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Wandering or Elopement Risk

A patient trying to leave the unit, heading somewhere that made sense decades ago. What's actually driving it, and what to do in the first minute after they're noticed missing.

NBefore You RespondNotice

Notice the alarm doing the thinking for you. A bed or door alarm tells you someone is moving. It doesn't tell you where they think they're going, and that's the more useful question.

What May Be Happening

Read

Find out where they think they're going before you focus on the door

Most exit-seeking is purposeful, not random. It attaches to something specific: getting to work, picking up a child now decades older than that, getting home to an address that isn't theirs anymore. If this is new, with no history of it, treat it the same as any other sudden change and rule out pain, a full bladder, or an unmet need before assuming it's simply the dementia.

What's actually driving it

The destination is old, but the urgency is real right now. Arguing the facts, that job ended years ago, goes nowhere. Acknowledging the urgency usually goes somewhere.
A locked or badge-access door reads as an obstacle, not a safety measure. Someone who can't understand why they're contained experiences containment as confinement, which increases the drive to leave rather than reducing it.
The unit itself doesn't look like anywhere. Long identical hallways and unmarked doors give a confused person nothing to orient by, so movement becomes the only way left to search for something familiar.

What to Say

Reach

"Where are you headed? Let's talk about it while we walk this way."

Redirecting rather than blocking. It meets the task instead of correcting it.

"I need your help with something first."

A reason to stay or redirect that isn't a command, and doesn't require them to agree they're wrong about where they're going.

"She's not in her room. Starting the count now."

Said to the team, immediately, the moment someone is noticed missing. Naming the protocol trigger out loud is what starts the clock instead of losing five minutes to "she's probably fine."

"Let's sit for a minute before we figure out the next step."

Slows the moment down once you've reached them, rather than escalating straight into logistics.

What Not to Say

"You can't leave."

A flat command with no redirect gives them nothing to do and confirms you're the obstacle.

Waiting to see if they turn up before starting the search.

"She probably just walked to the day room" costs the minutes the search will need later if she didn't.

Physically blocking the doorway with your body as the first move.

Can escalate a calm redirect into a struggle. Verbal redirect first, when there's time for it.

What to Try Next

Start the count and the standard search the moment someone is noticed missing from where they should be. Don't wait to see if they turn up.
Check the obvious first: bathroom, day room, another patient's room, before checking anywhere less likely.
Redirect with a task or a reason rather than a flat instruction to stop. "Walk with me" works where "go back" doesn't.
Look at what's actually driving the exit-seeking, pain, hunger, a bathroom need, a specific hour, so the next attempt might be prevented rather than only caught.
Know your unit's specific protocol, door alarms, wander guard, security notification, before you need it. The moment it's needed is a bad time to learn it.

When to Escalate

Search and security protocols are set by your hospital, and this page doesn't replace them. What's worth carrying into that call: every minute before the search starts is a minute the search has to cover later.

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