Wandering and Keeping Someone Safe: Risk, Locks and the First Hour Missing

People with dementia walk for reasons, and the reasons are usually findable: a routine that has not been unlearned, a house they lived in forty years ago, a person they are looking for, or a physical need they cannot name. The risk you are managing is almost never the walking itself. It is the road, the water, the cold and the fall at the end of it. That distinction decides everything else on this page, because a problem understood as “she keeps escaping” produces locks, and a problem understood as “she is trying to get to work at half past seven” produces a plan that works.

The safety case is quantified and it is not reassuring. Alzheimer’s Disease International reports that “seizures are up to seven times more common in people with dementia compared with peers of the same age, while falls that cause injury are two to three times more common”¹. That sits on top of an already high baseline: around a third of people aged 65 and over, and around a half of people aged 80 and over, fall at least once a year, and the one-year mortality rate after a hip fracture is 31 percent (NICE guideline NG249, published 29 April 2025)². In England, around 234,800 emergency hospital admissions related to falls occurred among people aged 65 and over between 2019 and 2020, of which around 157,370, some 67 percent, were among people aged 80 and over².

I should be straight about the limits of my own experience here. My mother does not have dementia and has never gone missing. I have sat with people in a carers’ group on the evening of the day it happened to them, and I have read a great many forum threads written at two in the morning by somebody waiting for a phone to ring, and that is a different thing from having done it. Everything practical below comes from the guidance and from those carers. Where a first-hand beat belongs to someone else, it is theirs and I have said so.

This article sits under caring for a parent at home and belongs with dementia care at home.

Why do people walk?

Because they are going somewhere. Almost every episode has a destination attached, and finding the destination is more useful than counting the episodes. Worldwide, 57 million people were living with dementia in 2021 (WHO, Dementia fact sheet, page dated 3 July 2026)³, and the list of reasons is remarkably consistent across all of them.

• A routine that has not been unlearned. Leaving for work at the same time for forty years, collecting a child from a school gate, walking a dog that died in 2014. The behaviour is intact even where the context has gone.
• Going home, to a house they lived in decades ago. “Home” in this sentence is usually a time as much as a place, and the feeling underneath it is wanting to be somewhere safe. Repeated questions and what to say covers how to answer it before it reaches the front door.
• Looking for a person. A parent, a spouse, a child who is now sixty.
• A physical need they cannot name. Pain, needing the toilet, hunger, thirst, being too hot or too cold. Restlessness is one of the ways discomfort presents in someone who has lost the words for it.
• Boredom, or too much stimulation. A day with nothing in it produces walking. So does a house with three conversations, a television and a visitor in it.
• Fear. Not recognising the room, or the person in it, is a reason to leave. When they do not know you covers that from the other side.

And one more, which gets forgotten: walking is a normal, healthy thing that adults are entitled to do. Some of what gets logged as wandering is a person who used to walk two miles a day and still wants to. Framing it entirely as a risk to be eliminated is how households end up more restrictive than the situation requires.

What does a proper risk assessment look like?

Specific, written down, and about the destination and the conditions rather than about the frequency. Vague risk produces vague responses. The questions that produce a usable answer are these.

• What is the actual hazard on the route? A road, a river or canal, a railway, a steep hill, a car park. A person walking in a village with pavements and a shop is in a different situation from one who has to cross a dual carriageway.
• What time of day does it happen? Late afternoon and evening episodes point at one set of causes; three in the morning points at another. See sundowning and difficult nights.
• How far do they get, and how fast?
• How are they dressed when they go? Slippers and no coat in February is a hypothermia risk before it is anything else.
• Can they ask for help, and would they accept it? Somebody who can still say their address to a stranger is in a very different position from somebody who cannot, or who would deny being lost.
• What do they say when they are found? This is the most informative question on the list, because it usually names the destination and therefore the fix.
• Have they fallen before, and what is being done about that? Falls at home covers the assessment to ask for.

Write the answers down with dates. Keeping a care file is where they live, and a file with four dated entries in it changes what a professional does with the fifth. Then ask for the assessment to be done formally, by an occupational therapist and a social worker, rather than doing it alone: who does what: GP, district nurse, social worker is the cast list.

What reduces it without locking anything?

Meeting the need that generates the walk. In the accounts I have heard, the interventions that work are almost always mundane and almost never technological.

• Answer the destination. If they leave for work at half past seven, give the morning a job at half past seven. A walk together, a task, a routine that occupies the same slot.
• Deal with the physical causes first. Toilet, pain, hunger, temperature. A great deal of evening restlessness is a full bladder or a sore hip.
• Build a real walk into the day, ideally outdoors and ideally at the time the walking tends to start. Exercise earlier in the day is one of the few reliable levers on a difficult evening.
• Reduce the exits without eliminating them. A visually plain door, a curtain, moving the coat and keys out of the eyeline, a bell or a chime that tells you a door opened.
• Fix the sensory basics. Glasses, hearing aids, and good light. Poor light makes an unfamiliar hallway frightening.
• Occupy the day. Regular structure outside the house is one of the strongest protective factors families report: see day services and community support.
• Tell the neighbours and the local shops. Unfashionable, and effective. The great majority of people who go missing are found close to home by somebody who recognised them.

NICE’s carer recommendations sit behind all of this: NG97 recommends a psychoeducation and skills training intervention covering personalised strategies and skill-building and understanding and responding to behaviour change, and notes that “carer interventions are likely to be most effective when provided as group sessions”⁴. Nobody should be working this out unsupported. Getting help in covers how to trigger it.

Can you lock the door?

This is the question every family asks, and it deserves a real answer rather than a shrug. Confining an adult to a building is a restriction of their liberty, not a household arrangement, and the fact that it is done kindly does not change its legal character.

Where somebody has capacity to make the decision, they make it. Where they lack capacity for that specific decision, there is a framework. In England and Wales the Mental Capacity Act 2005 sets out the principles that any substitute decision runs on: a person is assumed to have capacity unless it is established otherwise; they are not to be treated as unable to make a decision merely because they make an unwise one; anything done for someone who lacks capacity must be done in their best interests; and before it is done, regard must be had to whether the purpose can be achieved in a way that is less restrictive of their rights and freedom of action⁵. Confinement that goes beyond restriction engages a separate authorisation process, and the named safeguards differ across the United Kingdom, Ireland, the United States, Australia and Canada.

What that means in practice, for you, on a Tuesday:

1. A locked door is not automatically unlawful, and it is not automatically fine either. It depends on the risk, the alternatives, and whether the person could leave if they wanted to.
2. Raise it rather than resolve it. Say to the GP and the social worker: “I am worried about the front door, and I want to know what is proportionate here and who authorises it.” Ask for the answer in writing, and put it in the care file.
3. Prefer the least restrictive thing that works. A door chime, a bracelet and a neighbour who knows are less restrictive than a lock, and often more effective.
4. Never lock somebody in alone in a house they could not leave in a fire. That is the line that turns a safety measure into a hazard.
5. Record what you are doing and why. A written, dated rationale, agreed with a professional, protects the person and protects you.

The related question of who can make decisions at all is covered in power of attorney and decisions, and the difference between an unwise decision and an absent capacity is set out in when a parent refuses help.

What identification actually works?

Two of everything: something worn and something carried, because one of them will be left behind.

• Worn: a bracelet or a pendant with a first name and a phone number on it. Not the home address, which tells a stranger the house may be empty.
• Carried: a card in a coat pocket and in a handbag or wallet, with the same details plus a line saying the person has a memory condition and may not be able to explain where they live.
• Sewn or written into coats and shoes, because the coat is the thing they leave in.
• A current photograph, updated at least once a year, showing them as they look now rather than at a wedding in 2011. Keep it on your phone and printed in the care file.
• A written description: height, build, hair, glasses, walking aid, and what they usually wear, including the coat and the shoes.
• The address list. Every place they might be trying to reach: the old house, the former workplace, the church, the parents’ street, the cemetery. This is the piece of paper that most often ends a search, and it is the one nobody writes until after the first episode.

Keep all of it in one place, and tell everybody who comes into the house where that place is. Sharing care with siblings is where the arrangement gets written down so that it survives your being unavailable.

What do you do in the first hour?

In this order, without waiting to see whether they come back.

1. Search the house and the garden properly, including the places where somebody could have fallen and be out of sight: behind a door, between a bed and a wall, in the bathroom, in a shed, in a car. A significant proportion of “missing” people are still on the property. If you find them on the floor, falls at home covers the first minutes.
2. Check what is gone. Coat, shoes, keys, handbag, walking stick, dog. It tells you how far they intended to go and how they are dressed for it.
3. Check the immediate street and the two or three routes on your list, quickly, and ring anybody who can check another one at the same time.
4. Ring the police. Do not wait a set period; there is no rule requiring it, and the first hour is the one that matters most, particularly in cold weather. Say the words vulnerable adult and dementia, because they change how the call is graded.
5. Give them the photograph and the description, and tell them where the person has gone before. Previous destinations are the most useful thing you hold.
6. Say whether there is a medical reason for urgency: a heart or lung condition, diabetes, medicines that matter, a recent illness, a fall, or new confusion in the last day or two.
7. Stay reachable, and leave somebody at the house. People come home.

What do you do afterwards?

Treat the episode as information rather than as a fright to be recovered from. Within the same day, write down the time they went, the weather, what happened in the hour beforehand, what they were wearing, where they were found, and what they said when they were found. Four of those entries will show you a pattern that no single episode shows.

Then ask for a reassessment: an occupational therapy look at the home, a falls assessment if there was any fall, and a review of whether the current care package matches the current risk. Adaptations and technology at home covers equipment and what an assessment unlocks, and getting help in covers the rest of what exists.

On technology, honestly. Trackers, door sensors and alarms report movement, not safety. A sensor tells you a door opened, not which way the person turned. A tracker needs to be charged, carried and in coverage, and when it works it tells you where somebody is, not whether the road beside them is dangerous. They also raise a genuine consent question, because monitoring an adult who has not agreed to it is itself a restriction and belongs in the same conversation as the door. They are a useful part of a plan and a poor substitute for one.

On the night, honestly. Night walking is the version that costs carers the most, because it is the one that ends sleep. Sleeping when you are on call covers what genuinely recovers some of it, and carer burnout and your own health sets out the evidence on what sustained caring does, including where the popular claims overstate it.

When is the walking a medical sign?

When it is new, or suddenly much worse, over a day or two. This is the part that gets missed, because a family that has been managing walking for a year reads an increase as the condition progressing and absorbs it.

Dementia progresses over months and years. Delirium develops over 1 to 2 days, with an acute onset and a fluctuating course, and NICE says plainly that “it can be prevented and treated if dealt with urgently”⁶. The recommendation that settles the doubt is verbatim: “If there is difficulty distinguishing between the diagnoses of delirium, dementia or delirium superimposed on dementia, manage the delirium first.”⁶

Watch for the quiet version too, which in this context looks like the opposite of wandering. NICE tells clinicians to be “particularly vigilant for changes that may indicate hypoactive delirium, which are often missed, such as withdrawal, slow responses, reduced mobility and movement, worsened concentration and reduced appetite”⁶. A person who normally walks and has stopped is as much of a change as one who has started.

Delirium or dementia sets out the full distinction, and spotting when someone is getting worse is the general method for telling a slow change from a fast one.

This is a call today, not a lock to buy at the weekend

If somebody is missing now, ring the police now. Everything below is the separate question of when the walking itself needs a clinician the same day. Ring, and say what has changed and when:

• New walking, or a sudden increase in it, over a day or two.
• New night-time walking, or a person who is up and dressed at three in the morning when they never were.
• Walking with new confusion, or confusion that comes and goes through the day. Use the word confusion.
• Restlessness in somebody who cannot say what is wrong, which is often pain, constipation, urinary retention or infection.
• A fall, even one they got up from, or a spell on the floor or the ground before anyone found them.
• Withdrawal, drowsiness, slowed responses or a stop in eating, which is the quiet form of delirium⁶.
• A new or changed medicine, a recent hospital stay, or a new fever.

Who to ring: in the United Kingdom, their GP surgery, or NHS 111 out of hours. In Ireland, their GP or the out of hours GP service. In the United States, their own doctor’s office, or the nurse line their plan runs, or an urgent care center. In Australia, their GP, or healthdirect on 1800 022 222. In Canada, their family doctor or the provincial health line, 811 in most provinces.

Use the emergency number immediately for changed breathing, chest pain, one-sided weakness, changed speech, a first seizure, an unrousable person, or bleeding that will not stop: 999 or 112 in the United Kingdom and Ireland, 911 in the United States and Canada, 000 in Australia, 112 across the European Union. Use it too if somebody has been outside in the cold for a long period and is drowsy, shivering has stopped, or their skin is cold to the trunk.

The risk being managed here is not embarrassment. It is a person who cannot ask for help standing next to a road, and no episode is worth being polite about.