Tips on Alzheimer's Wandering Why it Happens and What to do

Wandering is among the most unsettling and even terrifying behaviors people with Alzheimer's display. Often poorly clad, they leave safety at random hours and strike out into unknown territory, for no apparent reason. But this seemingly aimless activity usually does have a reason. It's often an attempt to communicate after language skills have been lost.

Alzheimer's caregivers ask if I am worried that my mother might wander away from me and get lost. Wandering is one of the more widely known behaviors of people suffering from Alzheimer’s disease.

I am not worried about my mother wandering at this time because she can't walk very far. I can say I would be very worried at this stage if she could walk.

I can't remember how many people emailed me and were lamenting that there loved one wanted to "go home." When you hear this you really need to start paying attention. The patient could make a break for it at any time.

"Going home" is an elusive term. It could mean back home to where they last lived, or home to the place were they were born. In many of the stories about wandering the patient takes off to a place they once lived that brings back fond memories.

It isn't easy to find a person suffering from Alzheimer's once they "take off." They don't wander logically. Sometimes it is like looking for a needle in a haystack.

One of the most fascinating stories of wandering I read was about a woman that wandered way from her home in Frederick, Maryland at night on foot.

To find the missing elderly woman the Frederick police had to use 50 to 60 police and civilians, and four civilian K-9 search and rescue groups.

The woman was missing for more then 8 hours in temperatures that dropped as low as 20 degrees. She was finally located "huddled up" on a property adjacent to her home. Go figure.

Another man wandered from a Denver, Colorado suburb to San Diego,California. He was lost for three days. How did he do it? He walked down to the corner and took public transportation to the Greyhound bus station. He then took a series of buses to San Diego.

Alzheimer's: Understand and control wandering

Find out why people with Alzheimer's wander and what you can do to keep them safe.

  

Alzheimer's disease can erase a person's memory of once-familiar surroundings and make adaptation to new surroundings extremely difficult. As a result, people with Alzheimer's sometimes wander away from their homes or care centers and turn up — frightened and disoriented — far from where they started, long after they disappeared.

Wandering is among the most unsettling and even terrifying behaviors people with Alzheimer's display. Often poorly clad, they leave safety at random hours and strike out into unknown territory, for no apparent reason. But this seemingly aimless activity usually does have a reason. It's often an attempt to communicate after language skills have been lost.

Wandering may communicate something as simple as "I'm feeling lost," or "I feel as though I've lost something." It can also signal such basic needs as hunger and thirst, the need to void, or the need for exercise or rest.

Other causes of wandering:

Too much stimulation, such as multiple conversations in the background or even the noise of pots and pans in the kitchen, can trigger wandering. Because brain processes slow down as a result of Alzheimer's disease, the person may become overwhelmed by all the sounds and start pacing or trying to get away.

Wandering also may be related to:

• Medication side effects  
• Memory loss and disorientation
• Attempts to express emotions, such as fear, isolation, loneliness or loss
• Curiosity
• Restlessness or boredom
• Stimuli that trigger memories or routines, such as the sight of coats and boots next to a door, a signal that it's time to go outdoors
• Being in a new situation or environment
• Tips to prevent wandering

Although it may be impossible to completely prevent wandering, changes in the environment can be helpful. For example, a woman who was a busy homemaker throughout her life may be less likely to become bored and wander if a basket of towels is available for her to fold.

People with Alzheimer's often forget where they are. They may have difficulty finding the bathroom, bedroom or kitchen. Some people need to explore their immediate environment periodically to reorient themselves.

Posting descriptive photographs on the doors to various rooms, including a photo of the individual on the door to his or her own room, can help with navigation inside the home. Offering a snack, a glass of water or use of the bathroom may help identify a need being expressed by wandering. Sometimes the wandering person is looking for family members or something familiar. In such cases, providing a family photo album and sharing reminiscences may help.

Watch for patterns

If wandering occurs at the same time every day, it may be linked to a lifelong routine. For instance, a woman who tries to leave the nursing home every day at 5 p.m. may believe she's going home from work.

This belief could be reinforced if she sees nursing home personnel leaving at that time. A planned activity at that hour, or arranging for staff to exit through a different door at the end of their shift, could provide a distraction and prevent the wandering behavior.

Make a safer environment

If wandering isn't associated with distress or a physical need, you may want to focus simply on providing a safe place for walking or exploration.

Living spaces will be safer after you remove throw rugs, electrical cords, and other potential trip-and-fall hazards. Rearranging furniture to clear space can help. Childproof doorknobs or latches mounted high on doors help prevent wandering outside. Sometimes a stop sign on an exit door is enough.

Rooms that are off-limits pose a different problem. Camouflaging a door with paint or wallpaper to match the surrounding wall may short-circuit a compulsion to wander into such rooms. Night lights and gates at stairwells can be used to protect night wanderers.

Help ensure a safe return

The Alzheimer's Association's Safe Return program is designed to help identify people who wander and return them to their caregiver. Caregivers who pay a registration fee receive:

• An identification bracelet
• Name labels for clothing
• Identification cards for wallet or purse
• Registration in a national database with emergency contact information
• A 24-hour toll-free number to report someone who is lost

You can register someone by filling out a form online at the Alzheimer's Association's Web page or by calling (888) 572-8566.

Source Mayo Clinic

By Bob DeMarco

Alzheimer's Reading Room

HOME TREATMENTS / REMEDIES for Multi Infarct Vascular Dementia

About six months ago I gave up on the anti-oxidant approach as a treatment for her multi infarct dementia and begun treatment of the vascular dementia from a different angle.

However, the value of vitamin E and vitamin C as a preventative of vascular disease, including vascular dementia, is supported by research - but with the vascular dementia, you need to catch it in the early stages.

With her doctor's approval, we included into mum's dementia treatment protocol, 10mg of vinpocetine three times daily to maintain a lower blood pressure in the brain. Thereby reducing the risk of further vascular accidents, thereby slowing or stopping the vascular dementia - in theory. The drug also has several other advantages, including some equivalence to Vitamin E in antioxidant effect, known to improve eye sight a bit, hearing a bit, concentration a bit, can help with ringing in the ears... in short, vinpocetine seems good for treating vascular dementia. We also included fish oil into her multi-infarct vascular dementia treatment; begun using high dose fish oil three times a day to help maintain/improve neuron function (it also helps to relieve pain etc).

[ If mum's vascular dementia had been of the bleeder type, I would have tried out the vinpocetine under medical supervision, but the fish oil can aggravate bleeding conditions, so the fish oil would not have been included. I would have also checked with her doctor about the suitability of using certain herbal hemorrhoid tablet preparations designed to cure hemorrhoids and relieve pain, as the problem with having hemorrhoids is that the veins are weakened and the hemorrhoid preparations sometimes are made to strengthen the walls of blood vessels. ]

After making the adjustments to mum's multi-infarct vascular dementia treatment regime, clotting type, we begun seeing many improvements. She can now follow a person with her eyes and head, like our grand daughter, Hannah, on a Scooter. Mum is now able to sit upright in a wheel chair unsupported, is much more awake and is much more alert to things around her. Even the wheelchair taxi driver, who knows nothing about the vascular dementia treatment being used, has commented about how much better she seems to be doing with each trip. The vascular dementia, in essence, appeared to have been slowed dramatically, perhaps even stopped, allowing the brain time to reogranise it's neural pathways. We were looking at increasing her fish oil intake in the hope it will help alleviate the vascular dementia even further, but according to the American Heart Association, more than three grams of fish oil a day can cause excessive bleeding, so that idea went out the window. Even so, with multi-infarct vascular dementia in the very advanced stage, there is still room for hope when nearly everyone else has given up.

Well, mum came to visit on Christmas day, 2004 - 4 years after entering the dementia unit - courtesy of a wheel chair bus we arrranged. She had improved much more again. She tried to use her fingers to unwrap a present, she tried talking - for the most part unintelligible - and she tried to stand. She was very much alert and awake the whole 90 minutes. These improvements are just mind grabbing and I recall becoming teary thinking maybe we had finally stopped the onslaught of the vascular dementia.

Well, about five or six more months has now gone by, mum is still responsive to us, looks at me when I talk and smiles when I tell she is looking good. Her body, though, may be getting a bit stiffer, but that might be arthritis and cold weather, or, regrettably, the dementia.

http://www.alzheimersdementia.cdadc.com/vasculardementia.html

Advocate! Because Some Can't

By Suzette Armijo

Have you ever wondered what the Alzheimer's Association does besides events such as the Memory Walk and having great educational material? The Alzheimer's Association, along with volunteers just like you and me, is advocating for all those who can't. As an advocate, we help legislators understand that as the growing Alzheimer population continues to strain an already fragile healthcare system, the need for adequate care, services and critical federal research funding necessary to prevent, treat and cure Alzheimer's disease is increasingly urgent.

You can become an advocate today simply by contacting your legislators from the comfort of your own home. It is much easier than you think. Through our Alzheimer's Association Chapter website, www.alz.org/dsw, we can personalize and send letters directly to our legislators.

As an advocate, you will:

= Generate action from our elected officials by making calls and writing letters or sending e-mails.

= Stay on top of policy and legislative issues through alerts and updates.

= Help elevate Alzheimer's from a disease to a cause.

To become an Advocate, click here.

Fighting Alzheimer's with a touch of beauty

In her heyday, Rita Hayworth was known as the “Love Goddess”: so explosive was her appeal that her image was placed on the first nuclear bomb to be tested on Bikini Atoll after the second world war. As befits one of the world’s most glamorous women, she danced her way through 61 movies and five husbands. She was a pin-up for American servicemen and is listed as one of the American Film Institute’s greatest stars of all time.

But if Hayworth’s early life was sprinkled with stardust, her later life was tinged with tragedy. In her fifties, with a well established drink problem, she began to suffer mood swings and memory loss.
“The first signs were fear and extreme mood changes, paranoia — calling the police because she heard a burglar — and confusion. As a daughter I felt helpless,” says Princess Yasmin Aga Khan, Hayworth’s daughter by her third husband.

Nobody knew what the real problem was until Hayworth was diagnosed with Alzheimer’s in 1981, at just 63 years old. “It was extremely painful but I had to deal with it,” says Khan, who moved her mother into an adjoining apartment in New York and cared for her for the next six years until she died.

Hayworth’s behaviour could be nightmarishly difficult. She suffered from the anxiety, aggression and agitation common to Alzheimer’s, but as the disease progressed she found something that soothed her mood and gave her a focus — painting.

As her mind disintegrated, she worked away at an easel in her apartment, producing beautiful, detailed likenesses of flowers. “So many people give up with this disease,” says the princess, who is now president of Alzheimer’s Disease International, the umbrella organisation for Alzheimer’s associations around the world, “but it brought her peace of mind and helped her to relax.”

Could Hayworth’s experience help us to understand how to support and treat people with Alzheimer’s? John Zeisel, the founder of a pioneering programme caring for people with Alzheimer’s in the United States — endorsed by Khan — and a visiting lecturer at Salford University, believes that it could.

“What the scientific research tells us is that Alzheimer’s attacks the part of the brain that handles what we call logic — the executive function that copes with handling complex situations. Taking a photograph, for instance: you have to find the camera, slot in the memory chip, work out where the shutter button is and so on . . .

“But what’s not damaged is your appreciation of a beautiful picture. The part of the brain that deals with emotions is shaken up by Alzheimer’s but it’s not damaged in the same way. In fact, emotional response seems to be heightened, not lessened.”

In other words, people who appear to be lost to the world can still be reached through art, literature and music — and love. At Hearthstone, a group of seven homes looking after some 220 people with Alzheimer’s that Zeisel had helped to found in Massachusetts, residents are encouraged to paint and are taken on regular outings to galleries. They have reading circles and a film club.

“The development of new drugs to treat Alzheimer’s is helping people live a little bit longer,” says Zeisel. “What we’re asking ourselves is, how do we make that life worth living?”

Life expectancy remained low for centuries — in 1900 it was still only 47 — but advances in medical science and public health have added another 30 years to our lives. A British man can now expect to live until 77 and a woman until 81.

That increase in lifespan has brought with it a tidal wave of dementia, for which there is no cure. There are 700,000 people living with dementia in the UK, some 417,000 of them with Alzheimer’s. By 2015 that total is predicted to reach 1m and by 2050 it will be 1.7m.

“Everything has happened so fast we don’t know what’s hit us,” says Zeisel. “One of the reasons everybody’s so afraid of Alzheimer’s is that there are so many unknowns. When someone is diagnosed, we grieve for their lost future. But maybe everything isn’t lost: we have to get past the fear and grief to see what remains."

I’m Still Here, Zeisel’s book about the development of the Hearthstone programme, is to be published in paperback by Piatkus next month. On March 15 he is hosting an arts and dementia day at London’s October gallery, an event that is already booked out.

One of the first things the Hearthstone team looks for is an activity that elicits a response from a new resident. It might be an old hobby — gardening, perhaps — or something new. “Families come in and say, ‘My father doesn’t dance’, and I say, ‘Well, we’ll see — maybe he’s never been surrounded by women and nice music before’.”

They then build a routine around the activity. George, a former teacher, arrived at Hearthstone anxious and aggressive and, on the assumption that he would like books, was taken to the library. He now runs a residents’ book circle at 10 o’clock each morning.

“It’s a reason to get up and get dressed,” says Zeisel. “If he’s upset or confused, the staff will say, ‘You’ve got to get dressed, the book group needs you’. He has a meaningful role. He passes books around, he and the others read aloud. Often people with dementia give up on reading because the type is too small. It seems confusing but it’s easy to fix — our books have large type.”

This kind of meaningful role, plus a simple routine, is key to helping people with dementia cope with life. “It’s not just about activities,” says Zeisel. “If it’s ‘bingo at 10, muffins at 11’ one day and ‘reading at 10, gardening at 11’ tomorrow, that doesn’t work. It’s confusing. If we go to an art gallery, we go every Tuesday at 11. Someone might say they don’t want to go but after a month they’ll wake up and hear it’s Tuesday and think, ‘Okay, it’s gallery day’.”

One of the things we need to get away from is the constant testing of people with dementia, he says. Bombarding them with questions compounds confusion with a sense of failure. Rather than say, “Mum, do you know who I am?” it is better to walk in, take her by the hand and say, “I’m your daughter and I love you.” And smile. You’ll reach the bit of the brain hard-wired to respond. If you are looking at a painting, don’t test her on whether she can remember who it is by: instead, open a conversation about the shapes and colours.

People with Alzheimer’s need to stay useful. They might not be able to find the dinner plates, but if you get the plates out of the cupboard they can put them on the table. This is not a cure, nor even a replacement for drugs, although Zeisel insists that the more effective the “person-centred” care, the lower the need for the antipsychotic drugs used to treat Alzheimer’s.

In essence, it is about quality of life for the people with Alzheimer’s and their families. You don’t need a team of highly trained art therapists on hand to make a difference. If you are one of the thousands of people stuck at home caring for someone with Alzheimer’s — saving the government an estimated £6 billion a year in the process — here’s what to do.

“Start an Alzheimer’s community,” says Zeisel. “There will be a cafe near you that’s quiet at 10 o’clock on a Tuesday morning run by some nice person who will smile at your mother. Find other people in your situation and invite them along.

“Go to a museum, same date, same time. Create a routine so the person you’re looking after gets used to it and expects it.

“Start your own film club. Rent a bunch of films you think your mother might like. See what interests her. It might be she can’t watch a whole movie but loves 10 minutes of Singin’ in the Rain. Play it when she’s agitated and remember: everybody is reachable, it’s just finding the way to do it.”

By Margarette Driscoll, Times Online