Wednesday 28 November 2012

Going places

For most of us, travelling is part of our everyday routine. From going to work, looking after our families, shopping or enjoying activities, getting from A to B is just another challenge along the way. Travelling, whether it be close to home or far away, is also associated with pleasure - we do it to see something familiar and nostalgic, or experience the amazing for the first time. You may travel to enjoy a change in climate, experience a different pace of life, tackle an adventure or simply find rest and relaxation.

All of the above are perfectly valid reasons to move yourself from one location to another, and that does not change when someone has dementia. Interestingly my father was never a great traveller - indeed he never left the UK his whole life - and yet when he went into care as a result of his dementia, he became one of the home’s most extensive ‘travellers’, or as it was termed in those days, ‘a wanderer’.

He would walk endlessly along the corridors of his nursing home, and although it kept him fit it brought problems too. Dad was often reluctant to rest during mealtimes, and even when he was persuaded to sit to eat or drink, he would often nag me to ‘get on with it’, so restless was he to keep moving. As he became more unsteady on his feet (partly due to his dementia, but mostly because of the long-standing knee problem that he had), he became prone to falling, resulting in numerous trips to hospital for wounds to be stitched up.

Still he kept walking, undeterred, with an increasingly unbalanced motion until one day, without warning, his walking stopped and never resumed. Efforts were made to restore his mobility, but his knee could no longer support him, and due to his dementia he was unsuitable for knee replacement surgery. So my dad was no longer ‘a wanderer’. Except in my mind he never was.

Wandering suggests aimless moving from place to place without any clear objective, but that is not the case in people with dementia. I have written previously about the need to appreciate, understand and connect with a person who has dementia within the world THEY are living in. It may be a world from their childhood or their years as a youthful adult, it may be a happy place or a sad and worrying place. Wherever it is and whatever the circumstances, the person with dementia may well feel compelled to do certain things, and have great purpose and direction in doing them, however fleeting that may be.

When someone with dementia walks constantly, it may be as a result of seeking, finding, expecting or hoping to see a person, place or object, or to get away from something. It may also be that they feel too hot or too cold in their current environment, they may be looking for the toilet or to make a drink or a meal, they may be bored, wanting to escape from a particular smell or noise, confused about the time of day, feeling energetic or needing to try and walk off a pain or discomfort. You may never discover what their reason is, or the person with dementia may go into great detail about what they are doing. It may prove to be a phase, or a physical problem, like in my father’s case, may end it.

For my dad, much of his walking was harking back to his life as a farmer and a gardener. Walking the fields, rounding up the cattle, sowing crops, ploughing and harvesting. Another man in the care home had also been a farmer, and if anything he walked even more than my dad. A female resident had very different reasons. She had been an executive and travelled extensively abroad for both business and pleasure, with a particular love of dancing the night away on cruise ships. Another lady had been a busy wife and mother all of her life, and was used to being on her feet cleaning, tidying, cooking and running around after her children.

Sometimes it can be important to find ways to persuade someone who walks constantly to take a break. If they lose too much energy they can become prone to falls, and walking constantly at night when they would normally be sleeping can also be dangerous as tiredness develops. Eating and drinking whilst on the move is not advised, especially in people who need more time to chew and swallow their food to avoid choking. Constant walking can also bring those who are doing it into contact with others who may find their movement objectionable.

Building those break times into the walking routine means excluding a physical reason why the person with dementia is walking (ie: needing the toilet), and then finding an occupation for them that either ties in with their reason for walking (if you are able to discover what that is) or involves something that captivates their imagination, thus temporarily overriding their compulsion to walk. Never fall into the trap of viewing their walking as unnecessary though. Re-read the first paragraph of this blog post and for every reason you or I have to travel, remember that in the world of someone with dementia, they may have those exact same reasons too.

Until next time...

Beth x

You can follow me on Twitter: @bethyb1886

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