2. Why might people walk about?
There could be a number of reasons why a person with dementia walks about. Once you understand these and can identify the person's needs, you can start to find ways to help meet them. Keeping a journal for a couple of weeks may help identify any triggers.
Possible reasons for walking about include:
- continuing a habit or interest
- relieving boredom
- lack of physical activity
- relieving pain and discomfort
- responding to anxiety and relieving stress
- feeling lost (especially in a new environment)
- restlessness (as a symptom of dementia or a side effect of medication)
- memory loss
- searching for the past or seeking a sense of fulfilment
- confusion about the time.
Continuing a habit or interest
As much as possible after diagnosis, people with dementia will want to continue with habits or interests that were part of their regular routine. Walking is one such example. You may find that a person wants to take more walks at times of the day when they used to be out and about. For example, at times when they might have gone to work, walked a dog or collected children from school. Try to accommodate this for as long as you can. If you are unable to accompany the person yourself, you could ask whether relatives or friends can help.
Many people with dementia do not have enough to do and often walk about to relieve boredom. They may also have previously done activities but now no longer feel fulfilled. Being occupied gives us a sense of purpose and self-worth, and people with dementia are no exception. Try to find ways to keep the person mentally engaged and physically active. This might be through playing games or taking part in hobbies. Involving a person with dementia in your daily chores and household tasks can give them a sense of fulfilment .
Lack of physical activity
Constant walking about may also indicate that the person with dementia has energy to spare and feels the need for more regular exercise. There are many simple ways to incorporate more exercise into a daily routine without making big lifestyle changes. Good examples include:
- using a rocking chair or exercise bike
- walking to the shops rather than driving
- walking up steps rather than using the escalator
- doing some gardening or brisk housework.
Encouraging the person to leave the house at least once a day for some fresh air may help address the issue. Seeing regular routines such as the rubbish being collected, postmen delivering the mail or schoolchildren going to school can also help to orientate people.
Relieving pain and discomfort
People often walk about when they are in pain, in an attempt to ease their discomfort. In the case of arthritic or rheumatic pain, walking can actually help. Alternatively, some people may be trying to 'escape' from the pain. If you think this might be the case, raise your concerns with the person's GP.
People may also start to walk about more when they are physically unwell - see 'Restlessness and agitation' below. If you notice a sudden change in a person's walking habits and restlessness, contact the GP who can examine them for any underlying physical illness.
Other sources of possible discomfort include needing the toilet, and ill-fitting shoes, clothing or dentures. The person may also be responding to an uncomfortable environment. For example, it may be too hot or too cold, or there may be unpleasant lighting, noises or smells. You may need to go through a process of trial and error to work out a cause of restlessness. For example, if the reason was not connected with the person needing to go to the toilet, try adjusting the heating or ventilation to change the temperature.
Responding to anxiety
Some people walk about if they are agitated, stressed or anxious. This may be a response to the issues noted above. A less common reason is that the person may be responding to hallucinations or issues with visual perception. This is a more common symptom of some types of dementia. Try to encourage the person to tell you about their anxieties, and reassure them in whatever way you can.
New surroundings can trigger feelings of uncertainty in people with dementia. Common examples include when respite (replacement) or residential care has been arranged, when the person moves to a new house or when they are attending a new day centre. If the person's living environment has changed, showing them familiar items, such as photographs or clothing, may help to assure them that they belong in a new place.
The person may need extra help in finding their way about. They may also be more confused about the layout of their own home if and when they return. This disorientation might disappear once they become familiar with their new environment. However, as the dementia progresses, the person may fail to recognise familiar surroundings, and may even come to consider their own home as unfamiliar. It may be helpful to provide signs, for example for the toilet, even in the person's own home.
Alzheimer's Society's free publication, Making your home dementia friendly, contains useful information on this subject. The booklet is also available to download from alzheimers.org.uk/dementiafriendlyhome
Restlessness and agitation
People who walk about may also feel agitated, fidget, tap their fingers or make other repetitive movements. Collectively these behaviours are known as 'restlessness' and may be a symptom of the physical changes in the brain caused by dementia.
The need to walk about may also be a side-effect of certain medication (such as some antipsychotic medications). Again, 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' which causes an overwhelming, irresistible urge to move the legs to prevent unpleasant sensations - mostly at night. This condition
can lead to people getting up and walking about during the night. If restless leg syndrome is suspected, arrange for the person to visit their GP.
Short-term memory loss can lead a person with dementia to walk about and become confused. They might embark on a journey for a specific purpose, with a particular goal in mind, and then forget where they were going and find themselves lost. This can be a distressing experience. The person could also be searching for something that they have lost or think is lost. Keeping personal possessions on view may help prevent this.
Alternatively, they may have forgotten that their carer has told them they are going out, and will try to look for them. This may lead to the person feeling extremely anxious, and they will need plenty of reassurance in return. In the earlier stages, it can help if the carer writes notes reminding the person where they have gone and when they will return. These should be securely placed in a location where the person will see them, such as near the kettle or on the inside of the front door.
Searching for the past or seeking a sense of fulfilment
As the person's dementia progresses, they may try to seek out someone or something related to their past. Encourage them to talk about this, and show them that you take their feelings seriously. Try to avoid 'correcting' things that the person may say. It is important to focus on what the person is feeling rather than the factual accuracy. For example, if the person is looking for their mother, ask them what they miss about her and maybe bring out some old photographs. This may help address their emotional needs.
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 for the next 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.
Having a large clock that shows am and pm, and keeping it by the person's bedside can help. Some clocks also show the day of the week and the date (see our page: Assistive technology). However, if the person's body clock is seriously out of sync, you may need to seek professional help.
If night time walking is a particular issue, the person may be having sleeping difficulties - something common in older people and particularly common in people with dementia. Simple measures that may help include avoiding daytime napping and not consuming caffeinated drinks such as tea, coffee or energy drinks in the evening or late at night. Drinking alcohol, smoking or eating a large meal should also be avoided near bedtime. Taking dementia medication in the morning may be helpful if nightmares or vivid dreams are a problem at night-time, but check with the GP. Exercise and some complementary therapies may also be helpful in addressing this.