Why might someone walk about?
A person with dementia might walk about for a number of reasons. If you try to understand why they are walking about and what they need, this can help you find ways to meet their needs.
Here are five possible reasons why a person with dementia might walk about
A person with dementia might begin a journey with a particular goal in mind and then, due to short-term memory loss, forget where they were going and become lost. Similarly, they might be searching for an item that they have misplaced or think that someone else has taken.
You can try to prevent this by keeping some of their favourite personal items where they can see them.
Confusion about the time
People with dementia often become confused about the time. They may wake up in the middle of the night and get dressed, ready to start the day. This confusion is easy to understand, especially in winter when it is common to go to sleep, and wake up, when it’s dark.
Some types of assistive technology can be useful. For example it can help if you place a large clock that shows am and pm by the person’s bedside. Some clocks also show the day of the week and the date.
If the person you are caring for walks about a lot during the night, this may be because they are having difficulty sleeping. This is common in older people and is particularly common in people with dementia.
You can do simple things to try to help them sleep – encourage them to avoid having daytime naps and to avoid caffeinated drinks such as tea, coffee or energy drinks, especially in the evening or late at night. They should also avoid drinking alcohol, smoking, or eating a large meal near bedtime.
Doing exercise and some complementary therapies may also help them to sleep.
Relieving pain and discomfort
People often walk about when they are in pain because they are trying to ease their discomfort. Alternatively, a person may walk about to try and ‘escape’ from their pain. The cause of a person’s pain will not always be obvious – for example if they have toothache. If you think the person is walking about because they are in pain, ask them and talk to their GP or dentist.
A person with dementia may also walk about more when they are feeling unwell – see ‘Restlessness, agitation and anxiety’ below. If you notice a sudden change in the person’s habits and restlessness – for example if they become less able than usual to focus or to be still – ask whether they feel unwell. You can also ask their GP to examine them for any physical illnesses.
It might be that the person you are caring for is walking about because they are uncomfortable. They might need the toilet or be constipated, or they may be wearing ill-fitting shoes, clothing or dentures.
Similarly, they may be responding to an uncomfortable environment – it may be too hot or too cold, or there may be poor lighting or bad smells. People with dementia can also find it difficult to cope with a lot of noise – simple things like closing a door when you are vacuuming can help. It often takes trying different things to work out what the cause might be.
Restlessness, agitation and anxiety
People who walk about may also feel agitated, fidget, tap their fingers or make other repetitive movements. These behaviours are known as ‘restlessness’. They may be a symptom of the physical changes in the brain caused by dementia.
A person may feel the need to walk about as a side-effect of certain medication (such as some antipsychotic medications). If you think this is the case, ask the person’s GP to check whether their prescription could be causing them to feel restless.
There is also a medical condition called ‘restless leg syndrome’ that gives people an overwhelming, irresistible urge to move their legs to stop unpleasant sensations – mostly at night. This condition causes people to get up and walk about during the night. If you think the person you are supporting might have restless leg syndrome, talk to their GP.
Some people may walk about because they feel anxious. A number of things can cause anxiety. For example a person with dementia might be more aware of the changes they are experiencing or because they are unable to continue with hobbies and tasks they enjoy.
A less common reason is that they may be responding to issues with their visual perception or hallucinations and how they interpret what they see. This is a more common symptom of certain types of dementia, such as dementia with Lewy bodies. Try to reassure the person you are caring for and encourage them to tell you why they feel anxious.
As with the information on relieving pain and discomfort mentioned above, you may need to go through a process of trial and error to work out why the person you are caring for is restless, agitated or anxious. It can be useful if you start by checking for any physical causes – make sure they are wearing comfortable shoes and clothing, and try adjusting the heating to change the temperature.
A person with dementia may walk about if they feel bored because they don’t do as much as they used to – for example, seeing friends or going out. Having things to do gives everyone a sense of purpose and self-worth, and people with dementia are no exception.
Try to find ways to help the person stay mentally engaged and physically active. For example, encourage them to play games or to take part in hobbies. You could also try to involve them in housework or daily tasks to help them stay active and engaged.
Lack of physical activity
If a person constantly walks about, it may be because they have energy to spare. They may feel the need to do more regular exercise. If they are able, it could help if they take part in exercise classes or activities such as walking groups. You can also help them to include more exercise in their daily routine without making big lifestyle changes.
Good examples include:
- doing seated exercises
- walking to the shops
- walking up steps
- doing some gardening or brisk housework.
If they are able, it could be helpful if the person accompanies someone to leave the house at least once a day to get some fresh air. If they see regular routines such as the rubbish being collected, post being delivered or children going to school, it can also help to orientate them.
Continuing a habit or interest
As much as possible, people with dementia will often want to continue with habits or interests they had before their diagnosis. Walking is one example of this.
You may find that the person you are caring for wants to walk about at times of the day when they used to be out and about – for example, when they would have gone to work, walked the dog or collected their children from school. Try to support their need to walk for as long as you can, although if they are mistaken about why they need to walk try not to reinforce their incorrect belief.
If you can’t accompany them, you could ask family or friends if they can help.
In some areas there are dementia-friendly walking groups. These groups help people with dementia to continue walking in a safe environment with other people.
If you are caring for someone with dementia, it is very important to encourage them to stay independent for as long as possible. However, you may be worried about the person being at risk of harm or injury.
In daily life, there will always be some degree of risk. You and any other people involved in the person’s care need to decide what level of risk is acceptable in order to maintain their quality of life and protect their independence and dignity.
Remember that if the person has capacity (the ability to make decisions) then they can decide to do things even if they put themselves at risk. If the person does not have capacity, they should still be involved in discussions about their care as much as possible, and all decisions must be made in their best interests.
The steps you take to look after the person will depend on how well they are able to cope and the reasons why they are walking about. You should also think about whether their environment is safe and whether any safeguards need to be put in place. There is no such thing as a risk-free environment, but some places are safer than others. For example, does the person:
- live on a busy main road or in an urban area where people don’t know their neighbours, or
- live in a quiet rural area where they are well known within the local community?
Looking at the person’s environment can help you to see whether you can reduce any risks.
Searching for a person or something from the past
If the person is on their own, sometimes even for short periods, they may walk about to try to look for a specific person. This may make them feel extremely anxious. If you are caring for a person with dementia, it can help if you write notes when you’re going out to remind them about where you are and when you will return.
Try to put the notes where they will stay in place and where the person will see them, such as near the kettle or on the inside of the front door. You may find it helpful to write key information on a whiteboard.
As dementia progresses, the person you are caring for may try to find someone or something from their past. For example, they may not remember that someone has moved or died. Encourage them to talk about this so you can try to understand who or what they are searching for. Show them that you are listening and taking their feelings seriously.
Try to avoid ‘correcting’ what they say. It is much more important to focus on the person’s feelings rather than whether what they are saying is true. For example, if they are looking for their mother, ask them about her and show them some photographs. This may help to identify and meet their emotional needs and reduce their need to walk about.
If a person with dementia is in unfamiliar surroundings, they might walk about because they feel lost. For example, when they move house, attend a new day centre or move into a care home.
If the person’s living environment has changed, try showing them familiar items such as photographs or furniture. This can help to reassure them that they belong in the new place. It can also help if you match the layout of their new home with their previous one – using some of the same furniture, if possible.
The person may need extra help from family, friends or care home staff to find their way around the new environment, but they may become less disorientated as the surroundings become more familiar to them.
As dementia progresses, the person you are caring for may begin to feel lost in their own home. For example, they may forget where the bathroom is and walk around to try to find it. Leaving the bathroom door open and the light on could help. There are also practical ways that you could make their home more dementia friendly.