Managing Wandering in Dementia Patients

Up to 7 out of 10 residents with dementia in nursing homes wander at least once, according to the Annals of Long-Term Care. Risk of injury is high, and negative consequences can be profound. Let’s take a closer look at what triggers wandering behavior and what interventions can help control it.

Why dementia patients wander

“People with dementia who wander are moving about in ways that may appear aimless but often have purpose,” according to Dr. Jane Tilly of the Administration on Aging. Conditions that may trigger wandering behavior include unmet needs, like hunger or thirst. Or wandering may signal someone simply seeking out human contact, she says. A patient may also wander in response to distress, pain, or a need to use the bathroom. “Although people who wander may gain social contact, exercise, and stimulation, they can also become lost or exhausted,” she explains.

Risk factors for wandering

Some of the risk factors for wandering include: an unfamiliar environment, recent change in medication, change in routine, being left alone, being spatially disoriented to familiar cues, and wanting to engage in a past practice, e.g., “I want to go home” (Annals of Long-Term Care).

In dementia, people may become more sensitive to the physical environment and have difficulty processing it. In the example of wandering because of a need to use the bathroom, part of the problem could be simply that a patient “cannot recall where the bathroom is,” according to Annals of Long-Term Care.

A person-centered approach

How does taking a person-centered approach to care help with wandering? Research cited by Tilly confirms that applying person-centered dementia care can reduce levels of agitation, feelings of boredom, and feelings of helplessness among patients. At the same time, in can increase staff satisfaction and sense of efficacy—a win-win.

Tilly lists these elements of an effective person-centered care approach:

• “Understand that the individual in people with dementia is increasingly hidden rather than lost.
• “Acknowledge the personhood of people with dementia in providing services.
• “Personalize the individual’s care and surroundings.
• “Involve the individual with dementia in decision-making.
• “Interpret behavior from the person’s viewpoint.
• “Ensure that the individual-caregiver relationship is as important as the care tasks.”

Interventions for wandering

While wandering is indeed common among dementia patients, these steps can help, according to Tilly:

• Pay attention to a patient’s behavioral patterns associated with wandering
• Observe possible triggers
• Address the triggers in a person-centered care plan
• Understand that a patient’s condition and behaviors can change; continue periodic assessments.

Manage the environment

Managing the environment can support patient comfort and safety. Here are some tips:

• Eliminate overstimulation, which can occur through noisy environments or clutter.
• Create safe, uncluttered pathways that have points of interest and places to rest.
• Use signage to provide cues, e.g., for bathrooms, bedrooms.
• Prevent boredom by offering person-centered, engaging activities (Tilly).

In an individualized approach, it is important for staff to tune in to behaviors such as pacing, signs of anxiety, or verbalizations such as “I need to go home” (Annals of Long-Term Care). An array of technologies, including electronic alert systems, can provide an additional safety net but do not replace person-centered care approaches.

Understanding your patient’s identity and respecting selfhood can go a long way in helping to prevent wandering. You can improve quality of life for patients and empower nursing home staff. If you are struggling to elevate levels of care for your patients with dementia, talk to us about designing clinical care protocols, reducing polypharmacy, and providing staff training. We are here to help.