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Perspectives: Addressing the Predicament of Wandering in Patients with Dementia
I never anticipated being 7 months pregnant and suddenly facing caring for my mother. My father’s death was totally unexpected, given the fact that he had never been sick nor had any ailments. My mother, diagnosed with dementia 2 years earlier, was approaching the end of her independence. Her disease was clearly winning; we watched her not quite understand that her husband of 52 years was no longer here. His death meant the end of her independence in her home of 46 years.
The decision to bring my mother into our home was based on love and the fact that I possessed special knowledge as a rehabilitation nurse. With more than 10 years of experience in the rehabilitation field, I believed I could manage the progression of my mother’s disease, slow the loss of her independence, and provide optimal functioning. As we managed my mother in our home, I learned some invaluable techniques that I have since shared with other caretakers in this situation. One issue in particular—wandering—challenged my family until we found a solution.
The renovation plans for our two-car garage included a bathroom, bedroom, and sitting room for my mother. The bathroom was built to anticipate the potential loss of mobility, and space was allotted for a shower chair. Furniture from my mother’s house was carefully chosen to preserve the flavor of her home’s decor. Rugs were removed to avoid a tripping hazard, cords were carefully placed out of walking areas, and lights were brightened in all rooms. One issue I could not solve was the distance from the renovated space to our bedrooms. How could I overcome the physical space between our sleeping quarters and my mother’s bedroom?
The first time my mother wandered from the house we were all at home. My mother had been settled in her room that afternoon watching television. She showed no signs of distress or anxiety about her new living space. By all accounts, it was a fine autumn weekend with everyone enjoying a break from daycare, school, and work. At some point, my husband realized that my mother was no longer in the house. We still don’t know how long she had been gone. We do know that when we found her walking around the three-square-mile town in which we live, she was going home. If anyone in town had asked her, my mother would have given her address for the past 46 years.
This disturbing incident heightened our surveillance of my mother, but, realistically, we did not have the ability to keep our eyes on her 24 hours a day with our newborn daughter and her three brothers. At this point, we enrolled my mother in an adult daycare center that kept her mental and social skills stimulated and encouraged her sense of self-worth. At the same time, we looked at the physical environment of our house and decided that locking the doors was the best option. It was, but only for a short time.
Weeks went by without further incidents. It appeared the locks were enough to keep my mother safe from her need to wander from the house until early one morning when the police called. Although I had seen my mother in her bed when I left for work at 6 am, she had “escaped” from our home and walked to the next town. The police thought it was prudent to stop her, and she was able to give her old address. Upon her return, we searched carefully to find her exit route, which we discovered, to our dismay, was the first floor window.
I had to consider that we might not be able to maintain my mother’s safety in our home. I was caught between maximizing my mother’s independence and ensuring her safety. Except for the wandering incidents, there were no other barriers to her remaining in our home. It was imperative to find a solution.
Using the problem-solving techniques ingrained in a rehabilitation nurse’s critical thinking process, I found a reliable solution to this problem. Although many nursing peers had suggested using a baby monitor, its sensitivity to noise is limited to a relatively small area. If a person moves quietly beyond the point of the monitor’s reception, it has limited value in the case of dementia wandering. Our goal was to stop my mother from exiting the house without our knowledge. At the same time, we had to safely maintain my mother’s independence in our home.
The solution, once discovered, made perfect sense. We purchased a house alarm system, which is normally used to keep criminals from breaking into peoples’ homes. In this case, the alarm’s function was to detect my mother’s attempts to open any window or door in the house. In other words, the alarm would sound if my mother attempted to “break out” of the house. Once all the windows and doors were alarmed, we were able to successfully manage my mother’s wandering.
With the power and knowledge of rehabilitation nursing, optimal functioning can be achieved with creative strategies. My mother lived in our home for more than 3 years without any further incidents of wandering. We successfully managed this common problem for families dealing with dementia with the use of a tool found in many homes today.
About the Author
Theresa Pietsch, MS RN CRRN CAN BC, is a faculty member at Helen Fuld School of Nursing, Blackwood, NJ.
The author took first place in the 2005 Rehabilitation Nursing Writers’ Contest for this article. An announcement of and guidelines for the 2006 contest appear on page 88 of this issue.