Dementia sufferers: Wandering and sundowning

By Micha Shalev

Wandering may be a response to restlessness, agitation, fear, boredom or physical discomfort. It may be a continued expression of a life-long habit of walking in a work situation or leisure-time pursuit.  Wandering in some cases may be viewed as a positive activity when contained in a hazard free environment.

Sundowning describes increasing confusion or agitation in late afternoon or early evening.  The causes are unknown.  Possibly, the individual becomes exhausted and unable or unwilling to cope with minimal demands.

Problem — Other residents or caregivers at home are annoyed by a person wandering around.

Staff and/or caregivers need to be hyper-alert for resident intent on leaving the area.

Resident insists on “going home.”

Resident is suspicious, disoriented and sometimes hallucinates in the early evening.

Resident paces aimlessly and continuously.

Resident has sore or swollen legs and feet from prolonged pacing.

Goal — Provide safe, hazard-free environment for resident to explore (in some instances, wandering may provide good exercise and stimulation).

Provide familiar, secure environment where individual needs are met, and thus, reduce the need for wandering.

Suggested approach:

•Provide activities that encourage use of excess physical energy, such as walking in an enclosed area, exercise classes, yoga, stretching, gardening and sweeping.

•Attend to the feelings that prompt wandering such as boredom, worry, hunger, pain or the need to use the bathroom.

•Provide personal identification such as medical alert bracelet should the patient get away. Keep a photo and a piece of unwashed clothing of the resident in a plastic bag to assist in the search if he wanders away from the hone or the facility.

•Provide structure so that resident feels safe and knows what is expected.

•Help  the resident make sense of his environment to reduce feelings of anxiety and “searching behavior.”

•Provide needed assistance to prevent frustration. Be sure activity fits the individual. If it is too simple, it may prove demeaning; if it is too difficult, it creates frustration.

•Check with family members about the individual’s history. Wandering may be an outgrowth of his work, which involved a pattern of walking, i.e. mailman, meter reader or factory supervisor.

•Clearly label areas such as bathrooms, dining room and resident’s own room.

•Decrease noise, clutter and activity which can add to confusion and anxiety.

•Distract when possible with another activity.

•Do not restrain the individual. This may provoke a catastrophic reaction.

•Do not argue or rationalize with the patient. Reassure.

•Prolonged pacing expends tremendous energy. The resident may lose weight. Check with nurse or physician. Prolonged pacing may also cause loss of fluid. This can be serious if dehydration leads to physical complications and increased confusion.

•Observe resident’s pattern and time of wandering. Are there triggering incidents, including staff behavior, which can be avoided?

•Judicious use of medication may be useful in controlling agitated or fearful behaviors.

•Provide articles or activities which provide comfort or security for the individual,  such as a favorite blanket or doll, soothing, familiar music or a quiet task like folding towels.

•Provide a night light.

Wandering is a potentially life-threatening danger that can cause acute stress for both the patient and his or her caregivers. It is important to recognize the confusion and help him or her refocus on real-life tasks.