A Guide to Walking About

WALKING ABOUT We all have reasons that we walk about. There are many benefits to walking as well. We use walking to get what we want or where we want to go. Walking about can be pleasurable and gives us an outlet for stress.

We also support our fitness by walking about. Walking supports our independence.

It is important to understand the reason behind your client’s walking to support the safety of the walking instead of trying to prevent it.

SUSPECTED ISSUE

POTENTIAL INTERVENTION

Infection/Illness/ Medication Side Effect

Is the excessive or persistent walking a sudden change in behavior? Consult a physician.

There may be a clinical issue contributing to the increased activity.

Unexpressed Pain

Inquire with the family and/or doctor about psychosocial history and whether it may be impacting pain levels. Explore client perspectives about pain management. Explore interventions, beginning with non-pharmacological options.

Unexpressed Hunger

Is special the excessive orpatterns persistent walking suddenIschange in Pay attention to any of walking and meala completion. the individual able to ask for or initiate eating food independently?

Are they consuming enough behavior? Consult a physician. There may be a clinical issue calories to fuel the walking? If the answer is “no,” consider offering frequent small to the increased activity. portions of foodcontributing and setting out non-perishable items in highly trafficked areas to Is the excessive or persistent walking a sudden change in encourage nutrition.

Restless Energy/Desire for Exercise

behavior? Consult a physician. There may be a clinical issue Consider whether the individual has regular access to exercise and fresh air. All human contributing to theand increased activity. beings need this.

If they have restlessness increased confusion, movement is a great

way to meet the need to expend built up energy. Consider exploring the types of exercise that appeal to your client and/or building regular walks into the routine. Approximately twenty to thirty minutes in the morning and early afternoon can cut restless energy significantly. Having trouble with motivation? Build a purpose and/or reward (getting groceries, having a pastry) into the routine. Unsafe to walk long distances? Consider setting up a secured outdoor area and/or consulting a physical therapist for adaptations or alternative forms of exercise.

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WALKING ABOUT SUSPECTED ISSUE

POTENTIAL INTERVENTION

Over Exertion

Some individuals may be over-exerted and having difficulty self-soothing. If possible, inquire about the individual’s routine before or after your shift. If you are present for a longer stretch (ex. 8 hours), observe. Does your client show signs of sleepiness/need for rest? Some individuals benefit from a rest of about 45 minutes once or twice daily to conserve energy. They may need external support with relaxation (ex. Darkening the space so that they can lie down comfortably, playing soft music, using aromatherapy).

Need for the Restroom

Wayfinding and negotiating small spaces can become difficult for individuals living with cognitive change - so much so that they may struggle to find the bathroom or maneuver onto the toilet. Supporting an individual with environmental adaptations such as an elevated toilet seat, signage, contrast in the bathroom, and/or motion-sensor night lights may help. An occupational therapist is a good resource to evaluate and support.

Major Depressive Disorder/Anxiety Disorder

Overstimulation

Understimulation/Lack of Socialization

Is individual the excessive or persistent walking change in If an living with cognitive change has a history ofaa sudden major depressive disorder or anxiety disorder, considera enlisting the support of a mental behavior?

Consult physician.

There may health be aprofessional clinical toissue strategize interventions.

Exercise, breathing mindfulness, and psychotherapy contributing to the techniques, increased activity. may all be possible. In the event non-pharmacological intervention is not meeting the Is the excessive or persistent walking a sudden change in individual’s need, we recommend consultation with a geriatric psychiatrist for specialized treatment.

Geriatric psychiatrists are often able to negotiate the potential side effects or behavior? Consult a physician. There may be a clinical issue interactions of medications commonly taken by older adults living with dementia. contributing to the increased activity.

Individuals living with cognitive change may experience over-stimulation. Assess environmental triggers. Is the space the individual is leaving or avoiding too noisy, too crowded, too bright or too hot or cold. If the environment is not overstimulating, consider whether care-partner action may be. Failing to recognize and match the tone and pace of a person living with cognitive change may lead them to “talk with their feet.”

Is boredom or lack of socialization a contributing factor? Is the environment too dark, quiet, or empty? Individuals who are living with cognitive change may struggle with initiating activity or conversation; however, many maintain curiosity and a desire to connect even as verbal skills decline. Consider implementing adaptations that empower the individual to participate in conversations and activities at their level of mastery (ex. branching questions, music, dance, or other forms of non-verbal expression and connection). Implementing Montessori-inspired learning programs and stations may also support active engagement.

www.inspiredmemorycare.com

WALKING ABOUT SUSPECTED ISSUE

Desire for Safety

POTENTIAL INTERVENTION

From time-to-time, individuals with specific diagnoses may experience a hallucination or delusion that causes them to perceive a need for safety. At these times, using fewer words, securing the environment, and waiting for the episode to pass may be the best course of action. For clients who have active hallucinations and delusions that are upsetting to them, it’s important to maintain an awareness of when, where, and with whom these occur, as this information can support a medical provider to make judgments about intervention. Alert the agency and family for further follow up.

For clients whose sense of safety is compromised by other factors (for instance, having a new care-partner, worrying that a care-partner is leaving), using orienting information to support learning and mastery are critical. Some examples might include a headshot and large print biography to help the client get to know who you are, a reminder that the client’s family member will call at the end of your shift for their daily phone call, etc.

Is the excessive or persistent walking a sudden change in

Finally, for clients who have a of trauma,There understanding the source of trauma and behavior?

Consult ahistory physician. may be a clinical issue potential triggers is critical.

It may be helpful to involve the client, their family, and their contributing to the increased activity. clinical team in brainstorming interventions.

Is the excessive or persistent walking a sudden change in

Desire for Emotional Comfort

Desire for Control

Individuals may Consult feel disconnected from family There or other sources of love comfort.issue behavior? a physician. may be a and clinical Implementing a contributing Connections Log, ritual phone or Facetime call, Memory Book, etc. to to the increased activity. support the sense of connection to family, friends, or other communities may help.

Support the client with active listening and reassurance. Consider the use of touch or music to validate. Consider engaging in activities that promote nurturing the client and supporting the client to nurture (ex. spa-themed activities, caring for a pet) Evaluate how much is being done on behalf of the client rather than with the client Evaluate whether the client needs to feel heard and have a choice of companion or task.

Be sure to ask “May I?” about specific tasks for which you hope to provide support when managing and supporting activities around the home. Respect the client’s wishes.

Emphasize how support (either personal or technological) will empower the client to have more independence in day-to-day life.

Identify goals and areas of mastery for engagement. For instance, when you are planning options for how to spend the day together, emphasize programs that support the client to have an active role and a sense of self-efficacy and accomplishment. Express genuine admiration for the client’s skill and independence.

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WALKING ABOUT SUSPECTED ISSUE

POTENTIAL INTERVENTION

Desire for Normalcy

Has the individual’s environment changed so much that it is no longer “home?” Consider who or what made space feel “homelike.” Engage validation techniques to learn more about what “home” means to the individual, paying special attention to objects, routines, and people that are associated with “home.” Work to integrate those into the present environment as much as possible.

Desire for Respect

It is important to have an understanding of whether a client may leave unattended prior to beginning services. Do not attempt to force or argue when a client declines to sit down or stay indoors.Validate the client’s feelings surrounding the agency over their routine. Once the client has an opportunity to share, attempt redirection. Reapproach as needed.

Use formal address if needed (for instance, rather than calling the client by their first name, you may use “Dr. Smith” or “Mrs. Jones” as a sign of respect). Culture plays an Is the role excessive persistent walking a sudden change important here as well.or Communicate genuine admiration for areas about whichin the client has pride. Consult Clients are more likely to accept supportmay whenbe theya feel a sense ofissue behavior? a physician.

There clinical rapport and trust. contributing to the increased activity.

Is the excessive or persistent walking a sudden change in behavior? Consult a physician. There may be a clinical issue contributing to the increased activity.

www.inspiredmemorycare.com

INTERVENTION

DESCRIPTION

MedicAlert & Safe Return Program

A MedicAlert membership plan with Wandering Support helps first responders and families reconnect with individuals living with dementia who experience a medical emergency or have wandered.

Includes: 24/7 emergency response.

Comprehensive health profile Family notification Community help

ID Jewelry

Scented clothing and photographs

Signage

COST

Card/Jewelry: $3-$1300 Annual Plan: $24.99-74.99

WEBSITE

https://shorturl.at/dvBC9

MedicAlert Jewelry Only - many styles including silicon, silver, gold, necklaces, watchbands, shoelace charms, etc.

$3-$1300

Maintain an item of clothing with the individual’s scent, and a current photograph. In the event an individual is missing, these are extremely important to a search.

Free

Not Applicable

Cost of ink and paper

https://shorturl.at/ghvzU

Is an inexpensive way to support wayfinding and decrease disorientation.

Consider whether using pictures or words will be most effective.

https://shorturl.at/LM245

INTERVENTION

Motion-sensored lighting

Life 360 App

Apple Air Tags

GPS Insoles

DESCRIPTION Perfect for indoor places like stairs, garage, kitchen, hallway, bathroom, basement, corridor, cloakroom, living room, etc. to bring you and your family safety (never tripping in the dark any more) and convenience (no need to always turn on room lights).

Protect and connect your loved ones, pets, & important stuff with Life360’s advanced driving, location, & digital safety features. Plus, link your Tile account to see your Bluetooth trackers on your family’s Life360 map. Relies on a phone being charged and with client.

AirTag is a super easy way to keep track of your stuff. Attach one to your keys.

Put another in your backpack. And just like that, they’re on your radar in the Find My app, where you can also track down your Apple devices and keep up with friends and family. Battery life is reflected on app.

SmartSole® is a GPS tracker hidden and sealed within a water-resistant shoe insert. It requires daily charging on an induction charger.

COST

$16.99

Free to $24.99/month depending on package

1/$29.00 4/$99.00

Insoles - $359

WEBSITE

https://shorturl.at/brzRX

https://shorturl.at/ovUZ3

https://shorturl.at/hnJM3

https://www.gpssmartsole. com/

INTERVENTION

GPS Watches

Project Lifesaver

COST

WEBSITE

There are several models on the market with different capabilities and price points. Apple Watch, Google Watch, TheraCare and Angel Sense are common. Watches must be charged and

Varies

Varies

Radio frequency rather than GPS. The premier search and rescue program operated internationally by public safety agencies, and is strategically designed for “at risk” individuals who are prone to the life threatening behavior of wandering. The primary mission of Project Lifesaver is to provide timely response to save lives and reduce potential injury for adults and children with the propensity to wander due to a cognitive condition.

Initial Equipment fee $300-400 (some scholarships available) Monthly Fee $10-15

https://projectlifesaver.org/ about-us/where-we-are

DESCRIPTION

Motion-Alarm

Bed exit alarm utilizing WiFi signal.

A sensor on the individual’s lapel connects to a care-partner’s cell phone to alert to a rise from bed.

Door Alarm

Simpl employs motion sensors with remote alarms to alert carepartners to movement near the door or other areas.

$199.00

$39.99+

https://www.safewander.c om/

https://www.alzstore.com/ door-alarm-sensor-kitp/0070.htm

INTERVENTION

DESCRIPTION

COST

WEBSITE

Door Camouflage

For some individuals living with Alzheimer’s disease and related dementia, camouflaging the door can serve as good exit control.

Depending on the vision of the individual, painting the door knob may be one intervention. For others, covering the door in a mural may be useful.

Varies

Varies

Locks

Alzheimer’s door lock requires no key and does not look like a lock. It opens by pulling and rotating the door-jamming "blocker" out of the way of an in-swinging door.

Caregivers can unlock the confounding door lock easily, but the person with dementia (who does not know the trick) can try for hours with no success.This is for inside-use only.

$27.95

https://www.alzstore.com/ confounding-door-lockp/0247.htm

Ring Alarm

Ring video doorbell alarm to monitor comings and goings at the front door. Carepartners receive alerts of movement to their cell phones. This is strictly useful to monitor patterns of movement.

Secure Outdoor Area

Creating a secure outdoor space by fencing in an area outside of the door can be very helpful. Individuals

$224.98+

Varies

https://ring.com/

Varies