UF nurse researcher identifies search criteria for wandering Alzheimer’s patients

Less than 4 percent of memory-impaired adults who wander away from home are able to return unassisted, according to a new University of Florida study.

The findings, based on data collected through the national Alzheimer’s Association Safe Return Program, underscore the need for public safety agencies to establish procedures for launching search-and-rescue efforts quickly when a missing person has Alzheimer’s disease or another form of dementia, a UF nurse researcher said.

“Law enforcement agencies often delay activating a search for missing adults because they assume the adults will return home on their own,” said Meredeth Rowe, R.N., Ph.D., an associate professor at the UF College of Nursing and at the UF Institute on Aging. “However, this research clearly shows those policies need to be different for adults who are cognitively impaired as a result of Alzheimer’s disease or other forms of dementia.”

Realizing the UF study results may be critically important in helping to find such adults, the American Journal of Alzheimer’s Disease and Other Dementias has given permission to release the research findings before publication.

While the study results are specific to the Safe Return Program only, it is the first time any data have become available on which to base policies related to cognitively impaired wandering patients, Rowe said.

“Law enforcement agencies have clear procedures for finding missing children, but the steps we take when the call is about an adult tend to vary with each situation,” said Sgt. James Troiano, a spokesman for the Alachua County (Fla.) Sheriff’s Office. “There are no established standards when we search for adults with dementia.”

From 675 missing and discovery incidents reported nationwide to Safe Return over a 13-month period, Rowe identified patterns of where people were found, how long they had wandered and how far they traveled. She also found that nearly 20 percent of the memory-impaired adults found wandering in communities left from nursing homes.

“Wandering happens even in the best caregiving situations, especially if the patient becomes angry or agitated,” Rowe said.

Therefore, caregivers should not be embarrassed to call for help, she said. In fact, it is critical for caregivers to file a missing-person report as soon as they discover their patient has wandered. In addition, law enforcement agencies need to encourage caregivers to file such reports.

Rowe said law enforcement searches also must begin immediately and be concentrated within a five-mile radius of the individual’s home. Furthermore, it is crucial to continue searching throughout the night because these adults will often continue wandering.

Wandering into the community without supervision is a major problem among people who are memory-impaired and can result in injury or death, Rowe said. Experts say 60 percent of those with Alzheimer’s disease will wander and become lost at least once during the course of the disease, and up to 46 percent of those wanderers may die if they are not found within the first 24 hours.

According to Rowe’s analysis, 82.3 percent of memory-impaired wanderers are found within the first 12 hours after they were last seen, with 42.9 percent found between noon and 6 p.m.

Although afternoon was the most likely time for these wanderers to be discovered, 19.6 percent were located between 6 and 9 p.m. and 17.8 percent between 9 p.m. and 7 a.m. Nearly half (46.1 percent) were found in under five hours, with only 9.2 percent missing more than 24 hours. One person was missing four days. Almost one-fourth of these individuals left during evening and nighttime hours.

Nearly half (49 percent) were found between one and five miles away from where they were last seen, while 37 percent were found less than one mile from home. The remaining 14 percent were found more than five miles away.

Places memory-impaired wanderers have been found highlight their unpredictable behavior, Rowe said. More than one-fourth were found in residential yards, and 22 percent were found standing in the middle of streets. In addition, 11.8 percent were found in miscellaneous businesses, 9.2 percent at health-care facilities, 5.8 percent at public access areas, 3.9 percent in shopping centers, 3.7 percent standing on sidewalks, 3.4 percent along highways, 3.1 percent at convenience stores and 3.1 percent in restaurants. Only 1.8 percent were found in remote natural areas, 1.6 percent in parking lots, 1.6 percent in food stores, 1 percent in banks, 0.8 percent along railroad tracks and 0.8 percent in senior care centers. Of those found in remote areas, all were found dead.

Most wanderers (84 percent) walked away from their caregivers, with only 5.6 percent driving away. The remainder used public transportation. All those who drove a car were found within 24 hours. All those missing for more than 24 hours were on foot with the exception of one who had taken a train. In this study, only four wanderers were found dead.

The majority of wanderers were most likely to be found by good Samaritans or law enforcement officials, despite the lack of missing-person reports in the majority of cases. However, when a report was filed, the wanderer was much more likely to be found by law enforcement officials, Rowe said. Educating the public about how to help a wanderer is also critically important.

Established in 1993, the Safe Return Program of the Alzheimer’s Association has helped return about 6,300 people. An estimated 78,000 people are now registered with the program, which provides identification jewelry that indicates the person has a memory problem and lists a 24-hour toll-free telephone number to call. The association has collected data on all registered users as well as data related to both missing persons and discovery reports.

A 1998 National Institutes of Health report estimates 4 million people in the United States have Alzheimer’s disease. The irreversible, progressive brain disorder develops gradually and results in dementia that influences memories, behavior, personality and the ability to think clearly. Other diseases, such as Parkinson’s disease, strokes, AIDS and other health conditions also can cause dementia.