Help prevent wandering and exit-seeking.

Dementia is not a single disease; it’s an overall term — like heart disease — that covers a wide range of specific medical conditions, including Alzheimer’s disease. Disorders grouped under the general term “dementia” are caused by abnormal brain changes. Many conditions are progressive, which means that the signs of dementia start out slowly and gradually get worse. These changes trigger a decline in thinking skills, also known as cognitive abilities, severe enough to impair daily life and independent function. They also affect behavior, feelings and relationships. Signs of dementia can vary greatly including wandering and exit-seeking.

The terms wandering and exit-seeking are often used interchangeably, but they are not exactly the same. Wandering is pacing or aimless walking. This generally takes place in familiar areas. These are the individuals you see who pace up and down the hallway, seemingly without direction. Exit-seeking, on the other hand, is wandering into unfamiliar places intentionally looking for a way out. According to the Alzheimer’s Association, 60% of people living with dementia will exhibit exit-seeking behavior at least once. A resident may be exit-seeking out of curiosity, closely watching people leave and enter their space and want to follow them. There are others that are distressed and try all doors and windows for a way out. Both wandering and exit-seeking behaviors can be challenging. Learning the possible triggers and warning signs can help address the behavior before it leads to elopement or danger.

Possible Triggers of Wandering and Exit-Seeking

1. Boredom
2. Environment
   • Lighting: going from a dark to bright abruptly, shine on the floor, shadows
   • Flooring: too many patterns, carpeting to tile
   • Noise: sudden loud noise in a quiet environment
   • Clutter: no clear pathways, narrow hallways, large gatherings of people
3. Comfort
   • Uncomfortable chairs or sitting areas
   • Illness
   • Disorientation (especially at night) and hallucinations
4. Disruption in Routine
   • Inconsistent bedtime
   • Not enough sleep
   • People coming and going from the environment
   • Searching for something or someone

What do you do when you notice a trigger?

When you notice someone starting to exhibit initial wandering and exit-seeking behaviors, try the following approach.

• Be respectful and calm.
  Respond to the person’s expressed feelings (ex. fear, anger, agitation) with empathy. Try to express that you are on their team and there as an ally.
• Walk with the person to their room.
  Reinforcing familiarity, comfort, and ownership in their space will help to reorient residents.
• Assess for pain and other unmet needs.
  Unmet needs lead to restlessness. Some things to check for are hunger, thirst, and over- or understimulation.
• Consult their physicians.
  They could be acting differently from a recent diagnosis like fever, urinary tract infection, or other illnesses.

After they stop wandering or exit-seeking, prepare for next time.

People with dementia who exhibit wandering and exit-seeking behavior are likely to do it again. Try to prepare for the next time they are triggered.

• Take note of behaviors and previous triggers.
• Encourage visits around common times of wandering.
• Remove things that may stimulate thoughts about “going home” or “going out”.
• Engage in tasks they find meaningful, helpful, or interesting.
• Have other staff participate in keeping the person busy.

H2 Health helps people with dementia live life to the fullest through specialized physical, occupational, and speech therapy services in their home. To learn more, call (904) 618-3778 or email seniorservicesfl@h2health.com.

For more resources, check out alzheimers.gov.