There is no single explanation for elopement behavior. However, there is one origin. Impaired cognitive function affects perception and responses, driving the behavior of the person living with Dementia. Elopement behaviors tend to be temporary in nature, emerging and diminishing as the underlying disease process progresses.
The best way to prevent elopement is to understand conditions that elicit the behavior. Two main categories of triggering conditions are:
Those that produce a fight or flight response, and
When time/space confusion interrupts planned or purposeful activities.
Fight or flight is a biological response to fear, be it a general sense of insecurity or a specific threat. Pain can lead to elopement as a person living with Dementia tries to flee discomfort by changing their environment. Note that pain can be physical or emotional, seen or unseen. Pain may be a product of illness, injury, loneliness, or a feeling of unfamiliarity.
Unsuccessful communication, failed execution of ordinary tasks, or unpleasant interactions can leave a person frustrated, exasperated, and ready to fight or flee their troubled state. Physical needs for food or drink or privacy to meet bathroom needs may produce an emotional state resembling panic in a person living with Dementia.
A medical evaluation may identify conditions such as anxiety, depression, infection, urinary issues, or pain that could contribute to an elopement event. These often can be treated by a doctor.
Time and space confusion can lead to critical wandering during purposeful activities, whether planned or spontaneous. Routine activities like retrieving the mail or picking up milk at the corner store may become dangerously detoured. A person living with Dementia may feel compelled to travel to a workplace from decades prior or return to a previous home and become lost on the way.
To reduce the chance of an elopement or critical wandering event:
Become a student of your loved one.
Observe their behavior and be familiar with their life history so you can better understand their needs.
Learn how their facial expressions, postures, and patterns of eye contact may reveal their emotional, physical, and psychological state.
Clues about what drives a person moment to moment are revealed in their life history. Make a record, learn it, share it with other caregivers. Include significant life events, traumas, achievements, relationships, special places like childhood homes, workplaces, or favorite watering holes.
Once equipped to recognize an impending event, use a prepared menu of responses to your loved one's cues. Diffuse an escalating situation with a favorite snack, cool drink, warm blanket, reassuring hug or hand on a shoulder, familiar music, or an escorted walk or car drive.
Creating a safe and secure, calm, and comfortable environment for your loved one can help manage those moments of escalating fear or frustration. In the home, minimize clutter, consider concealing exits, inspect window and door lock function, use of voice assistant or monitoring technology.
Always working towards prevention, a way to improve outcomes of critical wandering events is to ensure the person is wearing a visible medical ID. Operation KeepSafe ID is a Dementia Society of America® medical ID registry program, and it is offered free to those at risk and in need. The program connects an individual's medical ID bracelet to an online profile available to first responders. Request an Operation KeepSafe ID Kit by visiting https://www/operation-keepsafe.org.
If your loved one does go missing, neighbors, business owners, and first responders will all play a role. Build this community safety net by using your knowledge of your loved one's patterns and habits to alert people they may encounter of their condition. Explain that they may see unusual behaviors and make sure they know to contact you if a situation arises.
Should it happen that you can't find your loved one, first search the entire home- closets, basements, attics, under beds, and behind furniture. Remember that they may be scared, hiding, or lost- unable or unwilling to answer your calls. Once you determine they have left the house, record the time. Scan the road or sidewalk, then search outdoor areas and buildings. Call on neighbors and family to patrol a ½ mile circle around the home. If, after 15 minutes, you haven't found your person, call 911.
The challenges and heartbreak of elopement by those living with Dementia are immense and far-reaching. Understanding what motivates elopement behavior and how and how to modify it is key to reducing adverse outcomes. Managing a loved one's environment for safety is achieved by employing a multi-layered approach that addresses the before- during- and after- stages of elopement.
Contributor: Karen R. Ogden, team member, Dementia Society of America.
The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org