dementia wandering singapore

Caregiver Guide: Supporting Persons with Dementia Who Wander

A wandering person with dementia can be a source of distress and anxiety for the caregiver or loved one. Here’s how you can manage unwanted wandering for your loved one with dementia.

by Elaine Francis, R.N.

A wandering person with dementia can be a source of distress and anxiety for the caregiver or loved one. Here’s how you can manage unwanted wandering for your loved one with dementia.

What is Wandering?

‘Wandering’ is common with dementia – it happens when someone with a cognitive impairment like short-term memory loss walks around without any apparent goal and cannot remember where they’re going or why. They may become lost, get into risky places or situations, and may go outside without appropriate clothing or other essentials like their house keys.

Having a relative who wanders can be a huge concern, and it’s important to strike a fine balance – keeping them safe without making them feel trapped.

Being restricted and feeling trapped can be very distressing, and people with dementia or other cognitive impairment feel that just as keenly as anyone else. In addition, wanting to go for a walk or to continue normal activities is very natural and normal. Getting some exercise and a change of scenery outside is important for everyone’s mental and physical health.

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When does wandering become a concern?

Wandering becomes more risky as someone’s cognitive function declines. With some mild dementia, a loved one may simply forget why they went out, but be able to find their way home when they’re in an area they recognise. As dementia progresses, people can become less able to find their way home, and may end up in unfamiliar, or even unsafe places like busy roads. Someone who consistently comes home within a reasonable amount of time may be safe to go out alone, but every person with dementia is different and will have different capabilities outside of their homes.

Wandering also becomes a problem when the person has variable or reduced mobility, an unsteady gait or often forgets essential mobility aids. Anyone with a high risk of falling, particularly for older individuals with a higher risk of sustaining serious injuries from a fall, may need extra care to prevent unsafe wandering.

The time of day that a person with dementia typically wanders can vary from person to person, and can make a difference to how safe or unsafe their wandering is. Going out in the middle of the night can increase the risk of becoming lost or tripping and falling, and can mean that person is more likely to go out in unsuitable clothes.

Why does my loved one wander?

Memory loss can present itself in different ways – some people follow old routines and routes, others may believe themselves to be at a different stage in their lives, or they may simply want to get out of the house and go for a walk.

I knew an elderly lady with dementia who was sure – and it was absolutely real to her – that she was back at a time in her life when she was a young mother, and that her children were very young and needed her. She couldn’t find them, and was as distraught as anyone would be to find their children missing. She believed that she had lost her young children and was inconsolable. Every day, she realised that she couldn’t find her babies. Dementia can be a nightmare for some people.

The reason they feel they need to get out can be compelling, even urgent and absolutely real to them. They may believe themselves to be late for work, that they need to pick their children up from school, or they may not remember the reason they’re up and about. 

It is normal – and healthy – to want to get out of the house, to get exercise and fresh air, to visit parks, shops, friends or any of the activities which make life enjoyable. A person with dementia will still want to do the things they enjoy, but may not be able to understand or retain information about why that isn’t always safe for them to do alone.

Symptoms of dementia can worsen in unfamiliar environments and situations, so wandering and changes in memory and even behaviour can be worse when a person with dementia moves house, moves into a care facility, or spends time in a hospital.

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How to reduce unwanted wandering

It’s natural for anyone to want to get outsides sometimes, but when someone is unable to keep themselves safe when they’re outside alone, restricting their activity may be the only way to keep them safe. Some tips that may help prevent your loved one with dementia from wandering include:

Making sure they get plenty of exercise and stimulation

Friends, family members or carers may be able to accompany them on a walk or a trip out, satisfying the need for fresh air, change and exercise.

Having a daily routine (especially with company and mental stimulation)

Day centres for people with extra care needs or cognitive impairment can provide a social outlet and it’s very reassuring to know that there is a safe place for your loved one to be at through the day.  

Lock doors and install door alarms

If wandering at night is an issue and they live with someone else or in a care facility, making sure doors are locked at night can help keep them safe. If the person with dementia lives by themselves in their own home, locking them in is not safe as they would be unable to get out in the event of an incident like a house fire or medical emergency. You can get also get door alarms that alert members of the household or close neighbours when the front door is opened at night.

Meeting their needs as much as possible

In more advanced stages of dementia, your loved one may be unable to verbalise the reason they’re wandering, or may not even know; sometimes it can be as simple as needing to find the toilet, or being hungry or thirsty. Making sure these basic needs are met can reduce some wandering.

Assign carers

Have carers or similar services to check on them regularly.

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Keeping a Wandering Person Safe

In an ideal world, the underlying causes for wandering can be addressed – plenty of safe activity and exercise, meeting basic personal care needs and providing a safe, familiar environment with people around as much as possible is perfect. That isn’t always possible, however, and when you can only be in one place at one time, it can sometimes be challenging to provide the optimal care to a loved one with dementia. 

Some people with short-term memory loss may be able to go out alone and stay safe – but dementia varies from one person to the next, and even from day to day. Putting some practical measures in place to support a wandering person can help them stay safe and give you peace of mind.

Practical ways of keeping someone with dementia safe when they wander include:

Some form of identification

Medical alert bracelets can be invaluable and can look good. They can include a phone number for a close family member, information about medical needs (whether someone takes insulin or blood thinners, for example), and other essential information for if your loved one gets lost.

Smartwatch or GPS bracelet

A smartwatch, medical alert bracelet with GPS technology built in or ‘find my phone’ type app to help track the location of a vulnerable person can be essential. This is potentially a quite intrusive technology so careful consideration of a person’s mental capacity and privacy needs compared to their likelihood of becoming unsafe should be considered.

Mobility aids and essentials are on hand

Ensuring that their mobility aids or other essentials are on hand so that if they do go out or wander around the home, their risk of falling is minimised.

Mobile phone or care alert device

Providing a mobile phone or care alert device that a person with dementia is in the habit of carrying with them and can easily use if they suddenly find themselves in need of help.

What can you do when your loved one goes missing?

Finding that your loved one isn’t where they should be can be frightening, and finding that person isn’t always easy.

  • Ask their friends and neighbours: someone may have seen them pass, or they may simply have decided to visit a nearby friend – even if it’s the middle of the night. Neighbours might also be willing to help with the search.
  • Check the places they usually go, or places they used to go when they were more independent.
  • Use the Dementia Friends app to report a missing person and get local support.
  • Use social media to ask local people to report sightings.
  • Alert the police: the police can help search and even check local CCTV footage to try and find an at-risk person. They will ask for some identifying information, ideally including a recent photograph

Once they’re found and safe, make sure you let everyone know that they’ve been found to prevent ongoing searching or worry.

Providing for a person with dementia’s basic needs can help reduce distress and wandering, and there are lots of care and support services available. Carers or friends and relatives who can drop in for safety checks, medications prompts and just a friendly hello can help. Having easy access to routine medical support via telemedicine or house call doctors, and meeting ongoing needs like medication delivery services and having meals delivered can help create a safe place.

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References
 

  1. Cipriani, G., Lucetti, C., Nuti, A., & Danti, S. (2014). Wandering and dementia. Psychogeriatrics, 14(2), 135-142.
  2. Gu, L. (2015). Nursing interventions in managing wandering behavior in patients with dementia: A literature review. Archives of psychiatric nursing, 29(6), 454-457.
  3. Wan, J., Byrne, C. A., O’Grady, M. J., & O’Hare, G. M. (2015). Managing wandering risk in people with dementia. IEEE Transactions on Human-Machine Systems, 45(6), 819-823.
  4. Hermans, D., Htay, U. H., & Cooley, S. J. (2007). ‐Non‐pharmacological interventions for wandering of people with dementia in the domestic setting. Cochrane Database of Systematic Reviews, (1).
  5. Robinson, L., Hutchings, D., Corner, L., Finch, T., Hughes, J., Brittain, K., & Bond, J. (2007). Balancing rights and risks: Conflicting perspectives in the management of wandering in dementia. Health, Risk & Society, 9(4), 389-406.

About the Writer
Elaine Francis, R.N.
Elaine Francis is a registered nurse with 17 years’ experience in healthcare. She turned to writing to follow her passion for realistic medical communication. She loves translating medical jargon into accessible language for the people who need to understand it most. When she’s not writing or working on a busy cardiology unit, she spends her time telling her children to hurry up.
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