increase the wanderer’s trust by humoring and cajoling g allow the person to verbalize feelings without arguing h alleviate fears "your family knows you are here " "your glasses are right here " i approach wanderer in a casual non-threatening manner it is best to approach wanderer from the front slowly and calmly fall into step beside person and walk a short distance with the person before gently guiding him her back to activity event or location j giver wanderer verbal identification or person place and time large numeral clocks may help orient to time keeping the wanderer safe 1 place night lights throughout the house 2 try locks on doors that are out of sight or reach install lslide bolts on either top or bottom of outside door 3 use dead bolt locks models are available that require a key for exit or entrance it is important to think about exiting in an emergency if key locks are being considered 4 try child proof door knob covers that prevent potential wanderer from turning door knob covers are available at toy stores or medical supply stores may be inadvisable for caregivers who have arthritic hands 5 place warning bells above door bells that jingle when door is opened will signal caregiver 6 try monitoring devices available in a wide price range which alert caregivers that exit door has been opened 7 order a ‘toddler monitor’ available through children’s stores and catalogs a small device attached to a person’s clothing will set off a beeper when person goes outside of a 25-50 foot range 8 make house accident proof keep medications toxic substances such as cleaning supplies sharp objects alcohol and matches locked in cupboards or closets 9 put locks on outside gates fenced in back yards allow people to wander safely 10 use a safety gate across doors and at top or bottom of stairs this may help keep the wanderer in a limited area where he she can explore safely 11 consider using a bean bag chair for sitting and resting this may be helpful because they are comfortable yet difficult to get out of by themselves the wanderer may need assistance in sitting down and getting out of the chair 12 provide the wanderer with some type of identification medic-alert bracelet available at many pharmacies identification labels sewn in clothing emergency identification card in wallet purse or pocket the alzheimer’s association offers the ‘safe return’ a nationwide identification support program at 13 have a current picture of person available in case he she becomes lost a videotape of person may also helpful 14 alert neighbors and police that a memory impaired person lives at residence keep a list of important phone numbers e g neighbors police physician and family members 15 notify police about circumstances in caring for someone with dementia they might want to keep a picture of person on file and perhaps fingerprints 16 use brightly colored outdoor clothing such as jacket coat pants reflectors sewn onto sleeves or pant legs may be helpful to police involved in searching for the person 17 have an unwashed piece of clothing available for tracking dogs if person has been missing a long time this clothing may be helpful to police involved in the search 18 for caregivers at home there are some physical restraints that can be used to keep the person in a bed or chair as a last resort while it may be distressing for caregivers to restrain the person there may be no other way to prevent injury restraints may also be helpful for the caregiver to use while in the bathroom cooking etc a posey or vest restraints may be useful geriatric chairs keep the person in one place and have a tray for eating or doing activities it is important that the person does get exercise regularly 19 keep walker or cane if used in the same place at all times keeping the wanderer comfortable and healthy 1 weight weekly to make sure the person is not losing too much weight loss of five pounds in six weeks for example is of concern 2 provide comfortable clothing such as jogging suits and tennis shoes 3 it the person wanders a great deal try to get him her to rest for a half hour every few hours with feet raised to prevent swelling 4 give frequent drinks of water or juice to prevent dehydration the person with dementia will often forget to drink or not recognize thirst dehydration can be dangerous and may increase confusion 5 check feet often for swelling or blisters elevate feet when swelling occurs in long-term care setting 1 provide opportunities for exercise particularly when person are waiting for a meal or activity exercise might also include signing rhythmic movements dancing etc 2 with help from families develop a social medical history that includes information on the person’s style or coping with change and stress patterns of physical exercise and lifetime habits both at work and at home this information may be helpful in determining whether the wandering is related to previous lifestyles 3 develop areas indoors and outdoors where people can explore and wander independently 4 reduce amount of noise and confusion in the environment for example change of shifts loud speakers noises from housekeeping activity delivery of food or supplies are all potentially stressful situations 5 use physical restraints such as belts geriatric wheelchairs half doors for only brief periods of time and only as a last resort often times restraints add to the amount of stress and tension the person may be experiencing 6 reinforce where bathrooms and other public areas are by having rooms clearly labeled painted bright colors or marked with lights or awnings 7 try a yellow strip of tape across doors to prevent wanderers from entering the strip is easy to get through in case of an emergency allows patients to keep their doors open to see and hear what is happening inside or outside their room 8 have a plan of action in place in case someone wanders away from facility 9 camouflage doors by painting exit doors same colors as walls 10 cover doors with curtains or movable screens 11 a large ‘no ‘ sign on doors may discourage wanderer from entering exiting 12 place full length mirrors on exit doors some people will turn around when they see the image not recognizing themselves 13 be aware than after a move into an institutional setting it is not uncommon for a person to become disoriented when awakening in the middle of the night often patients are searching for a familiar person place or possession reassure with a calm voice listen to what feeling is being expressed distracting with food drink or activity may be helpful walking with person to the bathroom may serve as a distraction as well as promote sleep other considerations 1 a written diary or log may be helpful to understand what leads to wandering write down your observations about wandering for several days is the person trying to find a room what was going on before wandering started what time of day is it consider how medications mealtime weather bath time other people relate to wandering 2 wandering may be due to the person searching for a part of life lost to the disease or for a person place or object from the past reminiscing about things from the past may be comforting photo albums travel books etc may be helpful ways to reminisce 3 for some people with dementia wandering is a coping mechanism to relieve stress and tension try to stop the wandering may increase agitation and cause anger and frustration 4 anticipating an event such as a visit to or from relatives may contribute to wandering consider if person should be advised of plans ahead of time and if so what amount of time is necessary without causing anxiety or restlessness 5 wandering may occur when a change of location is anticipated in event of relocation slowing introduce person to idea visit new location several times prior to move to help orient person to new surroundings involve person in actual move if possible when in new environment such as day care hospital or long term care setting stay with person to reassure him her about new surroundings 6 medications may be helpful in controlling agitation that leads to wandering again chemical restraint should be used only as a last resort as these medications do have side effects also it is important to know that for some people these medications may increase restlessness 7 a person who wanders at the same time every day may be returning to a former schedule or routine for example a person may be trying to get back to work after lunch references mace n & rabins p 1999 the 36-hour day baltimore the johns hopkins university press robinson a spencer b & white l 1992 understanding difficult behaviors ypsilanti mi eastern michigan university

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Categories: Cognitive Intellectual, Emotional Psychological, Medical Physical

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*This information is listed as a Fact Sheet and is not explicitly medically licensed

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