Older adults with dementia or other forms of cognitive decline may be likely to wander, which is the term for when a person leaves a safe area or responsible caregiver. Wandering can be a serious safety concern, as many older adults with dementia may not recognize the dangers they encounter while wandering, including getting lost or falling.
Wandering risks and warning signs
The Alzheimer’s Association estimates that six in 10 people with dementia will wander at least once. Wandering may be intentional or unintentional. Those at the greatest risk of wandering have some form of cognitive impairment or memory loss. Their impairment may already be diagnosed or show a noticeable decline. A person with dementia may be more likely to wander when they have a change in their routine or environment.
Many older adults who wander show cues or warning signs before leaving. Some common behaviors caregivers see before a person wanders include:
- Feelings of restlessness or agitation
- Disorientation or confusion about time and place
- Attempting to open doors or exit the home
- Repetitive movements
- Expressions of wanting to go home or leave
- Difficulty navigating familiar places
- Becoming anxious in crowds
- Looking for keys, coats, or personal items as if preparing to leave
Sundowning and Wandering
“Sundowning” is a term to describe a common set of symptoms many older adults with dementia experience in the late afternoon and into the evening. The behaviors and symptoms associated with sundowning are linked to faster rates of cognitive decline and an increased risk of wandering. Typically, sundowning behaviors include:
- Confusion
- Anxiety
- Aggression
- Pacing
- Wandering
Preventing wandering
Even the most committed caregiver can’t watch someone every moment of the day. So, engaging in preventative measures to keep the person you care for safe can give you peace of mind. Here are some ways to prevent wandering.
Conduct a Wandering Risk Assessment
A professional assessment using tools like the Neuropsychiatric Inventory (NPI) from the American Psychological Association can evaluate dementia-related behavioral risks. If a formal assessment isn’t feasible, caregivers can observe and answer questions such as:
- Has the person wandered before?
- When do they tend to wander—day or night?
- Are noise, discomfort, or certain times of day common triggers?
- Do they become fixated on leaving for work or returning home?
- Do they have a court-appointed guardian or trouble making safe decisions?
Understand triggers
Wandering often begins with an unmet need or an environmental cue. Here are some of the common triggers for wandering:
- Disorientation or confusion about location or time
- Boredom, anxiety, hunger, or discomfort
- Overstimulation from noise or unfamiliar settings
- Access to travel-related items like suitcases or outdoor clothing
- Exposure to exits, stairwells, or high-traffic areas
Preventative strategies
These are some of the National Institute on Aging’s recommendations for preventing wandering. Note: You’ll want to use these strategies along with the safety measures noted in the section below. Wandering preventative strategies include:
- Provide structured daily activities to reduce boredom.
- Create safe walking areas with enclosed gardens or paths.
- Limit access to exits by camouflaging doors or using childproof locks.
- Secure car keys in an inaccessible place if driving is a concern.
- Install a smart doorbell that chimes when a door is open
- Remove travel-related items (luggage, coats, wallets) from view.
Use technology and safety measures
While you want to do everything possible to prevent wandering, no plan is foolproof. Adding these safety measures can help you to ensure your loved one can return home:
- Medical alert systems with GPS tracking: Wearable devices like smartwatches or necklaces can locate a person if they wander.
- Vehicle tracking systems: Services like OnStar Guardian can help locate a missing person in a vehicle.
- Recent photos or videos: If your loved one becomes lost, you’ll want to have a picture to show police.
- Identification bracelets: Medical ID jewelry helps emergency responders identify a person and any health concerns.
What to do if someone goes missing
- Call 911 immediately and provide a recent photo and description.
- Specify that the individual has dementia to expedite search efforts.
- Request a Silver Alert, a public notification system for missing seniors with cognitive impairments.
- Contact hospitals, shelters, and local businesses where the person may have gone.
- Search familiar locations—frequent stores, parks, or previous homes.
- Use phone-tracking apps like Find My iPhone or Life360 if applicable.
Coping with the emotional toll of wandering loved ones
Caregivers often experience stress, anxiety, and grief when a loved one has cognitive decline and wanders. Helpful coping strategies include:
- Seeking support from family, friends, or caregiver groups
- Taking care of personal well-being to prevent burnout
- Finding counseling or grief support groups
- Exercise when possible, aim to spend some time outside daily
- Maintain community connections
What resources are available for families dealing with wandering?
- Several support systems exist:
- The Alzheimer’s Association’s MedicAlert + Safe Return program
- Local dementia support groups and educational programs
- Adult day care centers and respite care services
- Home health care agencies specializing in dementia care
- Technology solutions like GPS trackers and monitoring systems
- Medicare and Medicaid social workers and case managers who can help develop safety plans