3. Staying independent
It is very important that people with dementia are encouraged to stay independent for as long as possible. Some degree of risk is inevitable, regardless of the choices made. Those caring for the person need to decide what level of risk is acceptable in order to maintain the person's quality of life and protect their independence and dignity. Family and carers should support the person to be involved in these discussions as much as possible.
Steps to safeguarding the person will depend on how well they are able to cope, and the possible reasons for their behaviour. The safety of the person's environment should also be taken into account. There is no such thing as a risk-free environment, but some places are safer than others. Things to consider include:
- does the person live on a busy main road or in an urban area where people don't know their neighbours, or
- do they live in a peaceful rural area where they are well known within the local community?
- What can I do?
- Should I stop the person from leaving the house?
If a person with dementia wants to walk about, you should try to find a solution that lets them do so safely. You may be able to get help through a care needs assessment (also called a community care assessment) or through a local service, group or organisation that helps people with dementia to take part in leisure activities, including walking.
Alzheimer's Society provides leisure and wellbeing services in some areas, visit alzheimers.org.uk/dementiaconnect. There are also organisations that specialise in structured activities of this kind for people with dementia (for details see our page: Exercise and physical activity).
Some family carers decide to lock or bolt doors to prevent the person with dementia from leaving the house. You should never lock a person with dementia in the home if they are alone as this could be very dangerous in the event of a fire, accident or fall.
A situation may arise where you feel the person - even if they're not alone - should be locked in to prevent them from leaving. For example, if you live near a busy main road, you will want to stop the person from leaving the house and potentially endangering themselves. This can be done but only if you feel that the person is unable to make a decision on their own about the dangers of leaving the house. The decision must also be in the best interests of the person and not to make things easier for you or anyone else. It must also be the least restrictive option available for keeping the person safe.
If you do decide upon this option, make sure you have a plan to help them if they become upset and want to leave. Be aware of any fire risks and ensure that any locks or bolts are easy for you to operate. You should discuss this issue with any other people who are involved in their care, such as a community nurse or other family members. Any decisions taken should not place the person with dementia at any kind of risk.
There are less restrictive options to consider than locking doors. They include distracting the person and trying to engage them with a different activity, such as folding laundry. You can also try deterring them from leaving by fixing a bead curtain across the front door or painting the door the same colour as the surrounding walls. If there are outside lights it may be helpful to switch them off at night. These approaches do not suit everyone and may be confusing or distressing for the person.
Do not use medication, such as sleeping tablets, to prevent the person from getting up at night or walking about. Doses that are sufficiently powerful to stop someone from walking about can cause drowsiness and, in some instances, falls. It can also increase confusion, worsen memory problems and possibly cause incontinence.
Limiting the risk: tips for carers
- If the residence has a garden, consider making it secure so that the person can walk outside safely. Having a circular path with points of interest, such as birdfeeders and garden ornaments, can make the experience more enjoyable.
- Ask whether there are any local volunteer schemes, such as Neighbourhood Return, in your area that help return home people with dementia.
- If the person is determined to leave, try not to confront them, as this could be upsetting. Instead try to get them to put on appropriate clothing (eg outdoor shoes and a coat) and accompany them a little of the way. You can then divert their attention so that you can both return safely to the residence.
- Make sure the person carries some form of identification or the name and phone number of someone who can be contacted if they get lost. You could sew this into a jacket or a handbag so that it is not easily removed. Consider identification bracelets like those provided by MedicAlert (see 'Other useful organisations').
- If the person uses a mobile phone, ensure that the phone number of the primary carer is stored and is easily accessible. If the mobile phone is switched on it may be possible to trace the person if they go missing. Specialist tracking devices are also available.
- Consider sensitively telling local shopkeepers and neighbours whom you know and trust about the person's dementia and give them your contact details - they may be able to keep a look out.
If the person is in day care, respite residential care or long-term care, tell the staff about their tendency to walk about. You can also ask about the home's policy on safe walking and care for residents who are prone to walk about