Preventing wandering for dementia

July 26, 2017 9:55 PM

Mom has dementia and has just started a new habit of trying to wander. Fortunately, her mobility limitations likely limit how far she'll go, but still, it's scary. Are their known tips for preventing this?

She's home with either my dad or a friend who is helping care for her - never left alone any more. But if my dad who is also elderly falls asleep or goes upstairs, she may head for the front or back door. She still reads and I have put up notes saying, "Stay inside" which is a mild but not totally effective deterrent to her. She's fixated on the idea that her house is not her house and is trying to go "home".

For the foreseeable future, we're going to have to stick with this plan of her living at home and being alone with my dad for on weekends and in the evenings. (We will probably add more home care as necessary but not yet...) It's generally working out pretty well except for this new development...

Several neighbors know the score and look out for my folks - one called me tonight to tell me she'd seen my mom at the back gate. ):

posted by latkes to Health & Fitness (18 answers total)

This is distressing but it is also common. There are door locks for people with dementia, if your father is able to operate them. (That's just one type; there are many.)
posted by DarlingBri at 10:08 PM on July 26, 2017 [3 favorites]

It must be very stressful for her to look around and feel she is the wrong place and needs to back to somewhere familiar. I believe the current thinking is not to argue with these delusions but to reduce the person's stress by going along with them. I also remember reading about a nursing home (in the UK, I think) that had an old fashioned bus stop and bench right outside the door. People convinced they needed to go home, would sit down at the bench and wait for their bus.

Maybe in addition to any physical barriers, you might put up a sign telling her
"[Ethel], stay here now. [Paul] will help you go home tomorrow" or some similar message letting her know that she is supposed to be in this unfamiliar place.
posted by metahawk at 10:20 PM on July 26, 2017 [3 favorites]

There are floor mat alarms you could perhaps put near the door, or beside the bed, that will alert you if stepped on (ie if she is heading out the door, or gets out of bed in the night). Lots of other helpful adaptive products at that link as well.
posted by pseudostrabismus at 10:21 PM on July 26, 2017 [1 favorite]

One of the tips we learned after my dad passed from dementia was that a black door mat in front of the door will look like a deep hole to the affected person - and it will stop them from going through the door. Maybe try them inside the outside doors of the house?

Best wishes to you - this is a heart-wrenching gift of love, caring for a parent with dementia.
posted by summerstorm at 10:45 PM on July 26, 2017 [3 favorites]

A social worker suggested installing additional door locks either high up or near the floor. She said that most people with Alzheimer's aren't able to reason through looking for an additional lock when the door won't open after undoing the first lock. We never had to do that for my grandmother, mostly because we went to full-time in-home care, so I can't vouch for it personally.
posted by Snarl Furillo at 3:40 AM on July 27, 2017 [1 favorite]

Something to think about?

A woman with dementia who went missing in Florida was found by a police dog in a matter of minutes, having bottled her scent in advance.
posted by SuperSquirrel at 4:49 AM on July 27, 2017 [2 favorites]

Came here to second the black door mats and extra locks. Worked for a member of my family. If you want to go all out, I read about a dementia focused nursing home that made a fake bus stop outside their facility. People would wait at the official looking bus stop, no bus would ever come, then they would forget why they were waiting and head inside.
posted by donut_princess at 4:51 AM on July 27, 2017 [1 favorite]

Seconding an additional lock high up, out of reach. In addition to dementia-specific solutions you can also check baby proofing solutions. And as hard as it was to accept, sometimes flat-out lying works. Like, "the stove isn't working" was enough to deter my mom from insisting on using the stove in the moment.

I'm also dealing with a parent with dementia. I'm sorry you have to deal with this, too.
posted by Room 641-A at 4:54 AM on July 27, 2017 [2 favorites]

The fake bus stop is in Germany.
posted by bunderful at 5:43 AM on July 27, 2017 [3 favorites]

Really good suggestions above. You might also consider a GPS device as a back up to ensure you can find her if she does manage to leave home. Here is a list of some available options. Also if you are not yet connected to your local Alzheimer's Association, I cannot recommend them enough. They have been enormously helpful to our family in locating resources and providing advice.

I wish you and your family the very best.
posted by goggie at 7:39 AM on July 27, 2017 [3 favorites]

Another suggestion: the social worker at my mom's geriatric doctor's department (at Kaiser) has been invaluable in everything from giving me resources and suggestions for things like the sundowning to references for board and care facilities to just listening to me cry and ramble back when things were really dark and I was a walking nervous breakdown. If there's anyone on her team that fits this role, please reach out, if you haven't already.
posted by Room 641-A at 8:17 AM on July 27, 2017 [2 favorites]

You could also try floor length curtains over the doors to stop the sight of the door prompting the thought of going outside.
posted by kadia_a at 8:30 AM on July 27, 2017 [1 favorite]

This site talks about how to adapt a house to make it more dementia-friendly, including reducing wandering:

http://www.enablingenvironments.com.au/adapt-a-house.html

Among other advice it says "a door with contrasting coloured door frames and handles allow it to be seen easily and can therefore encourage movement through to other indoor/outdoor spaces" - so if you want to discourage movement, make the door to the outside world difficult to see - e.g. paint it the same colour as the surrounding walls.
posted by Murderbot at 9:24 AM on July 27, 2017

Just a small reminder that none of these solutions is fool proof. My mom eventually figured out how to turn on the stove without the knobs, bypass the child-proof knob covers, and once, after an unusually aggressive attempt to leave the house, I spent 20 seconds peeing only to find my 85lb mother moving the dining room table that I moved in front of the door so I could pee.
posted by Room 641-A at 12:16 PM on July 27, 2017

One important thing to consider--if your father is with her by himself often and if your mother is no longer able to use the phone, it is effectively as if he's alone. So, depending on her abilities and your father's health, you may want to have some sort of medic alert available for him in case of emergency. (I speak, unfortunately, from experience--my father had Alzheimer's, and my mother was his primary caretaker; she had a heart attack one morning and wasn't discovered until the evening, when it was too late to save her. I don't know if a medic alert device would have saved her, but I wish we had thought to make that an option.) Also from personal experience, it's important to have a plan B in case your father is somehow incapacitated and is suddenly unable to care for her. (And my apologies if you've got these things covered, but these are points I never see brought up in discussions like these.)
posted by carrienation at 12:56 PM on July 27, 2017 [3 favorites]

Hanging a bunch of jangly little bells on various doorknobs (bedroom, front door, etc) may be a good low-tech way to keep an ear on her movements (can also work to keep teenaged kids from sneaking out at night).
posted by pseudostrabismus at 3:42 PM on July 27, 2017

carrienation brings up a good point. My grandfather had Alzheimer's, and when my grandma fell and broke her hip, he couldn't understand why she wanted him to call 911, or bring or the phone or do anything to help. I think his "rationale" was that he didn't want to pay long distance fees. She was on the floor until the next morning when my uncle stopped by for his daily visit. A wearable alert device would've saved her so much pain.
posted by AFABulous at 10:13 PM on July 27, 2017

Response by poster: Thanks for the suggestions all. I am going with door alarms for now, plus a jangly belled rope across the bottom of the stairs to keep her from going up. I know this isn't full proof but... it's something.... for now. Fortunately (?) her mobility limitations are something of a help here.

I do think about the scenario of something happening to my dad when they're alone together. Sigh. Sadly, I can't make this situation perfect for them but it's OK for now.
posted by latkes at 9:37 PM on August 1, 2017