Last updated on April 25, 2021
What the heck do dementia, elopement and a gray cat have to do with each other you ask?
First, let’s define the term “elopement” because I don’t mean running off with the love of your life for a quick, secret wedding in the Isle of Skye or in Las Vegas with Elvis.
In medical terms, elopement is when a person/resident who has dementia, who is deemed too ill or impaired to make reasoned decisions, leaves the secure home/facility unnoticed and unsupervised. Their inability to protect themselves from harm or injury makes this a serious situation (1,2).
According to the Alzheimer’s Association, six in 10 people living with dementia will wander. And because a person living with dementia may not remember or be able to give their name, address or phone number, elopement is extremely dangerous and time sensitive (2).
The person may wander away and become lost or trapped. Depending on weather, length of time he/she is outside, and other environment factors, there is risk of dehydration, falling and other injuries, missed medications, drowning, exposure, being hit by a vehicle, and even death.
When or if there is elopement from a facility, protocols must be followed quickly and as a team to ensure return and safety of the resident.
In my experience, knowing how to recognize the signs and risks of elopement, and how to effectively deal with those behaviors and feelings is key to prevention.
Why Do People Living with Dementia Elope?
There are many different reasons why a person might wander. Often, it is the only way to express a basic human need, such as thirst or fear or boredom. It may simply be a way to exercise, preserve a sense of independence, or to get away from a person or thing they don’t especially like.
When someone living with dementia states “I want to go home” the walking about searching for an exit might actually mean he/she is seeking for the protection, and feelings of acceptance, familiarity, safety and love associated with his/her family and home. So the intent may not be to physically leave the building at all (1,3).
Formal caregivers, including CNAs, managers, and nurses in assisted living and skilled nursing homes are trained to watch for wandering and to respond quickly and appropriately to emotional and physical needs.
If walking around is due to pain, full bladder, or loneliness, staff can address issues with medication, toileting, or spending quality time with the person. When walking is just to look out a window or to stretch the legs, we always want to encourage and support the fact that he/she can walk about and is connected with his/her environment in a healthy way (1, 3).
The following strategies may help reduce unhealthy wandering:
- Meet all basic needs. Be sure she isn’t hungry, thirsty, in pain, too cold/hot, or needs to empty her bladder.
- Provide supervision at all times. Never leave him completely alone.
- Use devices that signal when a door or window is opened.
- Identify when wandering most likely may occur, such as late afternoon–you may have heard the term “sundowners” or “sundowning” used. Plan for games, exercises or activities that can help reduce anxiety and restlessness during this time of day. Read my article “Caring for Patients Living with Dementia: Why Routines are SO important.”
- Establish and stick to a daily routine. Participating in planned activities will enhance mental, emotional, physical and social health.
- Communicate: Reassure him/her that he/she is safe with you here and you are his/her friend (2, 3).
Formal staff in care facilities are required to regularly participate in elopement training. I conduct monthly drills so my team is prepared to respond quickly, appropriately, and efficiently in any situation.
Ah, finally we get to the cat.
Well, time rolled around for another elopement drill. It’s good to get all the practice we can get to find a “lost person”. So, I run the drill then we talk about actions, roles, and any concerns.
It’s inappropriate and really impossible to have a resident involved in a drill. A pretend person doesn’t work either. So I bundled the robotic gray cat in a blanket and found the perfect hiding place. Our furry little friend ended up in Liz’s room in a big box covered with blankets in the back of her clothes closet.
I don’t make finding the lost resident easy. Even though a resident would never be in a box, the purpose of training is to learn to search every nook and cranny, find the person ASAP and care for any needs immediately.
Staff look under beds, in closets, in boxes, behind shower curtains and headboards, on top of tall dressers, and behind every door even if doors are always kept locked. A thorough search could literally be the difference between life and death.
Just as I announced the drill, an emergency of a totally different nature suddenly fell upon us. All minds focused on the new situation. And by the time it was handled our elopement drill was long forgotten that day and for 8 days after.
What reminded me of the elopement drill? Well, when I spotted Liz holding the cat that I had hidden in her room the week before, as she huddled with a group of ladies proudly telling them her son had brought the little kitty to her so she wouldn’t feel lonely anymore.
Needless to say, we don’t use the gray cat for elopement drills any more. Liz won’t let the pet out of her sight. “Precious Kitty” sleeps with Liz, watches Liz brush her teeth and comb her hair, dress, eat, and always sits on her lap during daily activities.
I’m really glad Liz has bonded with the cat and that it has allowed her to feel part of the community. Before Precious Kitty came into her life, Liz stayed in her room, was paranoid, angry, uncooperative, and refused to participate in life.
To see such a drastic change in mood and attitude is nothing short of amazing. It was the gray cat who brought Liz out of deep depression and isolation. Today, the 2 are the life of the party!
This brings us to one of the best ways to prevent elopement: Routine, routine, routine, and engaging activities such as Pet, Doll and Music therapy, Reminiscing, Book Club, Biography, In the News, What About?, Interesting Facts & Trivia, Art, Scenic Drives, Word games, Whiteboard activities, US States, Puzzles, etc.
I am completely sold on robotic therapy cats and dogs for individuals living with dementia. Pets fulfill a basic human need–to give and receive love unconditionally. Caring for a pet provides a person living with dementia an important responsibility and loyal companionship.
Check out my review “Dementia Pet Therapy ~ Cat Review”
Please leave comments, questions, experiences below and I will get back to you soon.
All My Very Best,
- Yale New Haven Health @ ynhh.org/publications/bulletin/020217/hospital-issues-new-guidelines-for-elopement-risk.aspx#
- Alzheimer’s Association @ alz.org/help-support/caregiving/stages-behaviors/wandering
- Peterson, S., Houston, S., Qin, H, Tague, C, & Studley, J. (2016). The utilization of robotic pets in dementia care. Journal of Alzheimer’s Disease vol 55(2), 569-574.