Alzheimer patient wanders

By Michael Gordon
Vice-President, Medical Services

"We had quite a scare a few months ago," said Phyllis, the wife of one of my patients.
"Larry disappeared from the apartment one day while I was out for less than an hour. I had left him home like that many times before and never had a problem. I came home, the door was unlocked even though I had locked it, and he was not home. I went down to the lobby and asked the few people there if they had seen Larry, but no one did. I was in a panic and called my son and daughter who arrived at the house within half an hour."

My patient was 76 years old. His wife brought him to my clinic because she was concerned about his memory.

The first episode that really worried Phyllis occurred when he went out on an errand by car and ended up lost in Scarborough. He lived in North York. He had the presence of mind to call her and eventually managed to get back on Highway 401 and make his way home.

When I was interviewing him during the first office visit, he blamed his lapse on construction detours. This was almost plausible, but not quite. Formal testing revealed findings compatible with the early clinical stages of Alzheimer's disease. Sometime after I first met Larry, he was put on the then new medication for Alzheimer's, and I continued to monitor him along with his family physician.

He has done reasonably well considering the clinical diagnosis, with much of his success being due to a devoted wife committed to his care. Phyllis is determined to keep him at home with her for as long as possible.

However, as his memory and other cognitive functioning have declined, and with the support from a social worker, Phyllis decided to enrol him in Baycrest's community day centre for adults with conditions such as Alzheimer's disease. He seemed to flourish in the program, and was attending twice weekly which gave his wife a break.

That was the situation the day he disappeared. Everyone in the family was frantic as they went off in different directions in their cars, looking for Larry. In the meantime a phone message had been left on the family's answering machine stating that their relative had arrived at the day centre program by himself after hopping on a bus.

Eventually, Larry was picked up and taken home. The family interpreted Larry's action as an indication that he enjoyed the day centre program and felt at home there. He possibly needed to spend more time there than the two sessions a week. Phyllis responded by enrolling him three days a week.

She also registered him with the Alzheimer Society wandering registry. The registry gave Larry an information bracelet that listed home phone and cell numbers for his wife.

In addition, Phyllis started to think about her husband's needs down the road -- more help in the home or placement in a long-term care facility.

Wandering is a big issue for families whose loved one is experiencing Alzheimer's disease.

According to the Alzheimer Society of Canada, people who have Alzheimer's have a 20 to 60 per cent chance of wandering. Those with more progressive stages of the disease have the highest risk of wandering.

The society has a Wandering Registry but although 364,000 Canadians have Alzheimer's, only 12,000 have been registered. More families need to be aware of this registry and use it. The Alzheimer Society's Registry can be reached toll-free at 1-800-616-8816. Registration is $25, which includes an identity bracelet as well as other support services.

"Aging" Column (11-29-2002)
Reprinted with permission from Toronto Star