Responding to wandering and exit-seeking behaviour - understanding the message

Dementia can affect a person’s abilities to remember where they are and find their way around. As a result, they may attempt to leave their home, place of care or the company of others, when it is unsafe for them to do so. This is known as exit-seeking behaviour, or wandering. The following strategies can assist you in caring for a person with exit-seeking behaviour.

Why does exit-seeking behaviour occur?
Leaving to go ‘home’
Exploring the environment
Feeling trapped
What to avoid
Useful resources

Why does exit-seeking behaviour occur?

Exit-seeking behaviour may be caused by a person:

  • Being cued or prompted to leave. For example, seeing keys or staff/family leaving may be a trigger to go home.
  • Trying to meet a need. They may be looking to get to a place that looks familiar, go home or find a toilet.
  • Trying to fulfil long held routines and responsibilities like going to work or picking children up from school even if they no longer work or their children have grown up.
  • Trying to find a place where they feel more comfortable.
  • Feeling unwell or in pain.
  • Feel scared or unhappy where they are.

Always alert the police as soon as possible if the person goes missing. The following general approaches can be tried to support a person who is trying to leave. They can be tailored according to the person and their situation.

What to do if the person is trying to leave to go ‘home’, a more familiar place or to meet needs or responsibilities such as work or children.

  • Validate the person’s needs and reassure them. For instance, by telling them they are safe here.
  • Reminisce, distract or re-direct to something that is valued by the person.[Refer to the DSA Quick Reference Guide on Psychosocial Approaches: Validation]. 
  • Remove and store items out of sight that may make the person want to leave such as keys, coats, handbags, and suitcases.
  • Maintain the person’s routine. Support the person to do activities that are meaningful to them. These might include work tasks, outside jobs, domestic chores or adaptation of past hobbies.
  • Make the area the person spends time in look and feel familiar with family photos, pictures, mementos and their favourite music, for example.
  • Keep your focus and connection with the person in public settings to avoid them getting disoriented and lost.
  • Provide signs and night or sensor lighting to help the person find their way to places they need overnight, like the toilet.
  • Let neighbours know who they should contact if they see the person walking around the neighbourhood unaccompanied.
  • Provide opportunities for the person to talk with familiar family members or friends on the phone or computer, via Skype for example.
  • Try to understand and address the causes of their behaviour.

What to do if the person repeatedly tries to open doors and enter different areas as they explore the environment.

  • Consider signs on doors. In some situations, it may be helpful to place signs such as ‘Stop’ or ‘Do not enter’, a black non-slip mat or strips of non-slip black tape on the floor in front of exit doors and doors that are not safe for the person to open. These solutions need to be considered in the context of what is occurring and shouldn’t be the first option.
  • Consider minimising triggers and visibility of exits by camouflaging or disguising doors and keypads. You could try having portable screens in front of doors, painting doors the same colour as walls, covering key pads or door handles etc.
  • Provide safe indoor and outdoor areas the person can walk around in.
  • Provide physical activities during the daytime such as cleaning or walking.
  • Place interesting items near the areas the person frequently uses, like memory boxes or activity pods. These give the person something else to explore and collect instead of opening doors.

What to do if the person threatens to or tries to leave because they feel trapped or do not want to be there.

  • If the person has previously left a place of safety, find out what strategies have worked in the past.
  • Encourage the person to stay in areas that are supervised, or where they have to pass a supervised area to reach the exits. Accompany the person when they leave their home or care environment. A short walk may help. It can be safer to go with them then attempt to keep them inside.
  • If there are no other safe options you can keep exit doors locked, key padded, alarmed, or secured.
  • Consider the use of alarm mats, sensor lights or bells attached to door handles to alert others that the person is leaving a safe area.
  • Arrange for the person to carry ID, a security bracelet or GPS tracking device like a mobile phone, in their pocket, handbag or attached to their clothing or person. Some GPS devices can alert you when a person leaves the home.
  • Ensure you have a current photograph and information about the person should they wander away. List their details with the[Safe Return (SA)],[Safely Home (NSW)] or[Safe Return Home (NT)] services.

What to avoid

In all situations, ensure that you avoid:

  • Arguing with the person.
  • Making the person stay in an uncomfortable area.
  • Forcing the person to stay by physically restraining them.

Useful resources

Shifting focus: Wandering is a short video that explains how to address exit-seeking behaviour caused by dementia.

I Want to Go Home! How to Distract and Redirect is a video describing how to care for people with exit-seeking behaviour.

DBMAS Dementia and Wandering is an animated video focussed on responding to dementia-related wandering in Aboriginal and Torres Strait Islander communities.

This downloadable guide outlines various Tracking and Monitoring devices available to assist in supporting people with dementia. (PDF)

Safe Return is a joint initiative between Dementia Australia and the South Australia Police to help ensure the safety of people at risk of becoming lost.

Safely Home is a joint partnership between Dementia Australia and the Missing Persons Unit of the NSW Police Force, helping people living with dementia walk safely by providing rapid and accurate identification if they get lost.

The Northern Territory Safe Return program gives dementia caregivers peace of mind if the person in their care wanders.

This resource material is informed by literature and associate practice evidence. This guidance should be applied within your organisations policies and procedures.
 
©HammondCare Dementia Centre November 2018 (next review date November 2020)