Understanding Wandering Risks With Older Adults

Key Takeaways

• Approximately 36% of people with dementia will wander.
• The top dangers for people who wander include injuries, dehydration, harsh weather exposure, medical complications, drowning, or being hit by a car.
• Understanding and planning for wandering is vital in caring for someone with dementia.

For many of us, staying at home as we age, also known as aging in place, is ideal. In fact, a recent survey shows 90% of adults ^[1]Gavin, Kara. Michigan News. Most Older Adults Want to ‘Age in Place’ But Many Haven’t Taken Steps to Help Them Do So. April 13, 2022. Found on the internet at https://news.umich.edu/most-older-adults-want-to-age-in-place-but-many-havent-taken-steps-to-help-them-do-so 50 and over say they want to age in place. ^[2]National Institutes of Health (NIH). Aging in Place: Growing Older at Home. May 1, 2017. Found on the internet at https://www.nia.nih.gov/health/aging-place-growing-older-home But home safety is critical, and for older adults with cognitive decline, wandering is a safety concern you should consider.

Wandering, also known as elopement, is “when someone leaves a safe area or responsible caregiver” and can occur inside or outside the home. ^[3]Centers for Disease Control and Prevention (CDC). Disability and Safety: Information on Wandering (Elopement). Sept. 18, 2019. Found on the internet at https://www.cdc.gov/ncbddd/disabilityandsafety/wandering.html People who wander may not be aware of their safety, which puts them at risk of getting lost, falling, or other accidents with injuries.

“Aging in place can be feasible for some older adults with dementia,” said Sean Marchese, a registered nurse at the Orlando, Florida-based Mesothelioma Center with more than 20 years of direct patient care. “Depending on individual circumstances, familiar surroundings, caregiver support, and dependable routines can reduce the risks of wandering and elopement. Another essential aspect is emotional well-being. A fulfilling environment is crucial to safely aging in place.”

In this guide, we discuss safety precautions to prevent wandering for caretakers whose care recipients are aging in place.

What is wandering risk, and who does it impact?

The risk of wandering is common among people with dementia, including Alzheimer’s disease. According to the Alzheimer’s Association, six in 10 people with dementia will wander at least once. ^[5]Alzheimer’s Association. Causes and Risk Factors for Alzheimer’s Disease. Found on the internet at https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors Caregivers should be aware of this potential safety risk. Wandering can occur when people are:

• At home or alone in public: Those who live alone can wander away from home while shopping or completing errands. If accessible, your care recipient may use a car or other means of transportation to wander off.
• At home or in public with others: People can wander from their homes or while shopping unnoticed, even with family or friends.

Why does wandering happen?

Risk factors for wandering include cognitive impairment, restlessness, agitation, previous wandering attempts, and expressions of a desire to leave. ^[6]MeetCaregivers. Elopement and Wandering in Seniors. June 27, 2022. Found on the internet at https://meetcaregivers.com/dementia-wandering-prevention-management Wandering off may be intentional or unintentional due to confusion or loss of memory. ^[7]The Helper Bees. Wandering and Elopement: A Brief Guide. Viewed Aug. 19, 2023. Found on the internet at https://www.thehelperbees.com/families/healthy-hive/wandering-and-elopement-a-brief-guide Intentional incidents may occur when people feel they need to be somewhere, have something to do, or seek something they need. Some common triggers include changes in medication, changes in environment, and feeling overwhelmed.

What are the risks of wandering?

“Older adults with dementia face several risks from wandering and elopement,” said Marchese. “Memory loss, confusion, disorientation, and other impairments can lead to physical harm and forgotten surroundings without a plan of returning home. In some cases, restlessness and communication challenges can exacerbate these issues.”

A review of 325 U.S. newspaper articles describing incidents with people with dementia (PWD) found 40% of PWD who went missing were found dead the next day. ^[8]BMC Geriatrics. Persons With Dementia Missing in the Community: Is It Wandering or Something Unique? June 5, 2011. Found on the internet at https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-11-28 This statistic emphasizes the importance of recognizing the dangers older adults may face after wandering. These dangers include injuries, dehydration, harsh weather exposure, medical complications, drowning, or being hit by a car. ^[9]ECRI Institute. Continuing Care Risk Management: Wandering and Elopement. April 2014. Found on the internet at https://alnursing.org/wp-content/uploads/2020/03/WanderingandElopementPacket.pdf And experiencing these dangers could impact the mental and emotional well-being of the older adult and their caregivers.

Physical dangers of wandering

• Exposure to extremes in hot or cold weather can be deadly for someone who has wandered from their safe environment.
• Hurricane exposure increases the risk of death for people with dementia. ^[10]University of Michigan News. Risk of Death for People With Dementia Increases After a Hurricane Exposure. March 13, 2023. Found on the internet at https://news.umich.edu/risk-of-death-for-people-with-dementia-increases-after-a-hurricane-exposure The confusion and disruption of living conditions in the aftermath may lead to wandering.
• Annually, roughly 300 older adults die from drowning. Wandering may result in encounters with bodies of water when lost, like lakes or rivers. Some drowning also occurs in swimming pools that people may encounter while wandering.
• People who wander may feel they know where they are going, but their cognitive state can lead them to become lost. ^[11]Sundara Living. Elopement in Dementia. What do I do? July 26, 2021. Found on the internet at https://sundaraliving.com/living-with-dementia/elopement-in-dementia-what-do-i-do
• Falls may occur after a person has wandered away from home. Being in unfamiliar surroundings, medication effects, difficulty walking, and weakness are some contributing factors for older adults who fall. ^[12]Centers for Disease Control and Prevention (CDC). Facts About Falls. May 12, 2023. Found on the internet at https://www.cdc.gov/falls/about/index.html These falls may lead to serious injuries, like head injuries or broken bones.

Driving

In the focused review of 325 U.S. newspapers cited above, 74 articles noted that driving was a factor when the person went missing. Of these incidents, 80% drove with their caregiver’s knowledge, and 11% drove without their knowledge. ^[8]BMC Geriatrics. Persons With Dementia Missing in the Community: Is It Wandering or Something Unique? June 5, 2011. Found on the internet at https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-11-28 Results included missing-driver incidents, head-on collisions, and wrong-way driving. Studies have shown older drivers with cognitive impairment have an increased risk of motor vehicle crashes (MVC). Driving too slowly and taking too long turning left at intersections are two big reasons for MVCs in older people. ^[13]Dementia & Neuropsychologia. Cognitive Impairment and Driving: A Review of the Literature. October 2009. Found on the internet at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5619413

Common wandering warning signs

People with dementia often wander, and it’s estimated that 36% of those diagnosed with Alzheimer’s and living in a community will wander. For people who consistently wander, an estimated 80% will leave their area. ^[9]ECRI Institute. Continuing Care Risk Management: Wandering and Elopement. April 2014. Found on the internet at https://alnursing.org/wp-content/uploads/2020/03/WanderingandElopementPacket.pdf It’s important to note that allowing people to walk around their environment will not necessarily lead to wandering. Walking has many benefits, including relieving stress and boredom. ^[11]Sundara Living. Elopement in Dementia. What Do I Do? July 26, 2021. Found on the internet at https://sundaraliving.com/living-with-dementia/elopement-in-dementia-what-do-i-do

Caregivers should learn to recognize the signs and symptoms that may lead to a wandering incident. These include people who: ^[6]MeetCaregivers. Elopement and Wandering in Seniors. June 27, 2022. Found on the internet at https://meetcaregivers.com/dementia-wandering-prevention-management ^[11]Sundara Living. Elopement in Dementia. What Do I Do? July 26, 2021. Found on the internet at https://sundaraliving.com/living-with-dementia/elopement-in-dementia-what-do-i-do ^[7]The Helper Bees. Wandering and Elopement: A Brief Guide. Viewed Aug. 19, 2023. Found on the internet at https://www.thehelperbees.com/families/healthy-hive/wandering-and-elopement-a-brief-guide

• Have a cognitive impairment diagnosis or cognitive decline
• Become agitated or restless
• Make efforts to open doors leading to other areas or outside
• Have wandered or have left home in the past
• Express a desire to leave their current location (making statements they need to go to work or home)
• Are gone for extended periods when walking or participating in other activities
• Have difficulty finding familiar places in the home
• Become anxious when in crowds, like at a shopping center
• Look for keys, coats, purses, or other items that may reflect an attempt to leave
• Frequently search for missing people or lost items

What caregivers can do about wandering

The Joint Commission International considers wandering a sentinel event, which is an event that can result in temporary, severe, or permanent harm or death. ^[14]The Joint Commission. Sentinel Event. Viewed Aug. 20, 2023. Found on the internet at https://www.jointcommission.org/resources/sentinel-event Maintaining a safe environment can help prevent wandering and injury.

According to the Alzheimer’s Association, as the disease progresses, you can make your home safer with tactics that include making doors the same color as walls to camouflage them, installing monitoring devices above doors to detect when they’re opened, installing or planting fences or hedges around patios and yards, and creating indoor areas that are safe to explore. ^[4]Alzheimer’s Association. Wandering. Found on the internet at https://www.alz.org/help-support/caregiving/stages-behaviors/wandering

Conduct a wandering risk assessment

A wandering risk assessment evaluates a person’s condition and likelihood of wandering. Several tools can help determine an older adult’s risk of wandering, including the Rating Scale for Aggressive Behavior in the Elderly (RAGE) and the Neuropsychiatric Inventory (NPI), which measures dementia-related behavioral symptoms. ^[15]American Psychological Association. Neuropsychiatric Inventory. 2011. Foud on the internet at https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/neuropsychiatric-inventory

Consider having a risk assessment done by a health provider, so you can be fully prepared for a wandering incident while someone is in your care.

If you’re unsure if a professional assessment is needed, conducting a basic at-home assessment of your care recipient’s habits can help determine if they may be at risk for wandering behavior. Ask yourself questions, like: ^[6]MeetCaregivers. Elopement and Wandering in Seniors. June 27, 2022. Found on the internet at https://meetcaregivers.com/dementia-wandering-prevention-management ^[16]Agency for Healthcare Research and Quality (AHRQ). Elopement. Dec. 1, 2007. Found on the internet at https://psnet.ahrq.gov/web-mm/elopement

• How frequently has your care recipient wandered?
• When was the first time your care recipient wandered?
• Do they tend to wander more during the day or night?
• Are common triggers noise or discomfort?
• When your care recipient wanders, is it random, or does it happen at regular intervals?
• Can you identify a motivation for when your care recipient wanders?
• Does your care recipient have a court-appointed legal guardian?
• Is your care recipient dangerous to you or others?
• Has cognitive decline impacted your care recipient’s ability to make decisions?

These questions are excellent for caregivers to be familiar with, so they’re not caught (completely) off-guard if an incident occurs. Answering these questions may provide a reliable assessment of wandering risk. Once you complete this assessment, it should assist in determining if further assessment is needed.

Check out our Wandering Risk Assessment

Understand triggers

Recognizing the behaviors or events that may lead to wandering is one of the most critical factors caregivers need to prevent this from occurring. Examples of potential triggers for missing incidents include: ^[9]ECRI Institute. Continuing Care Risk Management: Wandering and Elopement. April 2014. Found on the internet at https://alnursing.org/wp-content/uploads/2020/03/WanderingandElopementPacket.pdf ^[6]MeetCaregivers. Elopement and Wandering in Seniors. June 27, 2022. Found on the internet at https://meetcaregivers.com/dementia-wandering-prevention-management

• Disorientation from the current location, going off in the wrong direction, and the inability to reorient due to dementia. People may not be able to self-correct, particularly in the later stages of the disease, but someone else with the right approach can often reorient them
• Experiencing feelings of hunger, pain, boredom, anxiety, or urge to use the bathroom
• Exposure to high-traffic areas
• Being near stairwells and elevators, which may prompt them to try to exit the area
• Easily locating suitcases, outdoor clothing, or other items associated with leaving their current location or taking a trip
• Exposure to noise, discomfort, or other distress

Understanding their habits and usual activity time frames can help you be more aware of when their triggers may occur. Watch your care recipient for signs of hunger, boredom, and anxiety, and act quickly when triggered. Be sure to keep your care recipient in an area with easy access to the bathroom and other frequently visited rooms to reduce their risk of wandering. Store suitcases, outdoor clothing, or other travel items, like keys, wallets, and handbags, in an area not usually accessible to your care recipient.

Take preventive steps

Avoiding wandering is crucial to prevent serious injury or death. Some suggestions for prevention include: ^[9]ECRI Institute. Continuing Care Risk Management: Wandering and Elopement. April 2014. Found on the internet at https://alnursing.org/wp-content/uploads/2020/03/WanderingandElopementPacket.pdf ^[6]MeetCaregivers. Elopement and Wandering in Seniors. June 27, 2022. Found on the internet at https://meetcaregivers.com/dementia-wandering-prevention-management ^[17]Sparks, Dana. Mayo Clinic. Alzheimer’s and Dementia: Understand Wandering and How to Address it. Nov. 30, 2020. Found on the internet at https://newsnetwork.mayoclinic.org/discussion/alzheimers-and-dementia-understand-wandering-and-how-to-address-it ^[4]Alzheimer’s Association. Wandering. Found on the internet at https://www.alz.org/help-support/caregiving/stages-behaviors/wandering

• Use a medical alert system that includes GPS tracking. Many new systems available on the market today have wearable GPS devices for older adults in the form of necklaces or smartwatches.
• If there is a risk of wandering by using a car, storing the keys in a location unknown to your care recipient may be beneficial. You can also track someone if wandering occurs in a vehicle using a GPS locator system, like OnStar’s Guardian or Safepoint.
• Provide a stimulating environment. Instances of wandering can begin with the person feeling bored. Keep an eye on your care recipient to prevent overstimulation, which can also trigger wandering.
• Create a safe space where your care recipient may wander without the risk of leaving. Gardens, walking paths, or outdoor lounge areas may serve this purpose.
• Create a schedule of daily activities for your care recipient. Participating in these activities may help them feel a sense of purpose and can prevent boredom.
• Use alarm systems and locks to prevent wandering away from the home.

Make a plan ahead of time

Readying a plan of action can help you find your care recipient sooner. Making sure recent photographs are available can assist authorities in searching for your care recipient, and ensuring they are wearing a medical ID bracelet can help with identification while providing crucial medical information in an emergency. These can be obtained through the Alzheimer’s Association or are available through stores, like Amazon. Additional considerations include: ^[4]Alzheimer’s Association. Wandering. Found on the internet at https://www.alz.org/help-support/caregiving/stages-behaviors/wandering ^[18]Alzheimer’s Society. Supporting a Person With Dementia Who Walks About. Found on the internet at https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/supporting-person-dementia-who-walks-about ^[9]ECRI Institute. Continuing Care Risk Management: Wandering and Elopement. April 2014. Found on the internet at https://alnursing.org/wp-content/uploads/2020/03/WanderingandElopementPacket.pdf

• Secure a case number from the police if your care recipient goes missing. Be sure to specify they are diagnosed with dementia or other cognitive deficits.
• Talk to anyone in the surrounding area where your care recipient was last seen to get information regarding their direction of travel.
• Request the police issue a Silver Alert (a public notification system broadcasting missing older adults with Alzheimer’s disease, dementia, or other cognitive decline) to media outlets and other police departments in the area.
• If your care recipient has a cellphone, contact the service provider and see if they can assist you in finding the phone’s location. Apps, like Find My iPhone or Life360, can help you track your care recipient as long as they have their phone on them.
• Contact nearby hospitals and describe your missing care recipient, including any medical issues they have.
• Check locations your care recipient frequently visits. These locations may include their favorite restaurant or shopping center. Leave missing person signs in these locations if available.
• Maintain a list of up-to-date phone numbers for friends and family, so you can alert them if your care recipient is missing or inquire when they last saw them and where they were headed next.

Coping with wandering

When a care recipient wanders, friends and family may experience many emotional challenges, commonly including anxiety, pain, and grief. ^[19]Cake End-of-Life Planning. How to Cope When a Loved One is Missing: 11 Tips. May 2, 2022. Found on the internet at https://www.joincake.com/blog/grief-for-missing-persons

Here are five steps to cope with a missing care recipient: ^[19]Cake End-of-Life Planning. How to Cope When a Loved One is Missing: 11 Tips. May 2, 2022. Found on the internet at https://www.joincake.com/blog/grief-for-missing-persons

• Seek support from friends and family. Ask them to assist with the search or other tasks to help you.
• Take care of yourself physically and emotionally. Avoid isolation.
• Find ways to express your feelings. Denying yourself the expression of grief can cause damage to your physical and emotional health.
• Limit your exposure to news coverage. Ask a friend or family member to share the responsibility of monitoring the news to prevent you from becoming overwhelmed.
• Keep hope alive. Seek out grief or missing person support groups online.

Bottom line

People with dementia benefit from exercise and activity, but caregivers should also be aware of the risk their care recipient will wander.

About six in 10 people with dementia will wander at least once. ^[4]Alzheimer’s Association. Wandering. Found on the internet at https://www.alz.org/help-support/caregiving/stages-behaviors/wandering Wandering is common among people with dementia, including Alzheimer’s. Serious injury or death can occur when wandering leads to leaving a safe place.

Preventive measures may include monitoring for triggers, like looking for car keys or stating they need to leave for work or home. ^[6]MeetCaregivers. Elopement and Wandering in Seniors. June 27, 2022. Found on the internet at https://meetcaregivers.com/dementia-wandering-prevention-management Prior planning is essential for quick response and recovery if a care recipient leaves home.

Many options are available to help find your care recipient should they go missing. Modern technology has brought us medical alert systems with wearable GPS locators. Additional location assistance may be available through vehicle GPS services, like OnStar, which can help find people quickly and safely. Consequently, when wandering occurs, anxiety, pain, and grief are common for caregivers and clinicians, so emotional support is critical to helping you cope with these emotions. ^[19]Cake End-of-Life Planning. How to Cope When a Loved One is Missing: 11 Tips. May 2, 2022. Found on the internet at https://www.joincake.com/blog/grief-for-missing-persons

Have questions about this review? Email us at reviewsteam@ncoa.org.

Sources

1. Gavin, Kara. University of Michigan News. Most Older Adults Want to ‘Age in Place’ But Many Haven’t Taken Steps to Help Them Do So. April 13, 2022. Found on the internet at https://news.umich.edu/most-older-adults-want-to-age-in-place-but-many-havent-taken-steps-to-help-them-do-s
2. National Institutes of Health (NIH). Aging in Place: Growing Older at Home. May 1, 2017. Found on the internet at https://www.nia.nih.gov/health/aging-place-growing-older-home
3. Centers for Disease Control and Prevention (CDC). Disability and Safety: Information on Wandering (Elopement). Sept. 18, 2019. Found on the internet at https://www.cdc.gov/ncbddd/disabilityandsafety/wandering.html
4. Alzheimer’s Association. Wandering. Found on the internet at https://www.alz.org/help-support/caregiving/stages-behaviors/wandering
5. Alzheimer’s Association. Causes and Risk Factors for Alzheimer’s Disease. Found on the internet at https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors
6. MeetCaregivers. Elopement and Wandering in Seniors. June 27, 2022. Found on the internet at https://meetcaregivers.com/dementia-wandering-prevention-management
7. The Helper Bees. Wandering and Elopement: A Brief Guide. Viewed Aug. 19, 2023. Found on the internet at https://www.thehelperbees.com/families/healthy-hive/wandering-and-elopement-a-brief-guide
8. BMC Geriatrics. Persons With Dementia Missing in the Community: Is It Wandering or Something Unique? June 5, 2011. Found on the internet at https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-11-28
9. ECRI Institute. Continuing Care Risk Management: Wandering and Elopement. April 2014. Found on the internet at https://alnursing.org/wp-content/uploads/2020/03/WanderingandElopementPacket.pdf
10. University of Michigan News. Risk of Death for People With Dementia Increases After a Hurricane Exposure. March 13, 2023. Found on the internet at https://news.umich.edu/risk-of-death-for-people-with-dementia-increases-after-a-hurricane-exposure
11. Sundara Living. Elopement in Dementia. What Do I Do? July 26, 2021. Found on the internet at https://sundaraliving.com/living-with-dementia/elopement-in-dementia-what-do-i-do
12. Centers for Disease Control and Prevention (CDC). Facts About Falls. May 12, 2023. Found on the internet at https://www.cdc.gov/falls/about/index.html
13. Dementia & Neuropsychologia. Cognitive Impairment and Driving: A Review of the Literature. October 2009. Found on the internet at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5619413
14. The Joint Commission. Sentinel Event. Viewed Aug. 20, 2023. Found on the internet at https://www.jointcommission.org/resources/sentinel-event
15. American Psychological Association. Neuropsychiatric Inventory. 2011. Foud on the internet at https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/neuropsychiatric-inventory
16. Agency for Healthcare Research and Quality (AHRQ). Elopement. Dec. 1, 2007. Found on the internet at https://psnet.ahrq.gov/web-mm/elopement
17. Sparks, Dana. Mayo Clinic. Alzheimer’s and Dementia: Understand Wandering and How to Address it. Nov. 30, 2020. Found on the internet at https://newsnetwork.mayoclinic.org/discussion/alzheimers-and-dementia-understand-wandering-and-how-to-address-it
18. Alzheimer’s Society. Supporting a Person With Dementia Who Walks About. Found on the internet at https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/supporting-person-dementia-who-walks-about
19. Cake End-of-Life Planning. How to Cope When a Loved One is Missing: 11 Tips. May 2, 2022. Found on the internet at https://www.joincake.com/blog/grief-for-missing-persons

Steven Marshall Author

Steve Marshall has more than 35 years of clinical and leadership experience in health care. He has worked in various settings, including emergency departments, intensive care units, air and ground transport, oncology, infectious disease, and infusion services.  He founded See Doc Nurse Write LLC in 2023 to expand the reach of his clinical knowledge and expertise.

Christopher Norman Medical Reviewer

Christopher Norman is a Board-Certified Geriatric Nurse Practitioner and Holistic Nurse. As a nurse’s aide, registered nurse and now nurse practitioner, he has loved working with older adults since 2004.