It was a dark and stormy night in January. Sally found herself walking down a road. She wasn’t sure in what direction she was heading. At times, she didn’t know where she was going. Her plan was to walk to work, as she had done, every morning at 4 a.m., for the last 50 years. She was a baker in town and her specialty, sweet Persian buns. In Maine, January is considered to be one of the coldest months and walking outdoors this time of year could have severe consequences to anyone not dressed properly.

The evening before, Sally and her daughter enjoyed watching a cooking show before they both retired to bed.

When Sally woke up in the middle of the night to use the bathroom, a thought from the show triggered her to think about going to work. She acted quickly on the impulse and left her house wearing what she had on, dark blue flannel pajamas and fuzzy brown slippers.

The weatherman on the evening news, said that it was going to be a cold evening and reminded his viewers to make sure their dogs and cats were inside for the night.

Without a coat, gloves or boots, Sally followed her short driveway to the secondary road that lead to town. Beech Street was a dark street and there were no house lights on at that hour to guide her along the rough and bumpy road.

This section of the road was in last year’s town budget to be repaired, but it never happened. Every year, the snow plows caused the paved roads to crack and break into bits and pieces of tar fragments littering the road and creating deep pot holes.

Walking in the daytime was difficult enough, walking in the dark was treacherous. There was no sidewalk or breakdown lane.

As Sally walked, she felt lost in her thoughts. She was aware that her mind had gone astray. She was unable to reel it back to create complete ideas. Words flew by like a ticker tape in her mind, unwilling to be captured, and used in a sentence. She could not explain how it feels to be unable to verbalize her thoughts and feelings when she couldn’t find the words.

Sally tripped several times but managed to keep upright. At the next corner, she turned right and then took another right leading her to an unknown area. She wasn’t far from her house but she did not know where she was. Her only thought was that she was cold. Looking around she had no idea in which direction she should go or what to do. She hoped to find someone to talk to, to help her get to work before she was late. Her thoughts were scattered and of no help to her. She was uncertain and powerless.

She spotted lights in the distance and stood in the middle of the street, staring, not moving as the car approached her. She was frozen with fear and anxiety, and the effects of hypothermia had taken control of her body. She took a step, fell and lay motionless on the ground.

                                       
**********************

Alzheimer’s Disease gradually destroys brain cells that are responsible for memory, reasoning and behavior. Wandering is a common activity seen in people who have some form of dementia. This symptom of wandering occurs as the condition progresses.

Six out of 10 people with dementia will wander. Some are found and others are still missing. They are often confused and unable to ask for help, leaving them vulnerable to weather, traffic and society.

One theory for this wandering activity is that it is triggered by an old memory. Other thoughts are that they feel restless when experiencing distress, or they see items as a purse, car keys, coat and hat and by association get the idea to go outdoors.

Your loved one with dementia may give you clues that they will start to wander, such as saying they want to go home, or they are going to see his/her children, or talk about going to work.

Here are some creative ways to prevent wandering according to the Alzheimer’s Association website:

• Keep daily routines structured. A controlled environment will decrease their restlessness and behavior is manageable.
• Limit daytime sleeping to a minimum so they sleep more at night. Most wandering happens at night.
• Camouflage doors that lead to the outside by gluing a mural of book shelves or another scenery on the door. This way the door does not stand out and give them the idea of leaving.
• Place a dark mat in front of doors. This can deter them from going through the door due to their perception that it may be a dark hole.
• Determine their nighttime needs, such as being hungry and looking for snacks. If they are getting up at night to use the bathroom, limit fluids by 6 p.m. Avoid high sugar drinks which will irritate the bladder, making them feel the urgency to use the bathroom frequently
• If they are still driving, hide the car keys.

• Buy alarms for doors, so that when they are opened, you will receive a warning that someone is leaving the house. Place a side lock at the top of the door where the person can’t reach it and lock it at night.
• Lower the temperature in the bedroom at night. No one wants to get out of a warm bed when it is cooler in the room.
• Purchase a monitor system that will track them throughout the day. People suffering with dementia are clever. Family and caregivers need to be one step ahead of them to protect them and keep them safe.
• When looking outdoors for a wanderer, keep in mind that if they are right-hand dominate, they will tend to keep turning right. And if left hand dominate, they will tend to keep turning left.

Roe Chiacchio RN, CPT, CDP, can be reached at roechiacchio@gmail.com