Missing Elderly at Risk

It is a familiar high priority call. Unfortunately, law enforcement can expect an exponential increase in these calls. An estimated 4.5 million Americans currently have Alzheimer's disease; that number has doubled since 1980. By 2050 the number of individuals with Alzheimer's disease could range from 11.3 million to 16 million.

In the United States over 125,000 Alzheimer's disease subjects become critical wanderers annually. It estimated by 2040, this number will increase to over half a million wanderers per year.

Overview of Alzheimer's Disease

Alzheimer's is caused by the degeneration and shrinkage of the brain as well as a decrease in neurotransmitters (brain chemicals). These changes impair the function of the brain and eventually lead to cellular brain death. The brain, unlike other cells, in unable to regenerate new cells. Alzheimer's disease (AD) is progressive; it is commonly broken down into three phases: mild, moderate and severe dementia. The hallmark of Alzheimer's disease is memory impairment, typically beginning with problems in short-term memory, slowly progressing to long-term memory dysfunction. Other key features of Alzheimer's include loss of reasoning, decreased judgment abilities, behavioral changes, communications problems, and difficulty performing routine activities of daily living. Disorientation is another common feature of AD that relates to wandering and becoming lost. The three brain systems healthy adults use for orientation are all compromised in Alzheimer's disease: short and long term memory (to identify landmarks), a sense of time and speed (to judge distance), and an intact visual-spatial sense (to know direction and expected arrival times). The incidence of wandering in the severe dementia phase is 50%. The term "critical wanderer" is given to anyone with dementia who wanders away from supervised care or cannot be located.

Time is of the Essence

The consequences of wandering are staggering, including death and severe medical compromise. Finding the wanderer as soon as possible is paramount.

Survivability Rate:

Survivability rates are also related to weather conditions. The leading causes of death for wanderers are hypothermia, dehydration and drowning.

Profile of the Wanderer

DBS Publications' The Source of Search & Rescue Research, Publications, and Training offers the following behavioral profile of the critical wanderer (Note: not all wanderers have Alzheimer's disease):

• "They go until they get stuck."
• Appear to lack ability to turn around.
• Subject oriented to the past, degree of the disease sends them back in time
• Subject usually found in a creek, or drainage and/or caught in briars/bushes (63%)
• Leaves own residence or nursing home, possibly with last sighting on a roadway
• Coexisting medical problems that limit mobility are common.
• Has previous history of wandering (72%)
• May cross or depart from roads (67%).
• Usually (89%) found within one mile of IPP, half found within 0.5 miles.
• Subject usually found a short distance from road (50% within 33 yards)
• Subject may attempt to travel to former residence or favorite place.
• Subject will not leave many verifiable clues.
• Will not cry out for help (1%) or respond to shouts (only 1% response rate).
• Succumbs to the environment (hypothermia, drowning, and dehydration).

Finding the Victim: Tips to Remember

1. Distance: 94% of Alzheimer's subjects will be found within 1.5 miles, but only 65% of the elderly without dementia will be found within that distance. Subjects with Alzheimer's travel an average of 0.6 miles; wanderers without Alzheimer's average 1.8 miles.
2. Direction: 25% of all wanderers have been found on a road or a trail; another 50% were found within 33 yards of a road or trail. They tend to travel downhill. 50% are located near creeks or other waterway, and/or stuck in the brush. Subjects with Alzheimer's are drawn towards light. Studies indicate that 3/4 of wanderers head south. The best tactic for starting a search is to head SE or SW (toward the light), depending on the time of day the victim was last seen.
3. Wandering History: Different types of wandering behaviors may help predict where the subject might be found. Ascertain what previous types of wandering the subject has been observed in. A non-goal oriented wanderer, who wanders aimlessly, will not travel as far as a goal oriented/ industrious wanderer (who is more likely to use a car or public transportation).

Search and Rescue Strategies

DBS Publications also outlines effective search and rescue tactics for locating the wandering victim.

• Highly systematic search of residence/nursing home and grounds
• Send patrols to areas the subject has been previously located
• Canvass the neighborhood.
• Patrol along roads.
• Establish containment points
• Early use of trackers and at point last seen (IPP)
• Early use of tracking dogs at IPP, along roadways, or clues
• Deploy air-scent dog teams into drainages and streams, starting nearest IPP.
• Early deployment of ground teams into drainages and streams nearest the IPP
• Dog teams and ground sweep teams (in separate sectors) expanding from IPP. Ensure teams search heavy briars/bushes.
• Air scent dog teams and ground sweep teams tasked 100 yards (initially) parallel to roadways.
• Search nearby previous home sites and the region between home sites and IPP
• Search accessible buildings (convenience stores, etc.)
• Repeat search of residence/nursing home grounds at least twice a day
• Post flyers in appropriate locations
• After initial task, search should expand outward from IPP

Preventing a Recurrence

If you suspect caregiver abuse or neglect related to the wandering suspect, contact your elder abuse detective and make a referral to Adult Protective Services.

Critical wandering is a life threatening problem that must be prevented. Caregivers need to prepare a response plan to prevent further incidents of wandering. After the initial crisis has been resolved officers need to encourage the family to take the following steps:

• Register the person in the Alzheimer's Association's "Safe Return Program," which offers numerous prevention strategies.
• Using materials supplied by Safe Return, sew cloth identification tags in the person's clothing or put on a bracelet/pendant that cannot be removed by the subject.
• Inform neighbors and/or local business of the subject's condition. Ask them to call an emergency contact or 911 if they ever see the Alzheimer's person out alone. Provide them with a photo.
• Create a wanderer's information packet, and update this at least twice a year. Include vital information, a recent photograph, driver's license, medical and medication information, as well as information on where and how to look for the subject. Keep this handy to give to law enforcement.

The family should also consider the reasons behind the subject's wandering to discuss with his/her physician to assist in appropriate treatment planning. Common reasons for wandering, other than memory loss, include a changed environment, excessive energy, expression of boredom, a searching for their past, confusion between day and night, continuation of a walking habit, agitation, discomfort or pain, belief that they have a job to do, and an inability to differentiate dreams from reality. The family should also report to the doctor any delusions or hallucinations related to the subject's dementia. A comprehensive and proactive medication, behavioral, environmental and exit control plan of treatment can then be formulated, implemented and evaluated periodically.

On a final note, officers should remember to utilize your special tools of the trade: patience, compassion and empathy. You may be able to retire with your accumulated 3%s at age 50, but if you were born in 1980, your current life expectancy is 78.8 years. You, too, at some point, may become a "911 BOL: Missing at Risk" priority call.

And never forget to be kind to your children; they choose your nursing home.