Patterns exist for people who get lost. Whether joggers, hikers, children, or those diagnosed with dementia, different groups exhibit different lost person behaviors. Knowing these patterns would help in finding them. Robert Koester's groundbreaking research has greatly expanded our understanding of “Lost Person Behavior” (Koester, 2008).
This evolving line of inquiry is becoming the bedrock for Search And Rescue (SAR) protocols. SAR personnel consider variables such as behavioral profiles, activity, terrain, health, and personal characteristics to help predict the behavior of people who are declared lost. Koester has analyzed more than 50,000 cases world-wide to identify patterns of behavior that lost people tend to follow, including a special section for people with any variant of dementias—Koester’s specialty.
Older adults with dementia typically get lost through wandering behavior. Six in 10 people with dementia will wander—take off in an aimless way—becoming disoriented and perhaps not remembering their name, address, or their location. Although effective programs exist in the United States—including MedicAlert®, Safe Return® Comfort Zone® and Comfort Zone Check-In®—the majority of people are not enrolled in such electronic tagging. Either they cannot afford the monthly premiums or they assume that they would never need such services. Due to America’s demographic changes, one thing is certain—people with dementia comprise an increasing concern for volunteer SAR teams, as well as state and federal agencies.
For SAR teams all dementias are treated the same. Koester & Stooksbury (1995) reported that when normal older adults got lost they traveled on average a greater straight-line distance (2.56 km) from the Point Last Seen (PLS) than older adults (in this case older than 40 years of age) with dementia (0.88 km). Although statistics indicate greater variability of distance traveled among dementia patients,here are some outliers where some might only travel a short distance while others travel greater distances (one in ten travel an average of 52 miles). Surprisingly, age did not emerge as an important consideration in how people with dementia behave when they get lost.
Dementia patients generally leave their own residence or nursing home and start traveling along roads. The patient is usually located (in 89% of cases) within one mile (1.2 km) of the PLS. If the patients were not on a road (14%), they were usually found in a creek/drainage (28%), and/or caught in briars/bushes (33%).
The majority of patients succumb to the environment. One in five dementia patients (42 cases in this study) were found deceased due to hypothermia, dehydration, or drowning. No fatalities were found among dementia patients when they were located within 24 hours. If they were not found within this 24-hour window, half of dementia patients were likely to be found dead.
Consequently, searches for dementia patients are considered urgent and require an aggressive SAR response. Koester highlights that the diagnosis of dementia is important to elicit urgency. However, he also points out that most primary care physicians fail to administer cognitive status tests, and therefore only correctly identify 58% of the cases as possible dementia. This is particularly true of patients who become lost in wilderness and rural settings, who often belong to disadvantaged socioeconomic groups and who receive minimal health care. Not knowing that the lost person has dementia diminishes the search’s urgency, with potentially detrimental effects.
A key hypothesis among SAR responders when looking for lost dementia patients is referred to as the “path of least resistance.” This theory states that when people with dementia start wandering they tend to follow terrain that provides less resistance (down rather than uphill, roads rather than meandering paths, or railway tracks rather than steps).
A considerable number (28%) of dementia patients were found in drainages or creeks—indicating that they most likely walked downhill—supporting the path of least resistance hypothesis. Another 33% of the patients appear to have become stuck in thick brush or briars. This insight is important because untrained searchers, or searchers working at night often avoid looking into brush or briars because most people tend to try to make themselves visible. Getting stopped in drainages, creeks, brush and briars support research indicating that lost patients with dementia are traveling a path of least resistance until they reach an insurmountable barrier.
Because prevention is the best cure, reducing wandering becomes the best first line of defense. A personal care plan that reduces agitation and depression will help minimize wandering. Because people with dementia tend to leave few clues when they are lost and often do not respond to shouts or voice-based searching, getting expert help as early as possible is crucial. Knowing how to look for lost people with dementia requires an urgency that only expert help can provide.
Local dementia organizations counsel families that when someone with dementia goes missing, SAR efforts should be initiated immediately. Ninety-four percent of people who wander are found within 1.5 miles of where they disappeared. After the family and/or caregivers search the immediate area for no more than 15 minutes, they should call "911" and report to the police that a person with dementia—a vulnerable adult—is missing. Reporting parties should provide enough detail, including any places nearby that might have been important in childhood for the missing person. Reports should include information on fears or phobias that the person might have, and what medications they are on. A Missing Person Report should be filed so that police will also initiate a search.
In addition, even if a concerned party is not enrolled in a locator program, they should file a report with MedicAlert+ Alzheimer's Association Safe Return at 1-800-625-3780. First responders are often trained to check this resource when they locate a missing person with dementia. Additional help can be accessed from the Alzheimer's Association 24/7 Helpline, 1-800-272-3900, which provides information and support to those who need assistance.Getting help as fast as possible might be the strategy that saves the lives of lost people with dementia.
Further Reading:
Perkins D & Roberts P (2000). Search Management for the Initial Response Incident Commander 2000. ERI International Inc.
Twardy CR, Koester R & Gatt R (2006). Missing Person Behaviour An Australian Study Final Report to the Australian National SAR Council. Accessed online: http://www.esf.com.au/documents/reports/RobertGatt2002VicPol.pdf (link is external)
Koester RJ & Stooksbury DE (1999). Behavioral profile of wandering Alzheimer’s patients. Wilderness and Environmental Medicine, 6,34-43 (1995)
Koester RJ (2008) Lost Person Behavior: A Search and Rescue Guide on Where to Look - for Land, Air and Water. Dbs Productions; Spi edition.
© USA Copyrighted 2015 Mario D. Garrett
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