He Wanders Even Inside the House

Before treating this as restlessness, check the ordinary causes of movement: a full bladder that isn't emptying, constipation, needing the bathroom and not finding it, hunger, thirst, being too hot or cold, or pain that makes sitting uncomfortable. If the pacing increased sharply over days rather than weeks, treat it as possible infection and call, before treating it as a behavior.

Indoor wandering looks aimless, and it usually resolves into a few patterns, each with a different fix. Some of it is searching: he is looking for a bathroom, a purse, a spouse, or a room that existed in a previous house, and cannot hold the search in mind long enough to finish it, so he cycles. Some of it is a need the body can no longer name. Some of it is stored energy with nowhere to go, which is common in someone who worked on his feet for forty years and now spends the day in a chair. And some of it is anxiety with nowhere else to go, since movement is one of the few self-soothing tools left when the environment stops making sense, which is why it worsens the moment you leave the room.

Shadowing, following you from room to room and waiting outside the bathroom door, is the same thing happening for the same reason. You are the last reliably familiar thing in the house, and when you leave the room, the room stops feeling safe. Rummaging is worth reading the same way, since drawers get emptied because there is a real historical task organizing the behavior: putting laundry away, finding a wallet, packing for a trip.

Movement is not, by itself, a problem. Walking is generally good for sleep, mood and bowels, and a person who paces is not doing something harmful by pacing. What needs watching is the point where it tips over, into pacing through meals, pacing instead of sleeping, or pacing until he is exhausted and unsteady. The goal is to make the movement safe, not to end it.

One cause deserves its own paragraph, since it is treatable and routinely missed. Akathisia, pronounced ack-uh-THIZH-uh, is a drug side effect that produces a physical inability to stay still, and it is regularly mistaken for agitation. It comes from antipsychotics such as Seroquel (quetiapine), Risperdal (risperidone), Zyprexa (olanzapine) and Abilify (aripiprazole), from some antidepressants, and from anti-nausea drugs such as metoclopramide (Reglan) and prochlorperazine (Compazine), and it can appear when a dose goes down as well as up.

It is also fair to ask whether the medication is still needed. Antipsychotics carry a warning about increased risk of death in older adults with dementia, and they are not a treatment for pacing or wandering. Whether a drug is still earning its place is a reasonable question to put to whoever prescribed it.

The most useful changes here are environmental rather than verbal. You are giving the movement somewhere to go and something to accomplish.

1. Walk with him for five minutes rather than asking him to sit, and ask what he is looking for. This is the only thing on the list you can do in the next five minutes, and it works more often than the rest of it.
2. Clear a route and light it. A single hallway with nothing on the floor and a chair at each end is enough, since most apartments have no loop. Put him in proper shoes with a back and a grippy sole rather than socks or loose slippers, which cause more indoor falls than anything else, and check his feet weekly for sore spots he may not be able to report.
3. Build a rummage drawer he is allowed to go through: folded towels, fabric squares, junk mail, large playing cards, an old wallet with expired cards. Keep everything bigger than a fist, with no real keys, no coins, no batteries, nothing sharp or breakable, and nothing that looks like food. Some people spend an hour with it and some spend four minutes, and four minutes is still four minutes. While you are at it, secure the drawers he shouldn't be in: medications, cleaning products, knives.
4. Put the effort at the front of the day and make the destinations findable. A real walk in the morning cuts afternoon pacing more than any afternoon intervention does, and a sign on the bathroom door, a nightlight along the route, and offering the bathroom every couple of hours removes a great deal of the searching.
5. For shadowing, try a waiting job. Hand him a towel, say you'll be back before he finishes it, then actually come back in a minute, before he's done, and do that twice before stretching it to three. You are not buying time yet, you are teaching him that you come back. Stay within earshot, and only as long as he can safely be alone.

Note where he ends up, not just that he moved. Consistently arriving at the front window, the back door, or the corner where the bathroom sat in a house he left in 1988 tells you exactly what to change. If the destination becomes the front door at night, that is a different and more urgent problem, and the exit-seeking guide is the one to read.

Shadowing is draining in a way that is hard to explain to anyone who hasn't lived with it, partly because it looks like devotion and feels like surveillance. If you have hidden in the bathroom, or felt a flash of anger when he appeared in the doorway again, that is what happens to every person who is followed for fourteen hours a day, and it tells you nothing about whether you love him. If you are alone in the house, as most people reading this are, you can still take the ten minutes: sit him somewhere safe with something in his hands, shut a door, and set a timer.