supporting safe walking and managing missing incidents

1. Create a safe walking path at home. Set up a clear, unobstructed loop through the living room, hallway, and kitchen where your loved one can walk safely. Remove clutter, area rugs, and cords from the floor. Use nightlights or rope lighting along the path from the bedroom to the bathroom to guide them at night. This reduces fall risk and fulfills the need to move without leaving the house.

2. Camouflage or secure exit doors. Paint the door the same color as the wall, or hang a large plant or a curtain that matches the wall color to make the door less noticeable. Avoid placing any rugs in front of doors, as these are trip hazards. Install door alarms or pressure-sensitive mats that alert you when someone approaches an exit. If you use locks, ensure they are always accessible to a caregiver in an emergency and that the person with dementia can unlock them if needed; never use locks that the person cannot operate themselves, as this can be dangerous in a fire or other emergency.

3. Remove triggers that prompt leaving. Store coats, hats, keys, wallets, and purses out of sight. Many women will not leave without their purse, but seeing it can trigger a desire to go out. If removing a purse causes anxiety, try placing it in a locked drawer or a less visible spot. Similarly, keep shoes and jackets in a closet that is not easily accessible.

4. Establish a daily routine that includes purposeful activity. Schedule regular times for walking together, light exercise, or engaging in a favorite hobby. Boredom and understimulation are major drivers of wandering. Activities like folding laundry, sorting photos, or simple gardening can provide a sense of purpose and reduce restlessness. Ensure the person knows where the bathroom is and offer regular toileting breaks every two hours to prevent discomfort-driven wandering.

5. Inform your neighbors and local community. Let trusted neighbors, friends, and local police know that your loved one has dementia and may wander. Give them a recent, clear photo of the person and a brief description of their medical condition. Ask them to contact you immediately if they see your loved one walking alone. This creates a safety net that can help locate them quickly.

6. Prepare a wandering safety kit. Keep an updated, close-up photo of your loved one, a list of their medical conditions and medications, and a note of what they are wearing each day. Store this information in an easily accessible place, such as a folder by the phone or a digital file on your phone. Also, have a list of emergency contacts ready, including family members and local authorities.

7. Use identification and tracking tools. Enroll your loved one in a program like the Alzheimer's Association's MedicAlert + Safe Return or the Dementia Society of America's Operation Keep Safe. These provide ID jewelry (bracelet or necklace) and a 24/7 support line to coordinate search efforts. For additional safety, consider a GPS tracker placed in a shoe sole, locket, or under a hat—especially if your loved one does not fidget with it. Discuss with your clinician which device is appropriate.

8. Have a clear emergency plan for when wandering occurs. If you discover your loved one is missing, act immediately. Check the house and yard first, then call neighbors and local police. Provide them with the photo, description, and any known walking routes. Do not wait—time is critical. Keep a list of phone numbers for people you can call to help search. Practice the plan with family members so everyone knows their role.

9. Reduce overstimulation and manage sundowning. Keep noise levels low and avoid crowded, confusing places like shopping malls. In the late afternoon, offer a calming activity, dim the lights, and play soothing music. Sundowning can increase exit-seeking behaviors, so be extra vigilant during this time. A consistent pre-dinner routine can help ease the transition.

10. Provide reassurance and redirection when they want to leave. If your loved one says they want to go home or asks to leave, do not argue. Instead, validate their feelings: 'I know you want to go home. Let's sit here for a moment and have a cup of tea.' Then gently redirect to a different activity or a safe walking path. This approach respects their emotional need while keeping them safe.