Wandering, a complex motor, cognitive and behavioral disorder, is a common symptom among patients with dementia. A contemporary definition for wandering is: “A syndrome of dementia-related locomotion behavior having a frequent, repetitive, temporally disordered, and/or spatially disoriented nature that is manifested in lapping, random, and/or pacing patterns, some of which are associated with eloping, eloping attempts, or getting lost unless accompanied.” Regardless of complex descriptions and sophisticated definitions and although multifaceted, wandering is easily identified by family members and straightforwardly diagnosed by experienced medical staff.
Older adults and senior citizens with Alzheimer’s disease and other forms of dementia are at elevated risk of wandering away from their home or medical care facility, which poses unique challenges for their family and specialized care facilities that house these patients. Wandering puts them in harm’s way; they could fall, get into an accident, become a crime victim, or suffer from exposure to the elements.
There are four major steps in the commonly accepted clinical best practice for wander-risk patients:
1. Identify which patients are at greatest risk of wandering.
2. Correctly supervise at-risk patients.
3. Identify and control wandering triggers in the environment (many time an impossible task)
4. Treat the root causes of wandering (if known).
Although patients do not seem to be disturbed by this phenomenon, the caregiver burden is high as patients with dementia may walk around aimlessly for hours, at times through most of the day and night. The prevalence of wandering differs across studies: 50% among community-residing elderly with dementia compared to 21% of patients with moderate to severe cognitive impairment in long-term care facilities.
Quality of life is a major concern at the advanced stages of dementia. For the healthy population, walking is a common and favorable leisure-time activity. Walking has both physical and social purposes and may have a relaxing effect on both healthy people and people with dementia. The physical activity may be beneficial for cardiopulmonary function, osteoporosis, muscle fitness, constipation and more. Walking may also contribute to “brain fitness” as it activates brain areas responsible for gait. However, wandering in dementia raises safety concerns. The association between wandering and falls is one such example.
Sleep disturbances were more common among patients with severe dementia who wander than among those who do not wander, but interestingly those patients who wander and suffer from sleep disturbances do not preferentially wander at night. Based on these clinical findings, it is generally assumed that although sleep disturbances and wandering co-occur there is no circumstantial association between the two symptoms.
Why patients with dementia wander is an unresolved mystery. It may be a remnant of an evolutionary essential inner drive to move and may also carry an evolutional advantage. Animals, as well as human beings who wander, increase their chances to acquire food, mate and find shelter. Basic knowledge on the anatomical localization of this behavior is lacking. A SPECT study showed that wanderers with the diagnosis of Alzheimer’s disease had more severely reduced regional cerebral blood flow in the left parietal-temporal lobe compared to patients who do not wander . However, the exact meaning of this finding is not clear and the role of other brain areas, such as brainstem, frontal lobes and the reward system, has yet to be investigated.
In view of the growing numbers of patients with severe dementia, the clinical, theoretical and ethical issues regarding wandering should be addressed in future researches.
By Micha Shalev
Micha Shalev MHA CDP CDCM CADDCT is the owner of The Oasis at Dodge Park, Dodge Park Rest Home and The Adult Day Club at Dodge Park located at 101 and 102 Randolph Road in Worcester. He is a graduate of the National Council of Certified Dementia Practitioners program, and well-known speaker covering Alzheimer’s and dementia training topics. He can be reached at 508-853- 8180 or by e-mail at m.shalev@dodgepark.com or view more information online at www.dodgepark.com.
