Understanding and Responding to Wandering in Aged Care
Published: 21 April 2021
Wandering is a potentially dangerous behaviour that causes carers and families to worry about their loved ones’ safety.
Knowing how to manage this behaviour and keep your clients safe from harm is crucial - as 60% of people with dementia will wander on at least one occasion, and some may do so repeatedly (Alzheimer's Association 2021).
What is Wandering?
Wandering, also known as exit-seeking behaviour, is when a client roams around or attempts to leave their home, their care facility or the company of other people (Dementia Support Australia 2018; Alzheimer’s Society 2018).
Wandering is typically associated with Alzheimer’s disease or other types of dementia, which cause people to have difficulty remembering where they are and how to find their way around (Dementia Support Australia 2018).
Other conditions that are associated with wandering behaviour include:
Autism spectrum disorder
Conditions that may lead to dementia
In a safe and controlled environment, wandering isn’t necessarily an issue (Mayo Clinic 2020). However, it may occur at any time of day or night and has the potential to be dangerous if the person leaves their place of residence and finds themselves in an unsafe situation. As dementia often causes problems with memory, orientation and recognising places and faces, a client who wanders may become lost and unable to find their way home. This can be greatly worrying for staff, carers and loved ones (Alzheimer’s Society 2018; Alzheimer's Association 2021).
Clients should always be afforded free movement and dignity of risk - that is, the right to make decisions and take risks. However, at the same time, providers must also appropriately manage risks and ensure clients understand the potential consequences of their choices (ACQSC 2019).
Providers have a duty of care towards their clients, i.e. the responsibility to that ensure clients do not sustain harm or injury that could have been reasonably foreseen (Aurrum 2020). When managing wandering, which may put clients at risk of harm, it is important to achieve an appropriate balance between the client’s dignity of risk and your duty of care. Always look for solutions that are the least restrictive of the client’s choice and independence (ACQSC 2019).
Why Does Wandering Occur?
Wandering is common among people with dementia and there are many reasons why it may occur. However, due to difficulties with memory and communication, the client may be unable to remember or explain why they are wandering (Dementia Australia 2017).
Potential reasons why a client may wander include:
Disorientation due to a new environment (e.g. entering an aged care facility)
Wanting to escape from a noisy, busy or uncomfortable environment
Short-term memory loss (e.g. going to the shops and forgetting where they are going and why along the way)
Boredom or lack of physical activity
Searching for someone or something related to their past (e.g. a deceased loved one or previous home)
Difficulty distinguishing between day and night due to insomnia, disorientation or sensory impairment
Continuing a previous habit (e.g. wandering at around the time they used to walk the dog)
Agitation, restlessness or anxiety
Feeling scared or unhappy
Discomfort or pain (e.g. due to tight clothing, illness or needing to use the toilet)
Feeling as if they have a job to perform
Difficulty distinguishing between dreams and reality
Wanting to stay independent
Feeling cued or promoted to leave (e.g. seeing keys or seeing a staff member leaving)
(Dementia Australia 2017; Alzheimer’s Society 2018; Dementia Support Australia 2018)
What are the Signs of Wandering?
A client who is at risk of wandering may display the following signs:
Returning from a regular outing later than usual
Forgetting how to get to familiar locations
Talking about former obligations such as work
Wanting or trying to ‘go home’ despite already being home
Pacing, making repetitive movements or becoming restless
Having difficulty finding familiar places such as the bathroom, bedroom or dining room
Asking where past or deceased friends and family are
Acting as if they are performing a hobby or chore without actually getting anything done
Never use medicines to prevent wandering as they are ineffective and may increase the risk of falls, memory issues and incontinence
Avoid environmental restraint
Never make the client stay in an uncomfortable area
Never physically restrain the patient
Avoid arguing with the client.
(Alzheimer’s Society 2018; VIC DoH 2015; FACS 2020; Dementia Support Australia 2018)
Wandering should be managed using individualised person-centred interventions (VIC DoH 2015). Potential interventions include:
Validating the client’s needs and providing reassurance (e.g. “You’re safe here”)
Reminiscing, distracting or redirecting to something that the client values
Placing familiar and meaningful objects and photos in the client’s room
Playing the client’s favourite music
Giving the client an opportunity to connect with family and friends via phone or computer
Maintaining a routine that allows the client to participate in meaningful activities
Providing adequate opportunities for exercise and activity
Identifying whether there is any underlying pain, illness or discomfort that may be contributing to the behaviour
Conducting a medication review (this must only be performed by a medical doctor or pharmacist)
Determining the reason for the behaviour
Determining whether there is a specific pattern to the wandering (e.g. certain time of day, certain triggers) and addressing any patterns that are identified (e.g. planning activities during times of the day when the client is more likely to wander)
Keeping objects that may prompt wandering (e.g. keys, outdoor coats, handbags) out of sight
Implementing night lights, sensor lights and signs to help orientate the client
Monitoring noise levels
Ensuring environmental temperature is comfortable
Decluttering and ensuring the client’s environment is safe
Ensuring the client’s room is away from stairs and elevators and close to the nursing station (so that they will have to pass it when leaving)
Ensuring staff are notified that the client may wander
Identifying strategies that have previously worked
Establishing indoor and outdoor areas where the client can mobilise safely
Ensuring the client has identification on them at all times
Recording a daily description of what the client is wearing and ensuring that an up-to-date photo of the client is available
Regularly checking on the client
Considering bed or chair alarms
Implementing bells and buzzers that activate when external doors are opened
Reducing liquids before bed (to reduce the need for the client to get up during the night to go to the toilet)
Assessing the client’s response to a new environment and refraining from leaving them alone if they are confused, disoriented or agitated
Ensuring the client has ‘in case of emergency (ICE) numbers saved on their mobile phone (if they have one).
(VIC DoH 2015; Dementia Australia 2017; Alzheimer's Association 2021; Loddon Mallee Regional Dementia Management Strategy n.d.; Dementia Support Australia 2018)