Making decisions and managing difficult situations

6. Walking about

It is common for some people with dementia to spend long periods of time walking around in their home or trying to leave their home to walk outside. Walking like this is not meaningless ‘wandering’ – it usually represents a response to a need. The person may be searching for someone or something, be bored or restless, or be attempting to relieve pain or discomfort. They may also have enjoyed walking in the past and want to continue doing this. This behaviour can cause concern for carers, especially when it comes to the person’s safety.

Sometimes carers consider locking doors and windows to prevent the person from coming to any harm. This is a very restrictive practice and needs to be considered carefully. It must only be done as a last resort after considering other options. It is important to remember that you should never lock a person with dementia in the home if they are alone. If you are worried to the point that you feel there is no safe alternative, call social services immediately and ask for an urgent assessment.

Finding the right solution

Help in finding a better, ie less restrictive, solution to walking about may be available. An assessment from social services (called a ‘care needs assessment’) can be requested and may provide some alternative options. One solution could be accompanying the person when walking for some of the way, and then moving their attention to something else so that you can both return. If walking is caused by boredom, providing meaningful activities for the person may help. If the person does walk alone and gets lost, they could carry identification to help ensure their safe return. Alzheimer’s Society Helpcards can be filled in with important details about the person with dementia, and can help if someone finds them when they are lost.

Some carers consider using assistive technology products, such as a tracking device, to help find the person. There is also a ‘panic button’ they can press if they get lost. Tracking devices are beneficial as they provide people with dementia and their carers with a better sense of independence and reassurance. However, they do raise ethical concerns if the person is unable (lacks the capacity) to consent to carrying the device. If tracking devices are used then the person must be consulted about this. Risks and benefits must be carefully weighed up, and any decision taken must be in the person’s best interests and be the least restrictive option available.

In some cases, after trying all alternative options, it may be decided that locking the door is the best solution. Discuss this decision first with any other people who are involved in the person’s care. The person must not be put at any kind of risk as a result of this decision. As this is a considerable restriction of the person’s choice and freedom of movement, doors should be locked for the minimum period necessary and only when they are not alone in the house. Extra support may help to limit how much this really needs to be done. Carers should look into what is available in the area – for example, through social services.

Things for carers to think about

  • What triggers the walking about?
  • Are there any helpful solutions to dealing with this?
  • Will assistive technology products, such as a tracking device, be appropriate?
  • Are there less restrictive alternatives to locking the doors?
  • What would happen if the person were able to walk about?
  • What would be the consequences of locking the doors?
  • How would you feel if the person had an accident, having been either locked in the house or allowed to walk about?
  • What extra help and support is available in the area?