How to Manage Wandering in Dementia Care

Wandering is a common challenge in dementia care. It may involve aimless pacing, repetitive walking, or purposeful movement that can lead to safety concerns, such as becoming lost or entering unsafe or inappropriate areas.

This article explores why people wander, when intervention is needed, and practical strategies to support people who wander safely.

Why People Wander

Wandering is a common behaviour in people living with Alzheimer's disease and other forms of dementia. As dementia progresses, many people develop a strong urge to move or walk. While wandering often appears aimless, it is frequently driven by an underlying need or purpose.

Purposeful wandering

Purposeful wandering occurs when a person is trying to achieve a goal that makes sense to them, even if it does not match their current circumstances. Common reasons include:

• Looking for a family member or friend
• Wanting to go home
• Believing they need to go to work
• Thinking they need to catch a bus or attend an appointment
• Worrying that children or loved ones need them
• Curiosity or wanting to explore

Aimless wandering

Aimless wandering has no obvious destination and is often related to physical, emotional, or environmental factors, including:

• Fear or anxiety
• A lifelong habit of walking
• Memory loss affecting orientation
• Changes to sleep-wake cycles
• Sundowning
• Restlessness or excess energy
• Medication changes or side effects
• Hunger, thirst, pain, boredom, or discomfort
• Noise, overcrowding, or other environmental stressors

Is Intervention Necessary?

Safe wandering

Not all wandering requires intervention. Walking can provide exercise, reduce anxiety, and promote wellbeing. However, supervision is still important because impaired judgement may place the person at risk.

Safe wandering generally requires:

• The person can walk safely and independently.
• Appropriate footwear.
• A secure environment designed for walking.
• Supervision by trained staff or caregivers.

Risky wandering

Intervention is recommended when wandering places the person or others at risk.

This may include people who:

• Are at high risk of falls.
• Wander until they become exhausted.
• Can access unsafe or restricted areas.
• Frequently enter other residents' personal spaces.
• Wander repetitively without awareness of their surroundings.

Wandering Out of Safe Areas

Boundary transgression (BT) occurs when a person wanders into restricted, unsafe, or unfamiliar areas. This can result in injury, becoming lost, or conflict with others.

Many care providers maintain identification kits for people who are at risk of wandering. These typically include a recent photograph, identifying information, and emergency contact details to assist if the person cannot be located. Wearable identification devices, such as bracelets or watches, may also be appropriate in some situations.

Managing Wandering Behavior

Most wandering incidents can be managed successfully through early intervention, good observation, and person-centred care. Rather than trying to stop the behaviour completely, the goal is to understand why the person is wandering and respond to the underlying need.

Identifying Triggers

One of the most effective ways to manage wandering is to identify what triggers the behaviour. Look for patterns in the person's routine, environment, and emotional state.

Step 1 - Observation

Ask yourself:

1. Is the person following or mirroring someone else's movements?
2. Do they appear anxious or distressed while pacing?
3. Are they attempting to leave the building?
4. What were they doing immediately before wandering?
5. Does the behaviour occur mainly at night?
6. Does the wandering appear purposeful or aimless?
7. Are they searching for a particular person or place?

Step 2 - Frequency and Timing

Consider:

1. How often does wandering occur?
2. How long do the episodes last?
3. Does it occur at a particular time of day?
4. Does it happen more often in a specific location?

Step 3 - Considering Underlying Factors

Consider whether:

1. The person has unmet needs such as hunger, thirst, pain, illness, or needing the toilet.
2. Previous routines or life roles may be influencing the behaviour.
3. A recent event, visitor, or perceived threat may have triggered wandering.
4. There has been a recent medication change.

Strategies to Reduce Wandering

• Encourage regular exercise and opportunities for movement throughout the day.
• Provide meaningful activities such as folding laundry, setting the table, gardening, or sorting household items.
• Create a safe, secure walking path where people can walk freely under appropriate supervision.
• Offer calming activities during periods of increased restlessness, particularly in the late afternoon or evening.
• Camouflage exit doors where appropriate to reduce visual cues that encourage leaving.
• Remove items that may trigger thoughts of going out, such as coats, handbags, umbrellas, or car keys, when appropriate.
• Assess the environment for factors that may increase agitation, including excessive noise, overcrowding, poor lighting, or uncomfortable temperatures.
• Clearly label bedrooms, bathrooms, and common areas to support orientation and independence.

We'd love to hear your feedback!
What strategies have you found to be most effective when supporting someone who wanders?