Category: Dementia Safety Topics™ Online Training Program

It’s natural to wonder, “Isn’t there some medication that could help this person?”
Specific medications can be helpful for people who truly need them. However, when we turn too quickly to antipsychotic medications to calm or control the behavior of a person living with dementia, there can be serious and unintended consequences.

Caution Against Quick Medication Use in Dementia Care

Many behaviors in dementia care—though challenging—are actually forms of communication. A person may be trying to express pain, discomfort, boredom, fear, or confusion. Turning immediately to medication may silence that communication without addressing the real cause.

Consider these examples:

• Getting up and down out of a chair

• Repeatedly trying to leave the building

• Screaming or crying

• Entering other people’s rooms

• Pacing the hallway

• Getting upset with caregivers

• Banging fists on the table

• Throwing things

Are these situations truly solved by medication—or are they signals that the person needs understanding, comfort, or reassurance?

Responding with Compassion, Not Control

If someone with dementia yells, hits, or even bites, it’s easy to feel frustrated or frightened. But remember: these actions are expressions of distress, not deliberate aggression. Before reacting, pause and take a moment to reset.

Here’s what to do instead:

• Slow down. Rushing or showing frustration can increase the person’s anxiety.

• Take a deep breath. Staying calm helps you think clearly and respond appropriately.

• Have compassion. Try to see the situation through their eyes—what might they be feeling or trying to say?

• Use the CARES® Approach. This person-centered method focuses on Connecting, Assessing, Responding, Evaluating, and Sharing—steps that help caregivers understand and support the person with empathy.

The Power of the CARES® Approach

These simple strategies can make a profound difference. They help caregivers connect with individuals, uncover what’s truly causing distress, and respond in ways that meet emotional and physical needs. Most importantly, they often eliminate the need for physical or chemical restraints altogether.
When we slow down, observe, and respond with compassion, we not only improve care—we protect dignity, safety, and trust.

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Although restraints are often used in care settings to prevent harm, research and experience show that they frequently cause harm instead. People who attempt to break free from restraints can suffer severe injuries—such as broken bones, concussions, or even death. Moreover, simply sitting or lying down for too long without movement can weaken the body and mind, leading to a wide range of health problems.

Below are some of the most common and serious complications caused by physical restraints:

1. Dehydration

People who are restrained are often unable to drink water independently. Without adequate hydration, they can quickly become dehydrated, which affects every system in the body.

2. Psychological Distress

Being restrained can be deeply traumatic. Individuals may feel anxious, stressed, frustrated, agitated, lonely, or ashamed. This distress can lead to depression, social withdrawal, or even increased aggression and restlessness—the very behaviors restraints aim to control.

3. Loss of Postural Tone

Remaining in the same position for extended periods causes a loss of “vascular tone”—the ability of blood vessels to constrict properly. When a person changes position, such as from lying to sitting, blood pressure may drop, leading to dizziness, confusion, or fainting.

4. Pneumonia

Prolonged bed rest increases the risk of pneumonia. When a person lies down for too long, fluid can accumulate in the chest, making it easier for infections to develop and spread to the lungs.

5. Decreased Appetite and Malnutrition

A lack of movement often leads to a reduced appetite. Someone who was previously active may lose interest in eating, resulting in malnutrition and weakened immunity.

6. Urinary Tract Infection (UTI)

Restraints can cause or worsen incontinence. Limited mobility, lack of fluids, and an inability to use the bathroom independently all contribute to the development of UTIs.

7. Constipation

Physical activity is crucial for healthy digestion. When someone cannot move freely, the bowels slow down, leading to constipation—made worse by poor hydration and reduced appetite.

8. Incontinence

Restraints can make it impossible for individuals to reach or use the toilet in time, resulting in incontinence. Over time, this can also lead to skin irritation and infection.

9. Decreased Bone and Muscle Strength

When people are confined and unable to move, their bones lose density and muscles lose mass. This physical decline can make walking or even sitting up difficult, increasing the risk of falls and fractures.

10. Swollen Feet

People restrained in a sitting position often develop swollen feet, as fluids accumulate in the lower limbs when movement is restricted.

11. Pressure Sores

Pressure sores, or bedsores, develop when the same part of the body bears weight for too long. Redness is an early warning sign; if ignored, these sores can progress to painful, infected wounds.

12. Contracted Muscles

Without stretching and movement, muscles and tendons can shorten and stiffen—a condition called contracture. This reduces flexibility and can permanently limit mobility.

13. Decreased Functional Skills

The combined effects of these physical and psychological issues lead to a significant decline in a person’s ability to perform daily tasks—such as eating, bathing, or using the bathroom—further reducing independence and quality of life.

Conclusion

Physical restraints may seem like a safety measure, but they often create new risks and diminish dignity. Understanding the consequences of restraint use helps caregivers seek safer, person-centered care alternatives that support both well-being and autonomy.

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For many years, physical restraints were used in dementia care with the belief that they kept people safe. But behind this idea lies a deeper truth — being restrained can be frightening, isolating, and deeply uncomfortable. To truly understand why restraint-free care matters, we first need to imagine what it feels like to lose the ability to move freely.

Imagine this:

1. You are seated in an uncomfortable chair.

2. You cannot stand up or move around.

3. Your arms are too weak to reposition yourself.

4. Your bottom aches from sitting too long.

5. You need to use the toilet, but no one is nearby to help.

6. You are cold from a draft, yet unable to shift or find a blanket.

You are thirsty but cannot reach for a drink.

Anyone would find this situation distressing and uncomfortable. Now, imagine being unable to communicate your needs clearly — this is often the reality for many people living with dementia.

For decades, physical restraints were commonly used in long-term care settings. Caregivers once believed that restraining a person was the best way to prevent falls, injuries, or wandering. In the early 1990s, studies revealed that nearly 6 out of every 10 nursing home residents were physically restrained.

Restraints came in many forms — tying a person to a chair, a wheelchair, or even a bed. Although these practices were often well-intentioned, they stripped individuals of their independence, dignity, and sense of control.

Today, we know better. Restraining someone doesn’t just limit movement; it affects emotional well-being, increases agitation, and can even lead to physical decline. Compassionate, person-centered care focuses on understanding the reasons behind behaviors and finding safe, respectful alternatives to restraint use.
By stepping into the shoes of those who are restrained, we can better appreciate the importance of preserving autonomy, dignity, and comfort in dementia care.

Restraint-Free Care

Restraint-free care focuses on supporting safety and dignity without restricting a person’s movement. Instead of using physical or chemical restraints, caregivers use observation, communication, and individualized care strategies to understand the person’s needs. By creating a calm, engaging environment and addressing the reasons behind behaviors, restraint-free care promotes comfort, trust, and well-being — helping people with dementia live with greater independence and respect.

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In the past, physical restraints were often seen as a necessary part of dementia care. Caregivers and healthcare staff believed that using restraints would help keep people safe—especially those at risk of falling, wandering, or becoming agitated. The intention behind their use was often good: to protect the person with dementia and those around them.

Why Restraints Were Commonly Used

Restraints were traditionally applied in situations where a person with dementia might:

• Be at risk of falling

• Strike out at others

• Wander or move unsafely

• Take food from other people’s plates

• Enter other residents’ rooms or take their belongings

• Get out of bed during the night

• Appear confused, restless, or agitated

• Require lifesaving medical treatment

These actions were often misunderstood as challenging behaviors that needed to be controlled. In reality, they were expressions of unmet needs, confusion, or distress.

The Hidden Harm of Restraints

Although restraints were meant to prevent harm, research has shown that they often do the opposite. Physical restraints can lead to serious injuries, emotional trauma, and, in some cases, even death. They may increase confusion, fear, and agitation in people with dementia, making behaviors more difficult to manage instead of improving them.

Simply put, the use of restraints causes more harm than good.

Knowing the Person Is Key

When caregivers and families take time to know the person behind the behavior, they can identify what might be causing distress or confusion. This person-centered approach allows for creative, compassionate solutions that keep everyone safe—without compromising dignity or freedom.

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In dementia care, our primary goal is always to promote safety without compromising dignity or independence. One area that continues to evolve is how we think about and manage restraints. While once considered protective, restraints—whether physical or chemical—can actually increase the risk of harm and distress. Understanding what constitutes a restraint and why minimizing their use is essential can help caregivers provide better, more person-centered care.

What Is a Restraint?

A restraint is anything that controls or limits a person’s movement, behavior, or access to their body. There are two main types of restraints: physical and chemical.

1. Physical Restraints

Physical restraints are objects or devices that restrict a person’s ability to move freely or access certain parts of their body. Examples include:

• Belts, vests, or wrist ties

• Lap trays or restrictive clothing that the person cannot remove easily

• Chairs designed to prevent standing or movement

• Bed or chair alarms that frighten people into staying still

While these restraints might appear to prevent falls or injuries, they often do more harm than good. They can cause fear, agitation, or even serious accidents when a person with dementia tries to escape them.

2. Chemical Restraints

A chemical restraint involves using medication—usually antipsychotics—to control dementia-related behavior or make care tasks easier for staff. These medications can sedate a person, reducing movement and responsiveness.

However, such medications should never be used simply to calm a person or manage behavior related to dementia unless absolutely necessary for safety reasons. The Centers for Medicare and Medicaid Services (CMS) has required nursing homes to reduce the use of antipsychotics for people with dementia since 2012.
There are times when these medications are appropriate—for example, when a person has a serious mental illness or poses a danger to themselves or others. In those cases, physicians must clearly document why the medication is being prescribed and for how long.

Misconceptions About Restraints

For many years, restraints were believed to promote safety, especially in preventing falls. However, evidence shows that they can actually increase the risk of injury or trauma.

For instance, bed rails were originally designed to keep people from falling out of bed. But for someone with dementia, a bed rail can become a source of danger. A person who doesn’t understand its purpose may try to climb over it, leading to a more severe fall or even entrapment. Without the bed rail, the fall might have been less harmful—or avoided altogether.

In short, restraints can create the illusion of safety while introducing new and serious risks.

Moving Towards a Restraint-Free Approach

The ultimate goal in dementia care is to eliminate the need for restraints by understanding each person as an individual. Compassion, observation, and communication are key. When we connect deeply with the person and respond to their needs—rather than control their behavior—we create a safer, more respectful care environment for everyone.

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When caring for individuals living with dementia, “wandering” is one of the most common behaviors caregivers encounter. But rather than seeing it as a problem to eliminate, it’s important to understand wandering as a meaningful activity that happens for a reason. By reframing our perspective, we can create safer, more positive experiences for both the individual and the care community.

Why Wandering Happens

Like all dementia-related behaviors, wandering doesn’t occur without cause. A person may walk around because they’re following a routine, searching for something familiar, or simply enjoying movement. Your role as a caregiver is to pay attention, recognize patterns, and learn what each person is trying to express through their actions.

When Wandering is Positive

Wandering isn’t always something to stop. In fact, when done safely, walking around can be a healthy practice that promotes exercise, reduces restlessness, and provides a sense of purpose. For many individuals with dementia, movement brings comfort and helps them feel engaged with their environment.

When Wandering Becomes Risky

Wandering can become harmful if it leads someone into unsafe areas, outside of the care setting, or into another person’s private space. These risks highlight why it’s so important to understand each person’s habits and to provide safe spaces where exploration can happen without harm.

The Importance of Knowing the Person

The best way to support safe and positive wandering is to know the individual well—his or her routines, habits, and preferences. This knowledge allows caregivers to anticipate needs, prevent unnecessary risks, and make wandering a safe and enriching activity.

Shifting the Language

Language matters. Instead of labeling someone as a “wanderer,” use positive, respectful terms such as “exploring” or “walking around.” This small shift reinforces dignity and helps everyone focus on the person, not the behavior.

Final Thoughts

Wandering is not a behavior to fear, but an opportunity to better understand and connect with people living with dementia. By recognizing the reasons behind it, ensuring safety, and using respectful language, caregivers can turn wandering into a positive part of daily life.

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Wandering is a common behavior among people living with dementia. While it can sometimes cause safety concerns, wandering also has positive aspects—it can help individuals stay active, reduce restlessness, and promote independence. The key is to support wandering in a safe and meaningful way.

That’s where the CARES® Approach comes in. CARES is a simple, person-centered framework that helps caregivers connect with individuals, understand their behaviors, and respond in ways that promote dignity, safety, and well-being.

Here’s how it works:

C – Connect with the Person

The first step in the CARES® Approach is to connect with the person. Taking time to build trust and establish a human connection helps encourage safe wandering and reduces feelings of confusion or distress.

A – Assess Behavior

Next, carefully assess behavior. Observe the person with dementia closely—when, where, and how often are they wandering? Are there specific triggers, such as time of day, routine changes, or environmental cues? Recognizing patterns helps you understand their needs and intentions, making it easier to guide them safely.

R – Respond Appropriately

The third step is to respond appropriately. Use what you know about the individual, combined with your observations, to address their needs in a supportive and respectful way. Your response should reduce risk while honoring their independence and dignity.

E – Evaluate What Works for Safe Wandering

The fourth step is to evaluate what works. Pay attention to which approaches are effective in supporting safe wandering and which are not. Continuous reflection helps improve care and ensures strategies remain person-centered.

S – Share with Others

Finally, share with others. Communicate your observations, successful strategies, and challenges with colleagues, family members, and the care team. Sharing ensures consistency, strengthens teamwork, and provides the best support for the person with dementia.

Conclusion

Wandering doesn’t always need to be prevented—it can often be supported in ways that bring comfort, activity, and purpose to people with dementia. By using the CARES® Approach, caregivers can create safe environments, reduce risks, and help individuals live with dignity and independence.
Safe wandering isn’t just about managing behavior—it’s about seeing the whole person, honoring their needs, and walking alongside them with compassion.

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Wandering is a natural behavior for many people living with dementia. While it can sometimes lead to unsafe situations, it can also be turned into a positive and meaningful activity with the right environment. By shaping spaces thoughtfully and offering calming outlets, caregivers can encourage “positive wandering” while discouraging unsafe or “negative wandering.”

Here are some simple ways to support safe and beneficial exploration:

1. Make Exit Doors Less Noticeable

Painting exit doors to blend into the environment—for example, with an outdoor scene—can help prevent unsafe wandering to restricted areas. This reduces risk while keeping people at ease.

2. Create Clear Pathways

Clutter-free indoor and outdoor walkways give people safe routes to explore. These paths encourage natural movement without the worry of tripping hazards or confusion.

3. Provide Resting Spaces

Placing comfortable chairs and benches along walking routes allows people to rest when they get tired. Having safe places to pause encourages longer, more relaxed wandering.

4. Offer Recreational Zones

Small nooks filled with old-fashioned objects, puzzles, or familiar keepsakes can provide enjoyable distractions. These cozy exploration spots turn wandering into a meaningful activity rather than a risky one.

5. Use Soothing Sounds

Playing soft music or nature sounds can help calm people who feel restless or anxious while wandering. A peaceful soundscape makes the environment feel safe and welcoming.

6. Introduce Gentle Activities

Structured physical activities like chair exercises or simple movement routines give people a healthy outlet for energy. Rocking chairs or glider seats are another safe, calming option for those who walk frequently.

7. Add Visual Cues

People with dementia can become confused about where they are. Personal cues—such as their name in large print, a family photo, or a favorite object near their door—can help them recognize their own space and feel secure.

8. Provide Simple, Hands-On Tasks

Activities like folding laundry or sorting objects can give a sense of purpose and comfort. These simple tasks keep hands busy and minds engaged, reducing restless wandering.

Positive Wandering- Final Thoughts

Positive wandering is not just about keeping people safe—it’s about giving them freedom, purpose, and dignity. By making small changes to the environment and offering thoughtful activities, caregivers can transform wandering from a risk into a beneficial part of daily life.

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Wandering is one of the most concerning behaviors associated with Alzheimer’s disease and related dementias. It can occur at any stage of the disease, though the likelihood and risks of wandering change as dementia progresses. Understanding how wandering appears at different stages can help caregivers recognize early signs and put safety strategies in place.

Normal Thinking (No Symptoms)

At this stage, a person does not have dementia. They may walk around, pace, or even take long strolls, but their actions typically have a clear purpose. Since their memory and judgment are intact, we don’t consider this purposeful movement as “wandering.”

Early Stage (Mild Symptoms)

Wandering can sometimes begin during the early stage of Alzheimer’s. For example, someone driving to the grocery store might become disoriented when faced with a detour. While they eventually find their way back using familiar landmarks, this brief period of confusion may be the first sign of wandering.

In new environments, such as an assisted living community, confusion is more noticeable. A resident might try to find the coffee shop they saw earlier but forget which floor it’s on, wandering in circles or even forgetting why they set out in the first place.

Caregiver tips for early-stage wandering:

• Provide gentle guidance in new settings.

• Use familiar, personal markers (like a photo or unique decoration) on doors to help with orientation.

• Establish consistent daily routines.

• Walk with them to common areas, such as the dining room, until the path becomes familiar.

Middle Stage (Moderate Symptoms)

Wandering tends to increase in the middle stage, when people still retain many abilities but are more vulnerable to confusion and unsafe situations.
You might notice behaviors such as:

• Moving in and out of other people’s rooms

• Picking up and carrying away personal belongings that aren’t theirs

• Difficulty locating familiar places like the bathroom or their own room

• Pacing due to delusions or hallucinations, sometimes reliving past memories that feel real to them

Since they may still be able to learn and memorize, people in this stage can even pick up on staff routines—such as remembering the code to a locked exit—making safety more challenging.

Caregiver tips for early-stage wandering:

• Use door alarms, motion sensors, or monitoring systems to be alerted if someone tries to leave.

• Post simple signs (like “Bathroom” or “Bedroom”) with words or pictures to help with orientation.

• Create secure spaces where the person can walk freely without risk of leaving or getting hurt.

• Having personal belongings within reach can reduce the urge to take things from others’ rooms.

• Structure daily activities to provide engagement and reduce restlessness.

• If someone is pacing or trying to leave, guide them toward a calming activity (like folding towels, looking through photos, or listening to music).

Late Stage (Severe Symptoms)

In the early part of the late stage, wandering can continue, but it often looks different. People may walk about aimlessly, unable to explain where they are going or why. Often, their actions are tied to basic needs: searching for a bathroom, looking for food, or following an old routine.

As dementia progresses further, mobility declines. People may lose the ability to walk on their own and need assistance to move from a bed to a chair. At this point, the risk of wandering becomes very low, and eventually, it disappears altogether.

Caregiver tips for late-stage wandering:

• Pay close attention to behavior patterns.

• Look for unmet needs that may be driving the movement.

• Ensure safe surroundings with clear cues for eating, toileting, or resting.

Caring with Awareness in Alzheimer’s disease

Wandering is not random—it often stems from unmet needs, confusion, or attempts to follow past habits. By recognizing how wandering looks at different stages of Alzheimer’s disease, caregivers can better anticipate risks and provide safe, supportive care.

With patience, observation, and the right strategies, it’s possible to reduce stress for both the person with dementia and those caring for them.

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Wandering of people living with dementia is a common behavior, and it often stems from a variety of causes. Understanding these reasons can help caregivers respond with empathy and create safer, more supportive environments.

Personal Causes (Physical and Mental Health)

Sometimes, wandering is linked to a person’s own health or emotions. It may happen because of:

• Pain or discomfort

• Boredom or lack of stimulation

• Delusions (seeing or believing things that aren’t real)

• Restlessness or the need to release energy

• Medication side effects, which can increase or trigger wandering

• Desire for fresh air—to see and touch plants, hear nature sounds, feel sunlight, or simply to move around

Environmental Causes

The surroundings can also play a major role in triggering wandering. Common factors include:

• Busy, confusing, or overstimulating environments

• Uncomfortable temperatures (too hot or too cold)

• Lighting changes, especially shadows or dim areas

• Transitions from day to evening (often called “sundowning”)

Problems With a Task for Wandering of people living with dementia

Wandering may also occur when tasks feel overwhelming or frustrating. This may be due to:

• Tasks being too complicated

• Inability to express needs clearly

• Vision or hearing difficulties

• Not being given enough time to respond or complete a step

Responding Appropriately and Sharing With Others

Caregivers and care teams play a vital role in supporting safe wandering. Whenever possible, allow people with dementia to walk or move freely—as long as they are not at risk of harm or disrupting others. Creating safe spaces for walking, such as gardens or secured hallways, can provide comfort and reduce frustration.

Most importantly, share your observations with the care team. Open communication ensures that everyone understands what might be causing the wandering and how best to support the person with dementia.

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