UK Wandering Network (UKWN)
Frequently Asked Questions
What is wandering – a person with dementia’s perspective
Are there different types of wandering?
Are there benefits of wandering?
How do we assess the risk associated with wandering?
Are there any strategies that help with the management of wandering?
Can assistive technologies help?
Should we encourage people with dementia who are prone to wandering to sit still?
Should I restrain the person who is trying to wander and is perceived as being unsafe?
What are alternatives to restraint?
What is wandering – a person with dementia’s perspective?
As yet, there is no published research that informs us what persons with dementia think and feel about wandering. However, we do know that persons with dementia want freedom to move around and to explore their environments (both indoors and out of doors). We also know that persons with dementia have concerns about having their freedom to move around reduced by others. Some persons are willing to take risks connected with wandering, whilst others with dementia want to be able to wander but in a safe place.
See Dewing J (2006) Wandering into the future: reconceptualising wandering? International Journal of Older Peoples Nursing 1 (4) 239-249 for more on what persons with dementia have to say about wandering. A pre-proof copy of this paper is available on this web site click here
Yes, the research literature suggests there are three main types or patterns of wandering; lapping, pacing and random. Lapping is a circuit, pacing is going back and forth and random seems to have no obvious pattern. It is important to assess which pattern of wandering you can see to identify the appropriate strategies. Some strategies only work, or work better with a certain type of wandering. Some people might have more than one pattern and the pattern can change over time as the dementia advances
Photo by Jane Stokes
This is a tough one to be definitive on. We know there are physiological changes in the brain which may contribute to wandering but there are lots of other reasons that should be considered
- Enjoyment of walking
- Pain and or physical discomfort/ need
- Wanting to leave the environment for several reasons
- Searching for security or familiarity – wanting to get home
- Boredom
- Orientation - the person uses wandering to work out where they are
Photo by Jane Stokes
Are there benefits of wandering?
There can be lots of benefits for the person who wanders and /or carers and staff. They are not always immediately obvious and may be conflicting.
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Person who wanders
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Carers |
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Physiological benefits of exercise eg better muscle tone, prevention of pressure ulcers & constipation, stimulating appetite Relieving boredom Improves mood Feeling of empowerment and better self-esteem Coping with stress May improve sleep |
Maintaining heath and mobility for person who wanders Respite if it occurs in a safe environment May decrease night time disturbances Can reduce the need for confrontation as person is occupied Provides an opportunity to engage in one to one conversation or a shared activity |
It is important to note that wandering is not always a pleasurable experience for the person with dementia especially where the person feels lost, alone and fearful. There is the risk that the person who wanders a lot can become dehydrated, more stressed, exhausted and yet find it difficult to stop wandering.
How do we assess the risk associated with wandering?
There are no recognised tools specifically for assessing risk associated with wandering. Often risk assessment for wandering is part of an overall risk assessment.
It is important that wandering itself is first assessed. If the person is not currently wandering then a screening assessment can be carried out to identify the likelihood of wandering or not. If wandering is present the following should be included in any assessment:
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Any trigger factors such as noise, busy places, mealtimes, evening time.
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Type or pattern of wandering
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Times of wandering
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Frequency
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Duration
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Locations or places visited
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What person does when they wander
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Any limitations or obstacles that stop the wandering
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Ease of diversion/distraction
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Successful strategies
Photo by Jane Stokes
Are there any strategies that help with the management of wandering in persons with dementia?
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A research project recently reported that there is no robust evidence to recommend any specific non-drug interventions to reduce wandering in dementia (Robinson et al 2006). There was some evidence, although of poor quality, for the effectiveness of exercise and providing multi-sensory environments.
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Random wandering is the most common pattern and is known to be influenced by noise, activity and other environmental stimuli and is often amenable to distraction and diversion. The more tailored made the distraction, the more likely it is to get the persons interest.
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Lapping type of wandering is known to occur more often early in day or after periods of rest. As lapping is associated with orientation and searching, interventions aimed at accompanying the person and helping them with their orientation and searching can be helpful.
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Pacing is the least common type of wandering. Because it is linked to anxiety, fear or anger, it is often the least responsive to distraction or diversions. With this type of wandering early rather than late or crisis intervention is better as the person is more likely to be successful.
Photo by Jane Stokes
Can assistive technologies help?
It is important to remember that assistive technologies do not help or work for everyone. Technology is available in many forms, including wander alarms. These alarms may dissuade people from going outside at what is deemed by others to be an inappropriate time. If the door is opened, an alarm activates a personal voice recorded message to be played. The message is usually a familiar voice that alerts the person that this is not the best time to venture outside.
Another type of alarm (without a message), is activated by the person leaving. This alarm is can be linked into a centralised point or to some ones phone. A designated person is notified and can decide what to do. Alarms do not prevent the person from leaving and may only be successful in deterring a person from leaving some of the time or for a limited span of time.
Other technology can be used to turn lights on and off , for example at night to guide a person to a particular place such as a bathroom rather than going downstairs. Sensor pads and mats can also be used to help others know when the person is on the move.
You can find out more about assistive technologies through the local Alzheimer’s society. Try to find who in your organisation or another local organisation has skills in the use and evaluation of assistive technologies.
Photo by Jane Stokes
Should we encourage people with dementia who are prone to wandering to sit still?
First ask yourself why is it necessary for them to sit still, unless there is a physical or medical problem that is more important than the person’s need to be on the move?
Just because someone has dementia doesn’t mean they need to or should be sitting down for most of the day. Quite often the person with dementia feels better for being on the go. Walking around and wandering can be beneficial for the person in several ways.
If you tell a person to sit down the chances are they will try to stand up. Avoid commands, particularly negative commands such as ‘don’t stand up’ (the person may just hear or understand ‘stand up’). This sort of communication is not respectful or helpful. What you could try is
- enquire how they are or if you can help them with anything
- to wander or walk with them for short time then suggest a rest
- suggest and introduce alternative activities
Photo by Jane Stokes
Should I restrain the person who is trying to wander and is perceived as being unsafe?
No probably not.
First of all what do you mean by restraint? Do you mean physically restraining someone, using furniture or other objects (such as sitting the person in a wheelchair, tipping chair or beanbag) to deter the person from moving around or by using medication. Research has shown that people who are restrained can become more agitated and can sustain injury. Injury through restraint can be more serious than supporting the person to move about. Using sedating medication can make the situation worse as it can increase the risk of harm and usually means the person often requires more personal care.
Restraint should only be used in exceptional circumstances and for short periods of time only and be introduced by a team decision. If the multi-disciplinary team does decide that someone needs to be physically restrained, there are steps that must be followed both in regard to local or Trust policy and professional standards.
Photo by Jane Stokes
What are alternatives to restraint?
It is important to know more about the type of wandering and its purpose. Wandering can often be accommodated if the team works out how to help support the person wandering or walk about safely. Asking family or friends to help accompany the person can also work well.
See the previous question on management of wandering in persons with dementia
Photo by Jane Stokes
What is a diversionary tactic?
When thinking of diversionary tactics that are appropriate to the individual, it is important to know what makes that person tick. Based on that knowledge, it is the possible to introduce activities that would interest and possibility reduce the need to wander.
You could try:
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regular structured walking out of doors in the morning
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be prepared to stop and talk to the person for a short time
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sit sown and have a cup of tea and a chat
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observe patterns in case they are looking for the toilet or are hungry/thirsty
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observe for possible causes of discomfort or distress
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alter the environment by placing pictures at eye level and have interesting objects close by to engage the senses.
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engage in listening to music
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using memory boxes or photo albums
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ask appropriate questions such as Can I help you? Can I come with you? Where are you going? What are you looking for? Who are you looking for?
Be aware that disorientation to time and place could be an issue for someone is wandering.
Photo by Jane Stokes