An article on wandering from Right at Home

"Wandering" in Dementia Patients: the Home Care Perspective
Wandering is one of the greatest challenges faced by family caregivers whose loved one has Alzheimer's or other memory loss. Over 60% of Alzheimer's patients will become lost at some time. Most are gone only briefly, though long enough to frighten their loved ones. Others may be lost for an extended period of time, and unfortunately, there are news reports each year of missing Alzheimer's patients who are never located. It is a sobering fact that if a person with dementia is lost for over 24 hours, he or she is likely to suffer a fall or other serious injury, or even death from injury or exposure. Reports one family caregiver, "The thought that Dad would climb onto a bus at the corner and we would never find him again keeps me awake at night, even on nights when he is getting a good night's sleep."
Why do people with dementia wander?
For people with Alzheimer's or other memory loss, confusion and disorientation make it increasingly difficult to recognize familiar faces and places, even a spouse or child, or a lifetime home. Geriatricians point out that the term "wandering" is something of a misnomer, because many times, in the person's mind, his or her activity is not purposeless. She may be looking for the bathroom but be unable to find it. He may think it is time to leave for work, even if he retired years before. A great-grandmother might be searching for her children, in the belief that they are still small and in need of her care.
Other factors that contribute to wandering include restlessness, agitation and stress; boredom and lack of a sense of purpose; sleep disorders; physical pain; and the side effects of medications.
Keeping loved ones safe
When a loved one with dementia wanders, family often decide that a nursing home or memory care community is the best choice for the person. However, many patients fare much better at home, in familiar surroundings. How can families keep their loved one safe at home, for as long as possible? Home care professionals offer these suggestions:
Observe your loved one's patterns. The first step is to understand as best you can the reason for your loved one's wandering. What are his "triggers"? Where does he usually try to go? During what time of day is he most restless? Does he seem to be looking for something, someone, or someplace?
Adapt the home to keep your loved one safe. Beyond the usual "aging in place" home modifications, you can add special locks to doors, safety gates to prevent exit, and an alarm that will sound if the front door is open. See the resources at the end of this article for information about other home modifications.
Be sure your loved one always carries ID, and a medical alert to tell others he has memory loss. If he doesn't consistently carry a wallet, try a bracelet, pendant, or clothing labels. Contact your local Alzheimer's Association office to learn about their Safe Return program. In addition, more and more families are also using a GPS or other tracking device to help locate loved ones quickly.
Notify neighbors and local merchants about your loved one's condition. Ask them to contact you if they see your loved one alone when he shouldn't be. Having this conversation makes it more likely that others will feel comfortable getting involved.
Find out if your state has a "Silver Alert" program, similar to the "Amber Alert" for missing children. As law enforcement agencies recognize the needs of growing numbers of adults with dementia, more states are implementing this broadcast notification system.
Try "behavior modification" strategies. If your loved one expresses feelings of being lost or abandoned, reassure him he is safe. Redirect him to safe activities that fill his need for a sense of purpose. If "sundowning" (restlessness at night) is a problem, limit daytime naps. In-home care professionals have learned from experience that "correcting" a dementia patient frequently can increase agitation. "Don't correct—redirect" is their guideline.
Hire professional in-home care. With jobs and other obligations, families are often overwhelmed by providing the full-time supervision their loved one needs. For many, hiring in-home care is the answer. In-home caregivers are trained to provide a watchful but non-intrusive presence in the home. Says one home care aide, "We've learned that for many seniors, 'hovering' makes things worse and leads to increased wandering." Families report that they have a more peaceful relationship with their loved one when the home caregiver takes over some of the basic personal care tasks.
A professional caregiver can support the well-being of loved one and family in several important ways:
In-home care provides respite for loved ones. Family caregivers need a break to renew their energy and take care of other responsibilities. A home health aide can fill in occasionally, or several days a week, or full-time. Overnight care is also available if the person with dementia wanders at night.
In-home care helps decrease disorientation. Wandering increases when memory loss interferes with the activities of daily living. A home health aide will help your loved one maintain their comfortable routine, helping with toileting, grooming, and preparing healthy meals.
Home health aides can supervise "safe wandering." Physical activity promotes better sleep and lessens agitation. With a caregiver along, your loved one can take a walk in the park or go on an outing. One home health aide reports, "I am there if my client needs me, but she feels a sense of independence because as much as possible, I allow her to decide where we will walk, when we will sit down."
In-home care promotes appropriate stimulation and activities for your loved one. Boredom is stressful for dementia patients, and increases wandering. Consulting with family, the home health aide will find the right activities to improve their loved one's quality of life. Folding laundry, setting the table, helping in the kitchen, dementia-appropriate crafts, music, dancing, and conversation are a few of the purposeful tasks that can be calming for people in the early and middle stages of Alzheimer's.
Home health aides assist with medication management. A person with Alzheimer's may take medications for the disease itself, for mood or other behavior changes, and for other medical conditions they might have. It is important to take medicines correctly, and it is just as important to be alert for side effects that might increase wandering and other difficult behaviors. A home health aide can provide medication reminders, help organize medications, and be alert for side effects.
In-home care helps those with memory loss remain at home, as comfortably and safely as possible. Home health aides know that caring supervision can enhance your loved one's sense of independence, while providing greater peace of mind for family members.

New research on music and learning in Alzheimer's

A Special Update for you From BU
Thank you for attending the screening of “I Remember Better When I Paint.” This beautiful documentary highlighted the impact of art therapy for patients with Alzheimer’s disease. At Boston University School of Medicine we continue to conduct research on the disease working toward early diagnosis, better treatment, and ultimately a cure for this devastating disease. We thought you might be interested in a few recent research highlights:
Music and MemoryRecently researchers have shown that patients with Alzheimer’s disease are better able to remember new verbal information when it is provided in the context of music even when compared to healthy older adults. Alzheimer’s disease patients and healthy controls were presented with either the words spoken or the lyrics sung with full musical accompaniment along with the printed lyrics on a computer screen. After each presentation, participants were asked to indicate whether or not they were previously familiar with the song they had just heard. The Boston University School of Medicine researchers found accuracy was greater in the sung condition than in the spoken condition for Alzheimer’s disease patients. However, for healthy older adults, there was no difference in accuracy whether the lyrics were sung or spoken. According to the researchers understanding the nature of musical processing and memory in patients with Alzheimer’s disease may allow the development of effective and comprehensive therapies for this increasingly prevalent disease.
The Eyes Have ItA team of researchers led by Dr. Lee Goldstein of Boston University School of Medicine has discovered that the protein that forms plaques in the brain in Alzheimer’s disease also accumulates in the eyes of people with Down syndrome. The new findings show that the toxic protein causes Alzheimer’s pathology in the brain also leads to distinctive cataracts in the eyes. This discovery is leading researchers to develop an innovative eye test for early detection of Alzheimer’s pathology in both disorders.
These are just two examples of the exciting research ongoing at Boston University School of Medicine Alzheimer’s Disease Center. We cannot do all that we do without the support we receive from our alumni and friends. We hope you might consider partnering with the BU Alzheimer’s Disease Center with a philanthropic gift. Your support will enable the researchers and clinicians to continue their pursuit in finding a cure.
Gifts can be made online at: http://alumni.bu.edu/links/link.cgi?
Harriet Kornfeld, BUSM Development, 72 E. Concord Street L219, Boston, MA 02118. If you have any questions, feel free to call Harriet Kornfeld directly at 617-638-5676.
Thank you,
The Faculty and Staff of the Boston University Alzheimer’s Disease Center

My radio Spotlight

I'm going to do my 4th Alzheimer Spotlight on WATD with Greg Porell this weekend. After being tested at BU Alzheimer's Disease Research Center a few weeks ago as part of the HOPE study, I began to think of the complexity of memory. I will talk about that this week on radio and expand on it in my column for the South Shore Senior News. Memory is so complex; the more I think about its impact on everyday functioning, the more sensitive I am to what the person with memory loss must feel. One must remember how to do things, what they did yesterday, last week, an hour ago. Memory involves holding on to information and manipulating it to be useful to you. Very complicated indeed. I'm anxious to write about it this coming month. Go to Google and find South Shore Senior News and read some of my previous columns. I can't believe I've been writing it for 4+ years! Love to write!
Beverly

New Trends in Alzheimer Care...Finding the Spirit Within

Finding the Spirit Within

When I visit my family member with Alzheimer’s, I see her sitting looking blankly ahead, or down, often falling off to sleep. I approach and as she sees my face, her eyes come alive and the wrinkles falling from gravity reverse direction in a gleeful smile, toothless though it may be. She has no idea who I am anymore; she just knows she feels happy with me and that somehow I belong to her. Her pleasures now are things she tastes, sights she sees, and feelings she feels. Hearing is all but gone, so getting a response from a question asked is difficult at best. How can I reach the spirit within her?
As cognition declines due to dementia, spirituality comes alive. Imagination is enhanced and emotional experience as well. Appealing to the senses remaining is the key. Emotional memory does not die in Alzheimer’s. Tap emotional memory.
What are emotional memories? Think about a memory you have that is very positive or perhaps negative .Is it the taste of your mother’s apple pie? Is it the smell of the pipe your favorite uncle smoked? Is it the view from a mountain you climbed? What feelings are evoked? Why do you think that is a memory you retain?
In dementia we have to look at behavior as a way of ‘speaking’ to us when language is difficult. As use of language decreases, doing something is the way a person with dementia expresses his wants, needs and feelings.
We need to appeal to emotion more than the ability to think, reason, use logic or remember. Increase positive experiences and decrease or eliminate negative experiences to avoid conflict and aggression.
Aggression is simply a way of saying behaviorally “I’m frightened.” “Slow down.” “I don’t understand what you want.” “Don’t take that from me.”
Some suggestions: look at photos of favorite people or places and YOU talk about them. Note the response. Is it one of interest? Joy? Is she frowning or is a smile beginning to form? You’ll soon discover what brings a positive response and have tools to spend quality time with your family member with memory loss.
Beverly Moore
StilMee™
The Leader in Alzheimer Coaching