Dementia wandering at night: how to keep her safe

Dementia wandering at night usually starts with a real need: a trip to the bathroom that loses its way, a body clock that says it's morning at 2 a.m., or a sense that she has to get to work or get home. You can't always stop her from getting up. You can make the house safe for when she does: a chime on every outside door, a lit path to the bathroom, locks she won't think to look for, and an ID bracelet with your number on it. If she ever gets out and you can't find her within 15 minutes, call 911.

Why dementia patients wander at night

It's 3 a.m. and the back door chime goes off. Your mom is in the kitchen in her robe, looking for her purse because she's late for the bank. She retired 25 years ago. To her, this is a normal Tuesday morning.

There's almost always a reason, even when she can't tell you what it is.

• Her body clock is off. The Alzheimer's Association describes a disrupted sleep-wake cycle, where the person is tired during the day and awake at night.
• She needs the bathroom. She gets up to go, can't find it in the dark, and ends up at the front door instead.
• She's following an old routine. The Alzheimer's Association lists talking about former obligations, like going to work, as a warning sign of wandering. So is wanting to "go home" when she's already there.
• She woke from a dream and can't tell it from what's real.
• She's hungry, thirsty, in pain or restless.
• The dark makes everything look strange. Shadows look like people, and a familiar hallway looks like a stranger's house.

Six in 10 people living with dementia will wander at least once, according to the Alzheimer's Association, and many do it repeatedly. Plan as if it will happen.

Dementia day night confusion: start with the daytime

A lot of night wandering starts at noon. If she naps for two hours in the afternoon and sits in a dim room all day, her brain has no reason to think 10 p.m. is bedtime.

• Get her into daylight in the morning, by a sunny window or outside.
• Keep her moving during the day, without wearing her out.
• One short nap, early in the day. Gently wake her if she dozes off late in the afternoon.
• No caffeine or alcohol late in the day.
• The same bedtime and the same routine every night: bathroom, pajamas, the same lamp.

The guide on sundowning goes through the daytime plan in more detail, since late-day agitation and bad nights tend to travel together.

How to keep dementia patients from wandering at night

These come from the Alzheimer's Association and the National Institute on Aging.

1. Put a chime or alarm on every outside door. A cheap battery chime that rings when the door opens is enough. It lets you sleep instead of listening for the door.
2. Add a pressure mat by her bed that sounds when she stands up. You'll hear her before she reaches the hall.
3. Move locks out of her line of sight. Put a latch or slide bolt high or low on the door, above or below eye level. Many people with dementia won't think to look there.
4. Disguise the door. A curtain over it, or a "STOP" sign on it, can be enough to turn her around.
5. Light the way to the bathroom. Night-lights in her bedroom, the hallway and the bathroom, and leave the bathroom light on.
6. Hide the signs of leaving. Keep coats, shoes, purses, suitcases and car keys out of sight at night.
7. Limit windows and secure the yard. Window stops that limit how far a window opens, and a fence with a locked gate if you can manage it.
8. Remove locks on interior doors, so she can't lock herself in a bathroom or bedroom.
9. Ease up on drinks before bed. The Alzheimer's Association suggests reducing, but not cutting out, liquids in the two hours before bedtime. Ask her doctor first if she has a heart or kidney condition or gets dehydrated easily.

What to say when she's up at 3 a.m.

You'll be half asleep. Keep a few lines ready so you don't have to think.

More lines to keep handy:

• When she's heading for the bathroom: "Bathroom's right here. I'll wait for you in the hall."
• When she needs to get to work: "They called. Nobody has to come in today. We can sleep in."
• When she's at the door: "Let me walk with you." Walk a few steps, then turn back toward the kitchen.
• When she's wide awake and anxious: "I'm up too. Let's have some warm milk and sit for a minute."
• When she's looking for someone: "He's fine. He's where he needs to be tonight."

Don't grab her arm or block the door if you can avoid it. Startling her in the dark makes falls and fights more likely. Arguing about what time it is won't work either. The guide on when she wants to go home has more lines for the "I need to leave" loop.

Set up a safety net before she ever gets out

Alarms slow her down. The steps below are for the night she gets past them.

• ID she'll keep on. The National Institute on Aging suggests a medical ID bracelet with her name, address and your phone number. If she takes bracelets off, label her coat and clothes with a name and number.
• MedicAlert Safe and Found. The MedicAlert Foundation runs this with the Alzheimer's Association. It pairs a medical ID with a 24/7 emergency line that helps police during a search and contacts you when she's found. It's part of a paid MedicAlert Protection Plan. You can call 1-800-432-5378 or start at medicalert.org.
• Project Lifesaver. Some police and sheriff's departments run this search-and-rescue program, using tracking bracelets for people who wander. It isn't available everywhere. Check projectlifesaver.org for an agency near her.
• A GPS tracker, which the National Institute on Aging mentions as an alternative or addition to an ID bracelet.
• A recent photo or video of her on your phone.
• A list of places she might head for: an old job, a store she used to shop at, a house she grew up in.
• Neighbors and local police who know she has dementia and wanders, plus your number.

Take Maria, whose mother got out through the garage at 4 a.m. one January morning. A neighbor heading to an early shift spotted her two blocks away in slippers, recognized her and called Maria. That neighbor knew because Maria had knocked on doors the month before. The next weekend, Maria put a chime on the garage door too.

If she's missing

Move fast. Don't wait because you feel embarrassed or think she'll turn up.

1. Start searching right away. The Alzheimer's Association says many people who wander are found within 1.5 miles of where they disappeared. It also notes that people tend to wander in the direction of their dominant hand.
2. If you haven't found her within 15 minutes, call 911 and file a missing person report. Say "she has dementia" in your first sentence.
3. If she's enrolled in Safe and Found, call MedicAlert's 24/7 emergency line after you call 911.
4. Check the places on your list, and send someone to stay at the house in case she comes back.

When dementia wandering at night needs a doctor or more help

New or sudden night wandering deserves a call to her doctor. MedlinePlus lists disrupted sleep and confusion among the signs of delirium, which comes on over hours or days and can be caused by an infection such as a UTI, a medicine or dehydration.

Don't give her a sleep aid on your own, including over-the-counter ones. Ask her doctor.

Then look at your own nights. If you're sleeping on the couch to hear the door, you can't do that for long. Overnight aides exist. Ask the agency whether the aide stays awake all night, because the price and the help are different. If she's getting out despite the alarms, or nobody in the house can stay alert at night anymore, it may be time to read about when it's time for memory care.

Questions caregivers ask

What stage of dementia does wandering occur?

It can happen at any stage, and the Alzheimer's Association says everyone with dementia is at risk. It's most typical of the middle stage, where the Association lists an increased tendency to wander and get lost, along with sleeping by day and restlessness at night. Earlier on, it may look like getting lost while driving.

Is wandering a symptom of dementia?

Yes, it's a common behavior change. Early signs include coming back late from a walk, forgetting the way to familiar places, pacing, and trouble finding rooms at home.

Is vascular dementia night wandering different?

The type of dementia doesn't change the safety plan. The Alzheimer's Association says anyone living with dementia is at risk of wandering, so door alarms, ID and a missing-person plan apply to every type.

Can you prevent dementia wandering completely?

Not always. The goal is to make it rarer and safer: fewer reasons to get up at night, a house that slows her down, and a plan for the night she gets out anyway.