People with dementia may spend long periods of time walking constantly either in a repetitive manner, for example up and down a corridor, or outside walking long distances. Sometimes the person may walk familiar routes or take new routes unknown to them.
This can present many significant concerns for carers regarding the safety of the person. For example where a person is walking up and down a corridor constantly, concerns can be around the risk of getting physically exhausted or falling. Where a person is walking outside, concerns can relate to risks of getting lost or risks associated with poor traffic awareness skills.
Walking is purposeful to the person though it may be difficult for the carer to find the reason. Often the walking is associated with a past lifestyle or occupation.
Consider reasons why?
Some possible triggers might include:
- The person is responding to a physical need:
- Looking to find and use the toilet
- Looking to find food/drink
- Feeling too hot or cold
- Stiff from sitting for long periods of time
- To relieve feelings of pain
- Feeling a sense of restlessness
- To relieve pressure areas (eg: elbows, sacrum)
- Exercising joints
- Life-long pattern – the person’s life history might indicate that the person has always walked (e.g. owned a dog).
- Response to past memories or previous roles – The person’s life history might reveal a work pattern that involved walking (eg postman).
- Searching for someone, security or familiarity.
- Needing to explore the environment.
- Opportunities to meet and engage with others.
‘Sundowning’ is a term that is sometimes used to describe walking or moving things in the late afternoon / evening. There are several theories which propose to explain why this occurs:
- Changes in natural daylight creating a trigger to move around.
- Feeling a need to be occupied at this time of day.
- As a response to a feeling of crisis.
Consider which psychological needs might be met through the person walking:
- Identity: Is it helping to uphold a person’s identity? A person may have always been active.
- Occupation: Is it providing meaningful or purposeful activity as a form of occupation?
- Comfort: Is it helping to comfort a person if he/she is able to relieve distress through walking?
- Attachment: Does it provide an opportunity for the person to meet up with others?
- Inclusion: Does it allow for a person to feel connected to their wider community?
What might help?
- Provide a secure environment using the least restrictive options available (e.g. monitored/alarmed doors).
- Use of assistive technology such as pressure mats etc.
- Provide for an obstruction-free environment as possible.
- Check for safe & comfortable footwear.
- Where needed provide supervision when walking.
- Discuss with family – outline risks and benefits to walking opportunities.
- Use colour, pictures and/or signs to orientate person to the environment.
- Use of identity information should the person become lost.
- Engage in reminiscence to connect with memories associated with past occupations.
- Reassurance and comfort related to past triggers.
How to respond when a person is responding to past memories
When a person is distressed and wants to go and find home – when ‘home’ is somewhere from the past, there is no ‘correct’ way to respond and communicate with the person. It is useful to think of using a ‘toolkit’ of potential approaches which might help:
- Reassurance and a gentle reminder of the current reality.
- Use of validation to identify and connect with how the person is feeling eg ‘I can see you are worried’.
- Use of reminiscence to engage with the person:
- Structured activities relating to past interests.
- Use of familiar soft toys or dolls as reassurance.
- Use of music associated with past preferences.
- Use of distraction in the form of:
- Food and/or drink.
- Aromatherapy (particularly lemon balm or lavender).
- Massage (hand or foot).
- Animal assisted therapy.
She is becoming increasingly agitated in the evenings when she insists on going home to see to the children.
When the care home staff respond in a reassuring manner explaining to her that she will be staying at the home she becomes further distressed and says ‘well that is nothing to do with me, the children are waiting so show me where it is’.
Task: In your notebook write down how would you care plan for this time of day for Mrs Street?
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