As the Alzheimer’s disease progresses, eventually the person with Alzheimer’s will succumb to more devastating and debilitating brain dysfunction. Alzheimer’s family members and search and rescue personnel should be aware of the following:
Dysphagia is a loss or reduction of the ability to swallow. This is particularly important to know because the Alzheimer’s person is at risk for choking or aspirating fluids into lungs. Combined with apraxia, a reduction of motor functions, a person has walking gait difficulties and/or is in terrain that may cause the person to fall and not be able to get up.
Catastrophic Reaction is often described as a “super anxiety attack,” as catastrophic reaction is generally a hyper-response to a stressful situation that may cause injury to oneself or others. The person with Alzheimer’s will break objects, scream, cry, take off clothing, kick, bite, moan, rock, withdraw, lock themselves into a room or hide. This could be the trigger that causes wandering or the behavior may be triggered because of wandering. In one case a missing person was located in an open space by a helicopter. When the helicopter tried to land near the person, they ran as if trying to get away. The helicopter tried to keep the person in sight as he kept running. The person eventually ran himself to death. Upon further investigation it was determined that the person had been a prisoner of war (POW), and there was speculation that he ran thinking the enemy was out to catch him.
Sundowning is associated with all dementias. Sundowning is a phenomenon in which during the evening hours certain behaviors increase, including agitation, wandering, anger, violence, catastrophic reactions, withdrawal, paranoia and hallucinations. As it starts to get dark all of the above become exacerbated. Another way to look at this behavior is that the person is getting tired at the end of the day and may be disoriented or confused.
Violence is one reaction that a person with Alzheimer’s may manifest when one realizes that they cannot control their environment or that they are uncomfortable and have a need they cannot communicate. These behaviors can be unpredictable. Once the Alzheimer’s person is found it is important to approach them calmly. When transporting them do not place them in the front seat where they could suddenly grab the steering wheel or hit the driver. Some persons with Alzheimer’s have been known to open the door and step out of a moving vehicle.
Incontinence As Alzheimer’s disease progresses, it also robs the person of bladder and bowel control. The bladder is essentially a large muscle and as the person loses recognition of the urge to urinate, the bladder will continue to fill until it spasms and voids. When this occurs often enough, the bladder muscle loses tension and control, which often leads to leakage. Additionally because of the infectious waste associated with loss of bladder and bowel control, people with Alzheimer’s often develop urinary tract and bladder infections. These infections only serve to further reduce bladder and bowel control.
This is of particular importance to the patrol officer, who is often called to transport a person with Alzheimer’s who has been found. This incontinence is yet another reason to safely place the person with Alzheimer’s in the back of the patrol vehicle, where the seats are often an easy to clean one-piece plastic bench. Loss of bowel and bladder control can produce what is considered a hazardous material spill incident (HazMat), which will require special clean-up services. Clean-up of such a spill on a fabric seat can take considerable time and often ends up with that patrol vehicle out of service for the rest of its shift.
Cognitive Mapping is the inability to sequence normal routine tasks. For example in the sequence of making a peanut butter sandwich, opening the peanut butter jar, scooping and spreading peanut butter on bread and eating it may be three sequential steps that are forgotten when trying to feed oneself.
This illustrates the point the person may not be aware and therefore unable to ask for help when they are lost. Because of the impairment to judgment and logical thinking, many persons with Alzheimer’s are unable to recognize a danger to themselves. They may wander across roads or highways, fall into bodies of water, or become entrapped in heavy brush.
This is extraordinarily important to realize since many law enforcement agencies do not consider a missing person with Alzheimer’s to be at risk, and will not consider a person over the age of eighteen to be missing until after twenty-four hours. Some departments still require a mandatory 48 hours, or even 72 hours since last seen. Wandering Alzheimer’s persons do not have the luxury of time.
Studies by Robert Koester and David Stooksbury (1992, 1995) show that wandering persons with Alzheimer’s lost in Virginia face a 46% mortality rate if not found within 24 hours. Information provided by the Emergency Services Council of British Nova Scotia reports death incidents of 70%. Records by the Rim of the World Search and Rescue team, 1968-1994, show 100% mortality rates for persons over the age of 60 who were not found within 24 hours (no distinction made for person’s with Alzheimer’s versus elder persons (“Operations of the Rim of the World Search and Rescue Teams from 1968 to 08/30/94”, Michael M. Dest, Captain James Nunn, Commander Gary Steffens).
Unfortunately, most persons who wander will succumb to personal or environmental hazards. The three leading causes of death for persons who wander are heart attack or stroke, exposure to the weather, and drowning. Rates remain the same for both those who wander and become lost in cities and in rural areas.
Seven out of ten people who have Alzheimer’s live at home by themselves or with family members. The daughter or daughter-in-law usually ends up being the caregiver. As the disease progresses the family caregivers become more frustrated with outbursts of violence and other reactions. The caregivers may have given up many things: work, their homes, sleep, vacations and other sacrifices. There may be signs of adult abuse (e.g., burns, malnutrition, bed sores)., It is important to be aware of the signs and symptoms and how the missing person will react to being back in this environment.
In some cases, the person may be in a room or automobile and refuse to leave. At this point it may be acceptable to tell a lie, for example: “Your wife is waiting for you to come to dinner.”
Be aware that a uniform may cause the person to think they have done something wrong. This will increase their stress. On the other hand, a uniform may gain a person’s trust and cooperation.
Remember the phenomenon dysphasia, the loss of the ability to swallow. The person may spit and choke, which can lead to death.
The person should be seated in the back seat of the vehicle and the door locked from the inside. Persons with Alzheimer’s have been known to step out of a moving vehicle. Other persons with Alzheimer’s have assaulted and injured police officers while sitting in the front seat, officers having assumed that frail 80 year-old Mrs. Jones would not hurt a fly.
The following tips are important to remember when searching for a person with Alzheimer’s who has wandered: