Challenging Behaviors for the Caregiver
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Some Suggestions for wandering
There are many reasons why an Alzheimer patient wanders or walks away from home or a well-known path or area. As a first step, try to determine the reasons behind wandering by asking these questions: Medication: Some medications have side effects that result in confusion and restlessness. Is the patient on such medication? If so, consult your physician.
Stress: Is the person trying to handle stress, noise, unpleasant people, crowding, or isolation? If so, consider changing the situation. Time Confusion: Does the person become confused at certain parts of the day, such as the middle of the night or early evening? Does the person claim that people have been gone for days or weeks and then searches for them?
Basic Needs: Is the person looking for something specific such as food, drink, the bathroom, or companionship? Restlessness: Does the person have enough movement and activity during the day? Is it possible that the person wanders in order to get up and move around?
Lack of Recognition: Is the person in a new or changed physical environment that makes him want to search for familiar objects, surroundings or people? Fear: Is the person trying to escape from something frightening? Is the person experiencing a delusion or hallucination, or has the person simply misinterpreted sights and sounds?
Past Behavior: Is the person trying to meet former obligations involving a former job, home, friend, or family member?
Other factors that may contribute to wandering include medical conditions such as stroke or other factors such as consumption of alcohol, changes in the weather, or feeling abandoned, useless or helpless. Wandering may be frustrating and irritating for caregivers, but it becomes a problem only when the person moves into an unsafe or unhealthy area or climate, puts others at risk, or invades others' property. For this reason, many people who care for Alzheimer patients decide to overlook wandering behavior until it becomes dangerous to the patient and to others. Or they permit the person to wander within safe boundaries or follow the individual on special outings.
Be Prepared. Be aware that wandering may or may not happen. There's no way to predict who will wander or when and how it might happen. Some people never get lost and others get lost frequently. he best advice is to be prepared. If the person has a daily exercise routine and hasn't yet wandered, you needn't be overly concerned. However, once the person begins to wander or gets lost, you should watch him more closely.
Encourage movement and exercise. Allow the person to move within safe areas or make a shared exercise such as walking part of your daily routine. Although walking in a circle might seem unusual, keep in mind that physical activity -- from walking and sweeping, to rolling yarn or folding clothes--is a positive experience for the person with Alzheimer's. Be objective.
Don't take the person's wandering behavior personally. The individual is probably trying to make sense of a world that no longer seems predictable.
Be aware of hazards. Remember that places that look safe might be dangerous for the person with Alzheimer's. For this reason, you should review the environment around your home for possible hazards, such as fences and gates, bodies of water, swimming pools, dense foliage, tunnels, bus stops, steep stairways, high balconies, and roadways where traffic tends to be heavy. Secure your living area.
Do whatever you can to keep your home safe and secure. Place locks out of the normal line of vision -- either very high or very low on doors. In addition, use a double bolt door lock, keeping the key handy for emergencies. Also, use a child proof door knob that prevents the person with Alzheimer's from opening the door. Other effective safety actions include the following:
Put hedges or fences around your patio or yard. Place locks on gates. Consider electronic buzzers, infrared electronic eye alarms, or chimes on your doors. Place a pressure sensitive mat at the door or person's bedside. Camouflage some doors with a screen or curtain, or put a two-foot square of a dark color in front of the door knob. Use a recliner or rocking chair; the person may need assistance to get up. Use night lights, signs, and familiar objects to help the person move around in a safe area. Put gates at dangerous stairwells.
Communicate with the person. Remind the person that you know how to find him and that he's in the right place. If possible, take the person for rides in cars or buses in addition to providing regular activity and exercise. And continually reassure the person, who may feel lost or abandoned.
Identify the patient. If your loved one will not wear any item, consider putting it in his pocket or try again later. Some experts even recommend putting identification on the person's dentures or attaching a sensor to the patient's ankle or wrist. In addition, choose bright-colored clothing and mark it with sew- on or iron-on label, permanent marker, or reflective material. Also, place identification on the person's shoes, eye glasses and keys. Try to be aware of what clothing your patient is wearing each day--make notes if necessary.
Involve your neighbors. Inform your neighbors of the person's condition and keep a list of their names and telephone numbers handy. Although neighbors can be helpful in guiding the person home, you'll probably want to teach them how to approach the person with Alzheimer's disease by using these steps:
Approach the person from the front. Introduce yourself and call or ask a name. Gently look for or ask to see identification, Offer help and re-establish the day, date, and time. Avoid pulling or pushing the person. Report the patient found.
Act immediately. As soon as you realize that your loved one is not where you thought he was:
begin to look for him close by. Call his name. inform neighbors that he is missing and ask them to help you look. Be aware that right handed people are apt to make right turns and vice-versa. Call the Sheriff or Police Department .
SOME ADDITIONAL HINTS ON WANDERING
Have a thorough medical evaluation, particularly if wandering begins suddenly. Consider possible physical causes such as illness, fever, hunger, pain, swelling, etc. Allow person to wander if environment is save and secure. Help direct person with clearly labeled rooms. For example, door decorations or name plaques may be useful for finding bedroom a picture of a toilet or a brightly colored door may help person locate the bathroom. Decrease noise levels and number of people interacting with wanderer at one time. Remove items that may trigger desire to go out: shoes, coat, purse, etc. Distract with conversation, food, drink or activity. Try to involve person in household activities, such as folding laundry, washing dishes, which will help him/her feel useful. Limit activities to 20-30 minutes or less, depending on level of impairment. Make sure the person isn't wandering because he/she needs to use the bathroom. Look for signals such as fidgeting with clothes. At night be sure the bathroom or a commode is easily accessible. Improve lighting throughout the environment, especially at night. Older people need about three times as much light to see properly as younger people.
With Wanderers Reassure person frequently about where he/she is and why. Speak in calm, normal tone of voice. Try written reassurance for mildly impaired person, such as "Liz will be here at 3:00 to pick you up." Try not to confront or argue with the person. Limit number of people to redirect wanderer. Increase the wanderer's trust by humoring and cajoling. Allow the person to verbalize feelings without arguing. Alleviate fears--"Your family knows where you are." "Your ____ (misplaced object) is right here."
Alzheimer's Support Network of Naples 660 Tamiami Trail North, Suite 21 Naples, FL 34102 (941) 262-8388
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