This blog is a continuation of our series on Behaviors as Communication. To read other entries in the series, please click through to one of the following links below:
- Behaviors as Communication (Introduction)
- Behaviors as Communication: Agitation
- Behaviors as Communication: Collecting
Early afternoon, on a mid summer’s day, our landline telephone started to ring. It was my grandmother’s neighbor, calling to see if we knew where grandma was. We were told that she had left in the Buick a few hours ago and had yet to return home.
Grandpa had passed away a few months before, and since then, we had noticed changes in Grandma. It was quickly apparent that Grandma’s mental health had been declining, and that Grandpa had been compensating for her, to help her maintain her dignity and save face.
It was curious that she had left in the car, as just a month prior, we had collected all the car keys and started taking steps to create a safe environment for Grandma to continue living independently. Ever resourceful and crafty, Grandma had a secret set of keys stashed away for a rainy day – although the sun was shining brightly this afternoon.
We jumped in the car and drove around town, checking any and all of her regular hangouts in hopes of finding her. With no luck, we returned to her house, and about 45 minutes later she pulled into the driveway. Noticeably shaken and disoriented, we helped her inside and quickly stashed the secret set of keys – the car battery was also disconnected and removed for good measure – who knows how many extra sets of keys Grandma had.
We were so thankful for Grandma’s safe return and realized that this outcome is not the case for all families who have experienced memory loss and wandering firsthand.
What is it?
Those affected by memory loss – as many as 60% of individuals with dementia – are at risk of wandering. Depending on the disease stage and process, some are more prone to this behavior than others. Wandering can start with subtle events, like searching for an object around the house, and graduate to more prominent ones, such as looking for loved ones who have since passed away.
Wandering deals with challenges of disorientation and spatial awareness. While it is possible and more likely for an individual to wander in an unfamiliar location, it is also possible for them to wander in places they have known all their lives. The more disoriented an individual becomes, the more likely they are to wander. For some wandering begins in the late afternoon and is associated with other behaviors due to sundowning.
Identifying the Cause
Wandering is typically driven by the inability of an individual to orient themselves within time and space. Other factors can include searching for loved ones, lost items, seeking to visit a familiar place (“going home”), and more. Below are a few helpful questions for evaluating the cause of Wandering. This is not a comprehensive list but should offer some good suggestions on where to start.
Basic Needs – Maslow’s Hierarchy
The best place to start with identifying the cause of Wandering is to review the basic needs of the individual. Check out our previous blog, Behaviors as Communication, and learn the role that Maslow’s Hierarchy of Needs plays into and drives behaviors. Review the basic needs of the individual and if they have all been met. Are they wandering due to hunger or thirst? Could they be looking for the restroom? Is it possible that they are tired and are looking for their room or a comfortable place to sleep?
After reviewing basic needs – and if all have base needs been met – continue to work your way up the hierarchy of needs to identify the cause of this behavior. It could be that the individual is early in their disease stage and is currently able to meet all of their own ADLs. They might be looking for purpose and meaningful interaction.
Engagement and Entertainment
When activities and meaningful engagement are lacking, many will go looking in search of purpose and activities that provide the opportunity to be productive. Could it be that the individual is lacking engagement? If they are bored and would like to find an activity to occupy their time, provide engagement that fits their personality, preferences, and life story.
Invite the individual to sit and visit with you for a while. Play a game while enjoying a cup of coffee or tea together. Ask for help with chores like cooking or folding the laundry – be sure to group these tasks by the acuity of the individual and provide support/oversight. Were you able to uncover a helpful method of engagement? Consider adding this into a routine for the individual that can be implemented on a daily basis.
Develop a Routine
Consistency and regularly scheduled routines have been known to help those affected by memory loss. Those who are responsible for providing care should view this process as involving mind, body, and spirit. By setting the routine of an individual who is being cared for, it is the act of guiding them through their day. Try to view the world through their eyes. What was their daily routine before their disease process and diagnosis? How can you provide the very best day for them, by emulating and honoring their patterns of life and living?
This is the heart behind our Meaningful Moments programming. By guiding each resident’s day, we are able to create Meaningful Moments that are unique, enriching, and joyful to them. Through caring together and focusing on individualized care, we are able to honor their experience of aging and celebrate their past habits, routines, and life story.
“Going Home” / Time-Traveling
When the party is over and it’s getting late in the evening, many of us start to gather our things, say “good evening”, and then head for the door to head home. Similarly, many individuals affected by memory loss do the same thing – even though they are already home. This behavior is typical in the evenings or late afternoons and may also be related to other behaviors that occur around this time of day. This is referred to as sundowning, which will be covered in greater detail in an upcoming blog post.
Many individuals may also get up early in the morning and start to get ready to head to work, even though they may have retired long ago. This “time-traveling” nature of their memories lends itself to wandering behaviors in many ways. Someone may also identify as a younger version of themselves, and say they are headed home for dinner, “before mom (or dad) gets mad at them”. Depending on their disease stage and process, consider re-directing them instead of attempting reality orientation.
With the loss of cognition and the ability to orient oneself, it is common and perfectly reasonable for someone to experience anxiety or nervousness. It is possible for those with wandering behaviors to be searching for someone or something that will help them remember who they are, where they are, or what they are supposed to be doing. The fear of the unknown is creating anxiety and nervousness. These individuals are looking for a map or any recognizable landmarks that will help them re-orient and understand that they are in the right place.
Anxiety and fear can lead to other emotions, including agitation, so when attempting to comfort the individual, approach with caution. Check out the Positive Physical Approach from Teepa Snow for resources on how to best approach those affected by memory loss. Also consider using validation therapy and re-direction in this case with the individual to respect their emotions and personal reality that they are experiencing, while also providing comfort and reassurance to their situation.
Approach Resolutions with Safety in Mind
When considering how to resolve behaviors, focus on the safety of yourself, and the individual(s) affected. Ask the question: what approach will provide the most positive result for the individual(s) affected? The best solution is providing an environment for the individual that meets all of their needs, while also providing them with the opportunity to continue living with maximum independence based on their abilities with a focus on oversight and safety. At JEA Senior Living, our approach starts with preventative measures that are built into our memory care communities. This proactive approach is called the JEA Difference:
“Our communities are purpose-built and intentionally designed to holistically meet the needs of our residents while providing them with a safe space and the autonomy to continue living their best lives. The layout of our Memory Care communities is in the shape of the letter-P. This layout allows for residents to walk a circuitous path through the community, or stop to rest at the sunroom, or in one of the beautiful and lush courtyard gardens.” – April Young, VP Sales and Marketing, JEA Senior Living.
April added, “This layout benefits all residents and families, especially when residents are faced with wandering or sundowning behaviors. By placing opportunities for purposeful interaction and Meaningful engagement throughout our communities, we are able to redirect residents towards positive and productive behaviors with the help of our amazing Team Members”.
Even with all of these helpful tips, it can be overwhelming for the family caregivers and loved ones who are giving of their time, patience, and compassion each day. If you, or someone you know, need a break or additional resources, please contact your local JEA Senior Living community for information on our Respite Stay programs or on how to approach Behaviors as Communication.