When people with dementia walk - what can carers do

If you can let the person walk freely in a safe area, do so. In order to best deal with the situation of a person with dementia who is walking, consider the reasons why the person is walking. You might find another Alzheimer Scotland information sheet useful: Understanding and Dealing with Challenging Behaviour – call the Dementia Helpline 0808 808 3000. If you know why the person is walking, you may be able to help him or her do it safely, or find another way to help.

Safety at home

Carers often worry that a person with dementia walking around at home may accidentally come to harm.

You can:

• make the house safer (see also Alzheimer Scotland Safety in the home – or call the Dementia Helpline 0808 808 3000 for a copy)
• set up simple alarms so that the person you are caring for cannot go out without your knowledge. This could be a simple string of bells on the door, or an electronic alarm sounded by a pressure pad under the doormat such as you sometimes find in shop entrances. (But a loud noise might be distressing to the person with dementia.) Door alarms are available that simply attach to the door frame without wiring, and cause a pager to silently vibrate. The pager can be carried in a pocket and picks up the alarm signal. These are designed for people who live alone: the alarms can activate a bell or light in a neighbour's house.

You can get help in safety-proofing your home from an occupational therapist (OT). You can contact an OT through the social work department, your GP or your local hospital.

There is no such thing as a completely risk-free environment. However, you can minimise risk.

Using technology

Every so often the newspapers carry stories about some new gadget that can be used to track someone with dementia who goes missing; or the use of tagging devices similar to those assigned by the courts to ensure that convicted criminals comply with curfew arrangements.

Safer walking technology can be divided into two categories:

1. alarm systems to alert carers to the fact that an individual has moved outside a set boundary. These devices may trigger a sensor (door, bed, chair, floor) and notify another person (perhaps a carer in the same house or living elsewhere, or a monitoring centre) should the person open a door where a sensor is located or leave a designated area. This can't help locate the person though. 
2. electronic tracking devices used to locate a person. These systems are now becoming more available but they vary in price and some can involve paying a subscription on top of the cost of buying the equipment.  Tracking devices use GPS (global positioning satellite) technology to enable devices, including mobile phones, to pinpoint the position of the person if they go missing. Once the person is tracked down, a carer, family member, friend or care professional can then collect them and bring them back home. 

If you are thinking about buying any "safer walking" equipment, it is important to consider the full cost (including any subscription and maintenance costs) and how easy it is to operate, as well as whether the person with dementia is able and willing to use it or wear it.  Having a mobile phone with GPS capability is no use if the person leaves it at home, or if the battery runs out, for example.  You also need to think about the range or distance covered by the equipment.  A physically fit person with dementia could cover quite a distance in a short time.

at dementia is a very useful website giving details of all kinds of assistive technology, including alarms and locating devices. See www.atdementia.org.uk or contact the Dementia Helpline on 0808 808 3000 for more information about technology.

Ethical issues

On the positive side, tracking technologies can be said to give people with dementia greater freedom and independence, enabling them to walk more freely; carers may feel greater peace of mind knowing that the person can be tracked should he or she wander from home. This type of technology could be said to be less restrictive than, for example, a constantly locked door.

On the negative side, there are issues of loss of privacy and the negative associations with the word tagging.  Information would need to be stored about the person and carer contacts – who would have access to that information?  Could the use of a tag lead to a carer having a sense of false security?  What if the person with dementia will not, or cannot, give consent to wearing a tagging device?

I think a way around this dilemma would be to discuss the issue of electronic tagging as soon as possible after dementia is diagnosed. Permission could be obtained in the same way that Power of Attorney has to be by law i.e. while the person is still able to make rational, informed decisions.
- Daughter.

Walking with company

Many people walk for pleasure. Walking, or other forms of regular gentle exercise, may actually help someone with dementia keep his or her mind in better shape.

You may not always be able or willing to walk with the person with dementia, but feel safer if the person is not going out alone. Ask friends and relatives for help. Perhaps a neighbour with a dog might like company on their daily walks. Some carer support groups offer group walks: it's worth asking if there is one in your area.

If the person with dementia is walking because he or she is bored, it might help to arrange outings.

"On Tuesdays, when I have him all day, we sometimes just jump on the bus to Inverness, because that takes an hour, and then we just wander around, and then we come home, and then that's one day taken care of. If we go on a bus it's not so bad, because I might see someone, and he's looking out of the window.
- Carer

Too much energy

If a person with dementia is walking because he or she has too much energy, it may help to join an exercise class. Regular physical exercise is good for people with dementia: consider dancing, yoga, tai-chi, or even a marching band. Some local councils offer special exercise programmes for older people. Talk to the person running the class and find out what's needed for the person with dementia to attend: safety requirements may mean that someone else must attend too. 

For a younger person with dementia, who has been used to regular exercise in a gym, (and if you can afford it and have space), you might consider buying a walking machine or treadmill, of the sort used in gyms. In this way the person with dementia can get daily exercise without the fear of getting lost. This would probably be unsuitable for a person who has never used a walking machine before. Experiment in the local gym first.

You may find that asking the person to help with household tasks that are still within his or her ability is a diversion from walking, as well as good exercise. For example, using the vacuum cleaner, sweeping a path, or cleaning the car. It doesn't matter how frequently the task is done, if the person with dementia still wants to do it.

Diversion

You may be able to divert the person with dementia from wanting to walk. Sometimes a person with dementia will forget having just come back from a walk and want to go out again, or want to go out at an inappropriate time (when it's night, or it's raining hard). Or he or she may want to carry out old routines: going shopping in his or her old neighbourhood, returning to a workplace, preparing a meal. 

Giving the person a clear task to perform may distract him or her from wanting to go out. For example, you could ask the person to sort objects – tidy out the cutlery drawer or one of the kitchen cupboards. Some carers have found that they can suggest a bath as a distraction. 

One carer gave her husband a box of garden tools. He would spend hours outside in the garden. The carer resigned herself to the damage he did because he was safe and active and she could watch him from the window while she did something else in the house.