When Wandering Becomes Worrisome

What Wandering Means

When you think of wandering, what comes to mind? In dementia care, wandering means aimless roaming or walking, and a wanderer is a person living with Alzheimer’s disease or another dementia who appears lost, confused, pacing, or seeking an exit, which is sometimes called elopement.

The word carries a warning label it has not earned. Someone who is wandering is standing, walking, seeking, exploring, and engaging with their environment. Those are abilities, and they are also communication. Wandering becomes worrisome in four situations. When it is excessive. When it happens in a dangerous location or situation. When it is beyond the person’s capability level. And when nobody around them recognizes it as a sign of boredom or an unmet want or need. Each of those puts the person at risk of harm, injury, or a poorer quality of life. The rest of this piece takes both sides seriously, the real risks and the real benefits.

When Wandering Becomes a Risk

Each of the four worrisome situations deserves a closer look.

Excessive walking takes a toll. A person with dementia can walk miles in a day, which can lead to pain, falls, exhaustion, and unhealthy weight loss.

Dangerous locations turn walking into hazard. A person may walk out of a building into traffic, high heat, ice, or snow, or into fall hazards such as stairs, construction areas, low lighting, or changing surfaces.

Walking beyond capability is the risk people miss. A cognitively intact person recognizes their physical limits, asks for help, and follows directions to stay safe. A person with dementia may not be aware of a physical deficit, may not recall or follow safety directions, and may not have the judgment to decide where and when walking is safe.

And wandering that goes unread is a need that goes unmet. If nobody recognizes what the person is trying to fulfill, the walking gets ignored or suppressed while the need behind it stays unaddressed. That is poor care, and it breeds anxiety, agitation, and unsafe situations for everyone.

I once learned of a lady with early-stage dementia who left her assisted living facility alone and was struck and killed by a car crossing a highway at night. The risks are real. The answer is not to stop the walking. It is to understand it.

The Benefits of Walking and Exploring

Take away walking and you invite weakness, falls, and other health problems. Discourage seeking and you reduce engagement and quality of life, and you stop the person from doing or getting what they want or need.

The benefits are concrete. A person who needs the restroom may wander trying to find it. Whether or not they succeed, they are telling you they need to go. A person pacing the hallways may be looking for someone or something, and the walking itself maintains leg strength and balance, helps the body’s systems function, and burns energy. Walking toward a person or a place is communication. It says I need company, or I need something to do.

This is why I prefer not to say wandering at all. The word tilts us toward seeing a problem. I prefer walk and explore, or simply walking, or propelling in a wheelchair. Those are benign, objective descriptions with no label attached, and they keep us able to see the abilities and the messages in front of us.

Keeping Walking Safe Without Taking It Away

If you observe or suspect any of the four worrisome situations, the answer is a comprehensive evaluation of the person and their environment, followed by a care plan that keeps them safe while prioritizing their personhood and including their wants and needs.

This is the approach we teach in Dementia Capable Care training. Learn the person and their goals, assess their abilities, their challenges, and their environment, then provide the right human support and a supportive physical space so they can do what they want and need to do each day, safely.

Take someone who loves walking and exercise. That is a care goal, not a problem. If assessment shows they are in middle-stage dementia, they will need help finding locations, their safety awareness and judgment will be poor, and changes in verbal communication will make it hard for them to tell you what they need. So the plan anticipates. Proactive support that meets their interest in walking. Help reaching safe locations and the right rooms. Oversight so the walking is not harming their health. Monitoring so they cannot reach chemicals, fall hazards, or unsafe outdoor areas. And where appropriate, GPS wearable trackers, which let caregivers monitor location in real time, receive alerts when a person leaves a pre-defined safe zone, and help bring them back safely if they do.

Positive outcomes follow when we see wandering first as an ability we do not want to take away and as communication we do not want to ignore, and then apply everything we know to keep it from becoming worrisome. That sets the person, the care team, and the organization up for success.

Watch: When Wandering Becomes Worrisome

Wandering and searching behaviors are common in dementia. Knowing when they cross the line into a serious safety concern, and how to respond, is critical for every caregiver. This session covers the risk of elopement and practical strategies for managing it while protecting the person’s safety and dignity.

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