Wandering in Dementia: A Safety Plan

Why people with dementia wander

Wandering is not random. Common reasons include:

• Looking for something or someone: the toilet, a spouse who has died, a former home, children.
• Following an old routine: going to work, to the market, to prayer, to collect children.
• Restlessness, boredom or excess energy, especially if there has been little activity or daylight.
• Pain, discomfort, hunger or thirst, or a full bladder or bowel.
• Disorientation: not recognising the home as their own, or feeling lost.
• Fear, anxiety or stress, such as from noise, crowds, visitors or changes.
• Sundowning: increased confusion and restlessness in the late afternoon and evening; see dementia sundowning.
• Sleep problems, with night waking; see sleep problems in older adults.
• Medicines or infections that cause confusion or restlessness; see delirium in older adults and dementia and medicines at home.
• Changes in environment, such as a new house, a hospital stay or travel.
• Searching for exercise or fresh air.

Understanding the reason helps decide the response. See also dementia challenging behaviours and dementia stages and what each needs.

Who is at risk

Anyone with dementia can wander, but risk is higher for those who:

• have moderate dementia, still mobile and physically able;
• have a history of wandering or getting lost;
• ask to "go home" even when at home;
• try to leave, check doors, or pace;
• are anxious or agitated, particularly in the evening;
• have recently moved house or changed routine;
• have poor sleep.

Step 1: reduce the reasons

Meet needs. Check regularly for pain, hunger, thirst, toileting, tiredness, cold or heat. Offer a toilet visit before bed and on waking; see bladder training and timed toileting.

Provide activity and purpose. Daily walks with company, household tasks such as folding clothes or sorting vegetables, music, gardening, prayer, photographs, and time outdoors in daylight. See dementia daily routines and chair exercises for seniors.

Keep a steady routine, with regular meals, bedtime and rest. Avoid overstimulation in the evening.

Manage the environment. Reduce noise, clutter and bright, confusing patterns; see dementia home setup.

Review health and medicines with the doctor, since infections, pain, constipation and medicine side effects can trigger restlessness; see medicine side effects families should watch.

Respond to the feeling, not the words. If your mother says she must go home or pick up the children, do not argue. Acknowledge: "You care about the children. Tell me about them." Then gently redirect to a cup of tea, a walk in the garden or a favourite photo album.

Walk with them. If the urge to walk is strong, accompany them on a safe, planned walk, which meets the need and tires them.

Step 2: make the home safer

• Secure the doors, with the right balance of safety and fire exit rules. Door chimes and sensors alert you when someone leaves; see door sensor guide. Locks placed out of the usual sightline, such as a high latch, can slow exit, but must never trap a person; a responsible adult must always be able to open them quickly in a fire; see lock and door safety for seniors.
• Camouflage exits. A curtain over the door, a mural or a mat that looks different can reduce interest. Some people avoid black mats that look like holes.
• Remove cues for leaving: keep shoes, coats, handbags and keys out of sight. Keep a spare key available to the family and neighbours; see key safe guide.
• Secure balconies, terraces and windows with rails, grills and locks; see garden, balcony and terrace safety.
• Light the way at night so that bathroom trips are easy; see motion-sensor night lights.
• Make the bathroom visible and clear; see dementia-friendly bathroom.
• Bed safety and night supervision: see bed safety for restless sleepers and bed choices for dementia.
• Kitchen safety for people who rise at night: stove guards and auto-off devices; see auto-off kettle and stove safety.
• Gate and compound: fix latches, add chimes, and tell security guards in apartments; see safety in gated societies and apartments.
• A safe outdoor space, such as a fenced garden or secure terrace, lets the person walk freely.

Step 3: identification and tracking

Prepare so that if the person is found, they can be identified, and so you can find them faster.

• ID bracelet or pendant with the person's name, a family phone number and "I have dementia" or a note to call the family. Avoid listing the home address if not needed for privacy, but consider the trade-off.
• A card in the pocket or sewn into clothing with name, contact and medical details; see emergency contact card and medical summary.
• A recent photograph, clear, face visible, kept on your phone and printed. Note clothing, height and any features.
• A GPS tracker, worn as a watch, pendant, shoe insert or in a pocket, which lets the family see location through an app, or sends alerts if they leave a set area (geofence). See GPS trackers for seniors and GPS tracker or smartwatch. Check battery life, coverage and whether the person will keep wearing it; a device left at home is useless. Consider placing it in a regular pocket or choosing a style they do not remove.
• Phone with location sharing, if the person carries a phone, though many with dementia lose or forget phones.
• Tell neighbours, shopkeepers, security guards and local police beat officers about the person, so that they can help and call you.

Respect dignity and consent: explain what you are doing in simple words, agree with the person where possible and limit who sees location data; see privacy and dignity with monitoring.

Step 4: a missing-person plan

Prepare a written plan, and keep a copy where all carers can find it.

If the person is missing:

1. Do not waste time. Search the home and immediate surroundings quickly: other rooms, the terrace, the garden, the stairwell, the lift, cupboards and nearby places they like. 2. Call neighbours and the security guard and ask them to check. 3. Check the usual routes and places: the old house, the temple, the park, a friend's home, a former workplace, the bus stop, the market. People with dementia often head to places from the past. 4. Use the tracker if there is one. 5. Call 112 (India's emergency number) early, within about fifteen minutes or sooner, particularly if it is night, hot or cold, or the person is frail or has a medical condition. Tell them: dementia, age, what they are wearing, photograph, last seen and where. 6. Give the police a recent photograph and a description. 7. Alert family and friends through a call tree or a group message, and ask people to look and keep their phones on. 8. Contact local hospitals and shelters, and community groups. 9. Stay near a phone, and keep someone at home in case the person returns. 10. Search in a widening circle, looking in unusual spots such as ditches, undergrowth, construction sites and water edges. 11. Do not give up, and keep the police updated.

When found: stay calm and kind, do not scold; check for injury, dehydration, heat or cold; give water and a comfortable place; take them to a doctor if they seem unwell; inform the police and search helpers. Review what happened and strengthen the plan; see what to do after a fall if there was an injury.

Step 5: involve your community

• Tell neighbours and ask them to phone you if they see your parent alone.
• Inform security staff in your building, and give them a photograph and your number; see safety in gated societies and apartments.
• Share information with local shopkeepers, rickshaw drivers and the police station.
• Join a dementia support group or carers' network for advice, such as those run by dementia charities. The Alzheimer's and Related Disorders Society of India has chapters in many cities.
• Call Elderline 14567 for information and support related to senior citizens.

Caring for the carer

Watching and worrying around the clock is exhausting. Share duties, sleep when you can, and ask for help; see caregiver burnout signs and prevention, respite care and taking a break and night-time caregiving routines. If wandering cannot be managed safely at home, discuss with the doctor and family the option of day care, more help at home or a care setting; see when home care is no longer enough and choosing an assisted living or care home.

What devices cannot do

Devices improve the chances of finding someone quickly, but they cannot prevent wandering, cannot work if not worn, charged or in coverage, and cannot promise a safe outcome. Alerts need a responder. Keep human supervision, a calm routine and community awareness as the foundation.

When to ask a professional

See a doctor or memory clinic if wandering is new, increasing or accompanied by sudden confusion, since infections, pain and medicines may be treatable. A geriatric psychiatrist or neurologist can advise on dementia care. An occupational therapist can assess the home. A social worker or dementia support organisation can help families plan care. In an emergency or when a person is missing, call 112.