Medical Elopement? ~ A Story of Dementia, Elopement and A Gray Cat
What the heck do dementia, elopement and a gray cat have to do with each other you ask? My memory care staff don’t know until I explain and give them a drill.
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 Las Vegas.
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 with dementia will wander. And because a person 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 with dementia may wander away and become lost or trapped. Depending on weather, length of time he 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 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 with dementia states “I want to go home” the walking about searching for an exit might actually mean she is seeking for the protection, and feelings of acceptance, familiarity, safety and love associated with her family and home. So the intent may not be to physically leave the building at all (1,3).
Formal caregivers, including CNA, 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 can walk about and is connected with his environment in a healthy way (1, 3).
In addition, the following strategies may 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 alone.
- Use devices that signal when a door or window is opened.
- Identify when wandering most likely may occur, such as late afternoon (sundowning), and plan for games, exercises and activities that can help reduce anxiety and restlessness.
- Establish and stick to a daily routine. Participating in planned activities will enhance mental, emotional, physical and social health.
- Communication: Reassure her that she is safe with you here and you are 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.
A Gray Cat
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 to find a “lost person”. I run the drill then we talk about actions, roles, and questions.
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 showercurtains 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 completely forgotten that day and for 8 days after.
What reminded me of the elopement drill? When I spotted Liz holding the cat that I had hidden in her room the week before. She was huddled with a group of ladies telling them her son had brought the sweet kitty 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. Cat sleeps with Liz, watches Liz brush her teeth and comb her hair, dress, eat, and 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 Cat 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 sweet gray cat who brought Liz out of deep depression and isolation. Today, she and gray cat are the life of the party!
This brings us to one of the best ways to prevent elopement: 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 with dementia. Pets fulfill a basic human need–to give and receive love unconditionally. Caring for a pet provides a person with dementia an important responsibility and loyal companionship.
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.