My father does not suffer from traditional wandering but I have watched him pushing himself along in his wheelchair with no apparent destination or reason. Wandering may appear aimless but I think most of the time there is a reason for it, even if the person with AD cannot express the reason.

You can register the person who wanders with the Alzheimer Wandering Registry through your local Alzheimer Society.

Reasons for Wandering

1. The person is looking for a lost item.

2. The person is looking for familiar surroundings.

3. The person may be agitated due to medication, too much noise, stimulation or confusion.

4. The person may suffer from sensory impairment..may be disoriented and may be hallucinating.

5. The person may be suffering from stress.

What Caregivers Can Do

1. Try to determine the type of wandering -- aimless or goal-directed.

2. If there is a goal, what is it? The need for food, drink, washroom, activity due to boredom or restlessness.

3. Try to provide an outlet -- a walk, an activity, memory book.

4. Minimize stress -- reduce noise, confusion, light.

5. If there are delusions present, try to talk the person through them.

6. If necessary, lock doors or place chairs in front of them; use child safety gates at top of stairs.

7. Leave lights on at night.

8. Make sure person carries ID/wears ID bracelet; register person with Alzheimer Wandering Registry.

1. Call police.

2. Notify Alzheimer Wandering Registry.

Comments on Wandering

• When my mom was in the hospital recently and was interested in getting out of bed without assistance, I firmly rejected the idea of a restraint. Instead, I asked for a "bed alarm" -- a flat strip about four to six inches wide that laid under the sheets the width of the bed. It was connected to an audible alarm that rang into the nurse's station. Strangely, the nurse on duty that night had never heard of one. When she asked around, she got it and figured it out. There is no reason that I can think of to physically restrain someone who is not violent. Wanderers are you and me, just with worse luck.

• Mother's wandering at night only lasted a short while but gave me heart failure. I got alarms for the doors and a motion alarm for the hallway outside her bedroom. It alerted me on several occasions when she got up and headed for the living area. It was easy to redirect her to her bathroom and then get her back in bed. The alarms were easy to install and came from Radio Shack. Best investment I made during mother's illness. I still have the alarms on the doors. Since I live by myself, it is nice to be able to hear the door being opened. It just goes ding dong but that is enough.

• In evaluating suggestions on erecting barriers to dementia patients wandering, I suggest that considerations include the patient's ready access to his/her personal hygiene facility, social isolation, "safety" in a confined space, and "emergency evacuation" of the residence in the event of fire, flood, and other unexpected hazards. It might be worthwhile to check out restraint plans for wanderers with the safety specialist at the Fire Department that has primary responsibility for the area where your residence is located.

• The problem: A long-term care facility is dealing with wandering by dementia residents into others' rooms, particularly at night. (The facility) is considering putting on more doors and/or placing sensor bracelets on residents to detect when they leave their rooms and start to wander into other residents' rooms.

Other Comments About Wandering By Subscribers to the Mailing List

• Two approaches that intrigue me but we have not tried -- the concept of "dutch doors," the bottom closed and locked in a way the wanderer cannot easily access while the top is open. If there were some way to get around the fire door thing maybe a second door on the inside of the first door.

• The second is this open "netting," similar to that on the back of pick-up trucks to keep the load on the truck. It is frequently a bright color, is easy to see through, and might be mounted on the inside of a door with hooks -- could be a deterrent.

• You definitely have a problem that all facilities have when they have dementia residents. I worked for a facility where I had the opportunity to work with architects in designing a state of the art Alzheimer's/Dementia Unit. We built from scratch a unit we call the SCU (Special Care Unit). We have tried netting across the resident doors but that did not deter them.

• It has been my experience that many residents do wander throughout the night. It may be beneficial to keep a record on these residents such as the activity, rest periods, bladder and bowel habits that they have. Some residents who wander at night are in the need of finding something, many times this is a bathroom. Toileting the resident will assist in redirecting them back to bed.

• I am against any kind of medication that has to do with the wandering resident. A product that we found beneficial to dementia residents, both with agitation and with wandering, is the Spinoza Bear. It is a wonderful product. This bear is soft and cuddly, and capable of playing cassette tapes that provide a calming for a resident.

• Try putting bright yellow strips of crepe paper across the room doorway with tape to the door jamb. Works great and allows easy safety access.

• My father-in-law had ALS, Parkinson's and Alzheimer's. Parkinson's came first, then ALS, then Alzheimer's. When the dementia started, it was well after my father-in-law had difficulty ambulating and had fallen several times. One of those times he compressed one of his vertebra by over 60 per cent. Surgery was avoided but the fear of another fall was on my mind all the time.

• We were living in a home which had concrete slab floors and though the carpet padding was good, it was not good enough.

• Your facility may want to consider a high-impact, high-density rubber floor coat (it can have carpet over it or even linoleum/vinyl tile). It won't eliminate all injury but can help to reduce the worst impacts.

• Unfortunately, my father-in-law's dementia became so bad that we did resort to restraints at night only. The facility where he resided was not really prepared to monitor his night wanderings and after several falls/scares we decided it was best.

• During the day when there was more staff to monitor him, they set him up in a chair that came with an arm/desktop. Many times they left the arm off but the chair's design did make it extremely difficult for him to get out of it, essentially restraining him without actively having to show the restraints.

• Before he went to the nursing home he did reside with me and my husband for over three years. At night we very rarely ever restrained him with a jacket (only when I couldn't stay up that night -- my husband worked during the day). We used expandable baby gates, one above the other so he couldn't climb over them. We secured them with spring eyehooks at both ends. The spring eyehooks were difficult (actually impossible) for him to open, easy for us to open and close, and during the day we stored the gates and the only sign they ever were there was the eye screws in the door jamb.

  We tried to get the nursing facility to consider it for his room but they didn't want to mar the door jambs. Too bad since it would have made the use of the restraint jacket unnecessary.

• Here is a list of possible interventions, starting with light'n easy and ending with industrial-strength.

  1. Try a Walkman. I've seen miracles when earphones were placed on severely demented residents with pressured wandering, shouting, sundowning.

  2. Increase staff-to-resident ratio and provide a lot more personal accompaniment. Wanderers are generally bored and lonely.

  3. Provide radically interesting alternatives to wandering through your activities program.

  4. Try a program of phototherapy.

  5. Redesign the facility.

  6. On an individual basis, using skilled observation notes, nail down the time wandering starts, and set up a well-tailored behavioural plan to head it off at the pass.