This article follows and compliments our post “Dementia – An insight into Walking, Wandering and Missing”.

For people with Dementia, walking can be beneficial, often relieving boredom, stress and giving a real sense of purpose and independence. Therefore, it is extremely important to allow that person to walk freely and unsupervised for however long it is safe to do so. The aim of this article is to provide some tips on reducing risk for those people with dementia, who may ultimately end up as a vulnerable missing person.

For a person still walking/wandering:

• help maintain safe physical conditions for the person – only give the person access to comfortable sensible footwear which will improve stability, clothing that fits the current elements and which is LOUD and colourful so that they stand out if they are reported missing.
• identification – ensure that the person carries some form of identification. Identity bracelets can be obtained for a relatively small fee and in many areas, are provided by the local authority/health trust. Cards in wallets with name, address and telephone number are essential. Ensure that there are multiple cards and place these in all the person clothing e.g. trouser/coat pockets.
• identification – consider sewing name tags/information tags into the persons clothing. You can also have bespoke information printed on tags that you can either sew or iron into clothing.
• be prepared – open a file on the person in case they go missing. This file should contain important information that will assist police in assessing the risk and maximising the opportunities to locate the person as quickly as possible. It is important that this file is kept up-to-date and any changes such as new medication or changes in appearance are recorded.
• does the Herbert Protocol run in your area? This is scheme run by numerous police forces within England & Wales in partnership with Local Authorities and other agencies. It is a simple risk reduction tool to be used in the event of an adult with care and support needs being reported missing. We will specifically feature the Herbert Protocol in a future article.
• if the person has a history of going ‘wandering’/missing, note down the details of where they were found and how they got there (method of travelling).
• routes – be aware of the familiar routes and destinations the persons usually chooses/travels. Risk assess these routes/locations. What are the potential hazards and likely points where they might be distracted or wander from a recognised route? Remember, a person with dementia will potentially perceive the route differently from you. Gaps in fence, hedge or tree lines, may well be perceived as a pathway which they may follow.
• if the person uses a mobile phone, ensure that the phone number of the primary carer is stored (I.C.E.) and is easily accessible. If the mobile phone is switched on it may be possible to trace the person if they go missing.
• consider sensitively and discreetly telling neighbours and trusted local shopkeepers about the person’s dementia and give them your contact details – they may be able to keep a look out. Are there any local volunteer schemes, such as Neighbourhood Watch in the area that may be extra pairs of eyes. Check with your neighbourhood watch organisation as their services don’t just deal with keeping an eye out for crime, many local schemes have a good awareness of dementia related issues.
• assistive technology – there are now many technological devices on the market that will reduce the chances of a person getting lost and assist in locating them safely when they are reported missing. These include GPS tracking and location devices, GPS enabled Smart phones and normal mobile phones which include a SOS button.

Where wandering becomes a significant risk:

Triggers- attempt to identify what triggers the walking/wandering.

• journal – carers should keep a daily diary for at least a month to identify any patterns or triggers to the persons wandering. It may occur at certain times of the day or in response to certain situations which can then be managed.
• medication – if a person is on medication for dementia or for other medical problems, it is vital that the medication and the doses are the correct ones and not causing other underlying issues such as causing drowsiness in the daytime, incontinence or increasing confusion. If there are any doubts, then carers should go back to the GP to discuss medication/dose etc.
• discomfort or pain – are there any physical or medical problems that might prompt wandering? Does this problem become worse at certain times of the day? Can these be remedied e.g. if a person is overheating at night, can the heating be turned down/off, lighter clothing applied to make the person and the environment more comfortable.
• distraction – attempt to reduce or remove visible objects which may prompt or act as a reminder to the person to wander e.g. shoes, coats, bags, letters for the post.
• daily routine – ensure that the persons daily routine is fulfilling and that they are kept both mentally and physically engaged with activities. Make some enquiries in your area as to what support groups there are. There may be organisations that run leisure activity groups for people with dementia to take part in.
• alternative exercise – if the person’s home/residence has a garden, consider making it secure so that the person can walk outside safely. Choose a circular route where possible and create points of interest, such as birdfeeders, garden ornaments, noticeable plants.
• familiarity – ensure that favourite or much used objects are kept well within sight. If a person believes that they have lost something, they are more likely to attempt to go and find it or seek a replacement. They will become anxious and agitated and this may prompt wandering. Likewise, if they are being cared for and the carer is not about, this might lead to anxiety and attempt to find that person. Have a plan for this, which might be as simple as prominent notes or the use of assistive technology.
• time confusion – people with dementia can often become confused about the time, becoming more active at unusual time such as waking in the middle of the night, dressing and setting off to achieve a specific goal e.g. work. Establishing what is causing irregular sleep patterns and causing restlessness is key. It could be as simple as too much caffeine or more complicated such as vivid nightmares. Seeking advice from a GP may help. If it is confusion around the time, then there are several clocks on the market that might assist.
• assistive technology –there are technological devices available that will reduce the chances of a person leaving their home or leaving without notifying a carer. These include: door alarms, movement-activated voice alerts, CCTV and motion monitors and recorders.

Some advice for Care Homes

•  door access should be restricted where possible and controlled by a key pad. These key pads should be covered by a shroud to prevent residents watching staff key in the number. Staff should be briefed to ensure they cover the number when entering it. A balance needs to be struck so that those people who are able to leave can do so, and those that will need to be escorted, are not free to leave alone.
• emergency exit doors should be controlled in a similar manner but also alarmed. Consider installing bells/buzzers/alarms which sound when external doors are opened.
• a daily gate / door checking regime should be put in place to ensure all are locked as required. (Particularly after fire alarms).
• ideally a CCTV system should be maintained to cover the doors of the premises, recording the dates, time and comings and goings of all persons.
• a minimum hourly checking regime should be in place for high risk residents, where the carer physically checks the resident’s location in the home and records the visit or sighting on a written log. This should be overseen by a senior carer to ensure that it is completed correctly. This should form part of the care plan.
• all resident files should contain information and be available as a grab pack or on a Herbert Protocol type leaflet.
• files should contain up-to-date medical details of any condition the resident may have together with an up-to-date list of medication they require and the consequences of what happens if they do not take this medication.
• details should also include, previous homes, places of previous treatment and areas frequented including old work places.
• think outside the box – research has shown that some people with dementia are deterred from leaving care homes if a large black mat, which they perceive as a large hole, is placed in the doorway or the lino/carpet is patterned to resemble water.
• if resident has previously gone missing then details of where they were previously found should be recorded. These can then be checked as a priority.
• details of any cash/freedom passes the resident may receive or can access.
• consider building a rapport with the landlords of the local pubs, eating establishments, shops and business in the area and considering telephoning these when a resident goes missing. A list of contact details should be maintained in the office for use in missing person cases.

On the discovery of a missing resident, as a minimum, the following actions should be completed by care home staff:

• ensure that all staff are informed of the missing resident and an ‘Open Door’ search is conducted of the home (including other residents rooms), grounds, cupboards and out buildings. This should also include staff vehicles ensuring they are secure in case the resident has entered a vehicle and hidden inside.
• a written record of this search should be made on a floor plan of the premises, recording who has searched where, marking what areas are being searched and marking when they are complete. This should be handed to the police when they arrive, who should recheck the premises.
• details of the missing person should be reported to the police control room (101 or 999 in an emergency) by telephone as this search takes place. The level of concern and all known risks (medical issues, disabilities etc) should be stressed to the call taker where applicable.
• staff should commence telephoning the list of contacts for local pubs and restaurants in the area giving a detailed description of the missing person, particularly if the resident has a history of alcohol use or smokes and is likely to go to a premise to purchase these items. Details of who has been called should be passed onto the police on their arrival.
• the CCTV system should be checked to try to pin point the time that the missing person left the premises, by which exit and the direction of travel.

This is not an exhaustive list of tactics. A balance must be struck between maintaining quality of life and ensuring there is an adequate safeguarding plan in place. Much will depend on the individual, their habits, interests, mobility and many other factors. Safeguarding plans should be tailoured to that individual and where possible include the views of the person.

Please read our Factsheet  Demntia Factsheet – A brief guide.