When you think of “wandering,” what comes to mind? "Wandering" can be defined as aimless roaming or walking and there are inferences that the individual with Alzheimer's disease or another dementia is lost, confused, pacing, or seeking an exit (sometimes called elopement).

"Wandering" becomes worrisome when

• it is excessive,
• it is in a dangerous location or situation,
• it is outside of the capability level and
• it isn't met with an understanding that it may be a sign of boredom or other unfulfilled wants or needs.

All these situations put the person at risk of harm, injury, poor quality of life, and/or lack of basic needs being addressed.

A Shift in Perspective Sheds Light on Benefits that Should Not be Deprioritized

For the record, I prefer not to use the word “wander” because it often conveys a negative connotation. When we apply this label with a negative context, it impairs our ability to see the good. I will use “wander” now to encourage connection with this material, but later I will introduce a term I much prefer that alleviates bias and the dangerous glass half empty perspective.

It is vital to view “wandering” through a positive lens and understand that the “wanderer” possesses the ability to stand and walk, to seek and explore their environment, and to engage.

These abilities shouldn’t be dismissed or squelched. Why?

• If we take away walking, it can lead to weakness, falls, and other health problems. 
• If we discourage seeking it can reduce engagement and quality of life and it can prevent the person from doing/getting what they want or need.

There are actually many benefits to “wandering.” For example:

• If the person needs to use the restroom, they may "wander" attempting to find it. Sometimes they are successful, other times not but regardless they are making us aware of their need to defecate or void. 
• If a person is pacing the hallways, they may “wander” into a room or to an exit door to find someone or something. Walking may be helpful to maintain lower extremity strength, balance and to help the bodily systems to function better. Walking can burn necessary energy. Walking to a person or place can be a communication telling us they are in need of company or an activity.

If we simply tell the "wanderer" to sit and/or restrict their movement, they are losing the benefits of the movement and communication described above, and that's not good.

The Other Side of the Coin Also Needs to be Understood and Addressed

But, there are causes for concern as I previously mentioned. Let's dig into each a bit further. 

"Wandering" becomes worrisome when:

1. It is excessive. A person with dementia could walk miles a day leading to pain, falls, and weight loss.
    
2. It is in a dangerous situation or location. They could walk out of a building and into traffic or high heat, or onto ice or snow. They could walk where there are hazardous materials or fall hazards like a construction area, stairs, low lighting, or changing surfaces. Each situation could be dangerous, creating a fall, injury, or something worse.
    
3. It is outside of their capability level. If there are physical and/or cognitive limitations, the person may require assistance. If cognitively intact, the individual may recognize their physical limitations and ask for help and follow directions to remain safe. But if the person has Alzheimer’s disease or another dementia, they may lack the awareness of their physical deficit, they may not be able to recall or follow directions for seeking assistance, and they may not have the judgement to make good decisions about where and when it is safe to walk.
    
4. It isn’t met with the understanding that the person is trying to fulfill a need. If those around don’t recognize the need the person is trying to fulfill, the “wandering” could simply be ignored or suppressed, without ever addressing the need. This leads to poor care and quality of life and can create anxiety, agitation, and an unsafe situation for all.

Solutions for Safety Without Compromising “Wandering” Benefits

Suppose you observe or suspect any of the above. In that case, I recommend a comprehensive evaluation of the person and their environment, followed by creating a care plan to keep them safe while prioritizing their personhood, also while including their wants and needs. 

As we teach in our Dementia Capable Care (DCC) dementia training, we want to learn about the person and their unique goals, and then we assess their abilities and challenges, and the environment. Our goal is to provide the right human care support (and activities) and a supportive physical environment to enable them to do what they want and need to do each day, safely, and with quality of life. Our DCC model definitely applies to managing “wandering.”

As an example: If someone enjoys walking and exercise (their interests), and wants to continue to do this, this should be a care goal. But if we assess and discover they are functioning in middle stage dementia, we know they will need assistance. They won’t have the capability to find locations on their own and they will have poor safety awareness and judgement. They will also have difficulty telling us what they want or need to do, due to changes in their verbal communication. 

• Therefore, this individual will require proactive care support that anticipates meeting their interests to walk and exercise. 
• They will need care support to walk in safe locations, to locate the right rooms, and to engage in exercise. 
• They’ll need oversight to ensure walking isn’t compromising their health.
• They will need someone to monitor their whereabouts to ensure no access to chemicals, fall risks, and outside areas that pose a hazard.
• Or we can introduce wearables that help to track their location if allowed to safely explore beyond secured areas.

There are a variety of GPS wearable trackers on the market. Wearable tracking devices are useful tools for managing “wandering” in individuals with dementia. They allow caregivers to monitor a person's location in real-time, receive alerts when they “wander” outside of pre-defined safe zones, and potentially aid in their safe return if they do “wander” off. 

Summary of a Balanced Approach that Creates Outcomes that Matter

The risks associated with “wandering” are definitely real. I once learned of a lady who had early-stage dementia who left her assisted living facility on her own and was tragically struck and killed by a car while trying to cross a highway at night. I have known of individuals who walk so much each day that they lose an unhealthy amount of weight. There are many who may walk on a slippery surface or walk so far that they become exhausted and fall.

While we want to prevent these risks from becoming reality, we must also recognize and weigh the benefits and need for physical movement. From my experience, when we implement the DCC model and understand that "wandering" in and of itself isn’t a problem, we are on the right track to facilitating a healthy and happy person, and great outcomes. 

Now back to the term "wandering". To help avoid that harmful negative perspective, I prefer the term "walk and explore" or we can just say "walking" or "propelling in a wheelchair". These are benign and objective, with no bad subjective label to taint what we see. 

Remember, someone who is "wandering" is also showing you their ABILITIES and COMMUNICATING what they want, need and/or how they feel. These must be recognized and capitalized upon for quality care. 

Let's keep our sights on a fundamental goal of delivering quality dementia care that promotes use of abilities, within necessary safety limitations, while always helping a person to function at best ability with quality of life.

Positive outcomes will follow when we first see "wandering" as an ability we don't want to take away and "wandering" as communication we don't want to ignore. When we do this while also knowing all the ways to ensure "wandering" doesn't become worrisome, we set the person, their care team and the organization up for success.

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