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My dad has mild dementia and I manage his medication. He has run away from home a couple of times over the past 10 years. I was tipped off that he is planning another trip. He won't go shopping, fishing, sightseeing etc. because he claims that he is in too much pain. Yet he is planning a 700 mile journey.
Do I have any pre-emptive options? The stress of finding him gone and issuing a silver alert is too stressful on our family.

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I have been told over and over to sabotage their transportation. Hide keys, pull a spark plug wire, etc. Take the Uber app off his phone, accidentally cancelling phone service, etc. Good luvk
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More info is needed. What do you call "mild" dementia. You don't say whether he lives with you or not but wifi cameras are a huge help. You can program them to alert you when there is motion at the entrance door or garage. There are inexpensive, easy to set up & very good cameras on Amazon. You can put a tracker on his car, which would really be key in locating him. If he uses a cell, you can set it to find his location.
Lastly, have a heart to heart with him and tell him how much he means to you and how worried you would be if he left. Is there anyone in your family that would be willing to make this journey with him? It may be invaluable time spent together that you won't regret.
Best of luck to you.
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Does he still drive? Maybe hide the keys. Put alarms on doors so you know if he goes outside. Dementia patients often can’t be reasoned with. However, changing subjects is very helpful because it puts the previous thoughts out of their minds. Redirection works well if he’s in the act of leaving. Direct him to a dessert or tv show. Camaras are helpful too, especially the ones that can be viewed from a phone. This way other family members can keep an eye on him too. It’s a challenge taking care of people with dementia but by giving them reasonable simple choices, it deverts the anger often associated with it. You must remember that your dad isn’t the same as he once was, some times it’s the illness talking. Don’t take it to heart. By giving choices he will feel like he’s still in control. Hope this helps you
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This is an answer from way out in left field. “Wandering” used to be a substantial reason for death, and might still be – it is not likely to figure as ‘cause’ on a death certificate. An older person would wander off, but die of exposure or from an accident (or exposure following an accident).

This site has regular discussions about the ethics of keeping people alive when their quality of life has gone. The supervision, the medical treatments etc keep them alive when they are ready for the end. If your father really wants to do something dangerous, and risk the consequences, is it your responsibility to stop him? Is it in the best interests of both of you? Is an alternative to notify the proper authorities and then just wait to see what happens? Just a thought….
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Beatty Jan 2021
Margaret, yes these happen. Don't know if you caught this one from Vic:
Elderly man missing for 12 days after leaving for car show. 95 yr old embarked on a road trip to the NSW south coast in his 1967 Vanden Plas sedan. He was found down an enbankment off a small road in thick forest, 60kms from the highway. Appears he took the wrong turn out of the last main town. Went doing what he loved. Driving his vintage car.
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We can only control so much. My sister, a nurse who works w/ the elderly, tells me all the time “Sometimes something worse has to happen in order for change to take place.
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People are saying just put him in Memory care. The Memory care facility here is $5,000/$8,000 a month. We don't all have that and make too much for any help.
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NYCmama Jan 2021
Speak to a well regarded elder car lawyer. It is well worth the consultation fee.
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Imho, eliminate all methods he would use to run away from home, e.g. no auto, no credit cards, no debit card, no cash, etc.
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Place a tracker on his shoes. They make some that go on the shoelaces. My mother never noticed them. Twice,I got a call from someone who found her lost across the street from her assisted living.
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This is why I educate caregivers or anyone with the potential to be caring for or who may be concerned for persons with cognitive impairment on the importance of creating a "care team!" Of course, a geriatric care manager like myself is helpful for families and caregivers who prefer eldercare expertise in creating such a team. The care team consists of a wide variety of professional healthcare individuals who will develop a care plan based on needs or concerns presented initially. The care plan will follow the care journey as the care team continues a cyclical assessment, plan, and evaluation on a regular basis for the life of the case.
At the onset, as a care manager, the very first medical professional would be either the aging loved one's own PCP or preferably a board-certified geriatric-psychiatrist who can assist me with helping the caregiver get conservatorship if they do not already have POA.
If the caregiver already has a healthcare proxy or POA, then it is a matter of having the physician deem the loved one to be decisional or not; in other words, is the aging loved one with known memory impairment or cognitive decline able to make appropriate or good health care decisions.
It is best for a caregiver to first have written evidence of an aging loved one's mental capacity before making any decision.
And it is a good idea to share the accountability of making tough elder care decisions with the eldercare professionals who do so on a daily basis and are knowledgeable and wil help on a continuum.
I also lead a caregiver support group where I coach caregivers on these very issues and STRONGLY would recommend that caregivers caring for those with dementia of any kind or at any stage be involved in a local caregivers support group. Go to https://alz.org and find a local caregiver support nearby. During the pandemic, our groups are meeting by Zoom, or most are!
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What is mild dementia in your opinion per your dad?

In the past ten years? If he has mild dementia now, that wouldn't indicate he had much problems ten years ago, right? Could you elaborate on his condition ten years ago and what the problem was when he ran away or maybe in his mind it was a getaway, a vacation. (I remember when my mom and I were claimed not to be able to go even to Dallas. We left anyway and for the whole weekend, 300 miles away and back. Then we moved out of state for two years. Of course I was with her. You understand if your parent is not able to listen, to be advised, or accepts your advice, you can't do that. And certainly not for two years. But others were not being reasonable and our trip proved it. We made a LOT of friends where we stayed.) Help us to know your reasoning.

If he's taken off before, then the pain probably isn't the main reason he doesn't want to go shopping, fishing, sightseeing. Or it would keep him from planning and taking those vacations. We were also said to have run away, but it was a vacation, but yes, we wanted away from the severe restrictions mentioned by those who weren't around us caring for her. So I don't know if that's an issue here as well. Your fear could be placing fears on him. Actually. Is there nobody he trusts that can go to a movie with him. When you offer to go shopping with him, or a movie, do you include any of his friends? Could it be he's afraid you want to put him in a nursing home? Do you spend all your time with him or just drop in daily or every other day? You said you manage his meds, but what does that mean?

How old is he? When did he starts meds? Which meds does he take? Does he take any meds himself or only if you give them?

It's really complicated if you don't want just a pat answer one-size fits all. I'll be glad to help you but we'll have to communicate about it. Do you live in Texas? You can PM me. I'm definitely an expert in these things. Multiple psych degrees. Twenty years dealing with AD focused on one patient, so the depth of my understanding is deep and takes in all stages and situations from beginning to end, medical and sociological and psychological.

Why don't you go on the trip with him? that's also a question I have. If we are in the same city, I'm glad to speak with you in person and to meet your dad as well. If you are serious about helping your dad, there are many things you can do to help him. It's not always all downhill. Unless you use 50's style care, which is what you find in nursing homes.
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I worked with a Swami at an ashram during his hospice. He would get quite depressed and ask me to drive him away and leave him beside the road somewhere as he felt useless.

I alerted the head Swami as my Swami went as far as to get his coat and shoes on and ask where I was parked 😳

They did an intervention and had him go to a isolated meditation building and stay the whole day to meditate. I don’t feel like they solved the problem more like a time out but I didn’t want to interfere with their spiritual practices as he was also seeing demons. (As did my own grandmother)

Everyone’s end of life is different, something is driving them. My Swami needed answers not prepared statements or to feel useless. That’s where I saw his frustration, sometimes that constant reassurance goes a long way.
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Convince him to take someone along with him.
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Why not find out where he wants to go and try to take him? My mom had this itch to go years ago and how I wish I took the time to take her. Now it is impossible.
If you can swing it, it will be a nice memory for you.
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There was a window with my loved one where he could still safely operate a vehicle, but often got lost. We put a GPS tracker on each of his vehicles. With the monthly subscription we got an app that allowed us to monitor not only where he was but also his speed. He kept his independence and we kept our peace of mind.
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IF he is competent he can do what he likes. He has rights, too. If you are concerned, you need to take this issue up with his doctor to evaluate his competency.
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1st, was wondering why he thinks he needs to run away?

Talk to him about it and let him know he doesn't need to run away, that if he wants to go on a trip, to let you know so you can help him plan it.

Then plan the trip with him and let him choose someone to go along with him if needed.
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Sometimes they are going to the home of their childhood. I was home with my husband all the time. Once he got out as far as the mailbox and hollered at me that he was going for a walk. After that scare I put chimes or noise makers on each door. When I heard that I ran, If he wanted to go for a walk we went together.
That worked very well for us. I did have help. My teen grandchildren and family lived just a few miles from us so they came by and walked him too. They carried their phones and only had to call me once because he wanted to walk too far.He is gone now and I even miss that.
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I think many of our loved ones go through this in the early stages of dementia. As time goes on it gets more and more impossible to execute. Unless you think there is a possibility that he could actually do it, I would just ignore it. Let him talk and fantasize about what he’s going to do. Eventually the day will come when he won’t be able to leave the house no matter what he says. Just be sure he is safe and doesn’t have access to large amounts of cash or credit cards.
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Please get a second and third opinion on how to manage his pain because in my urgent earnest sincere honest experience , I have learned that medical management of humans health for the last 30 years has switched to using Petri dish corporate science, rather than doctor nurse, time tested, clinical, professional hands on, human health care . Once you get the health care team to switch to the root cause of pain, that’s when you’ll have a chance to stop the madness.

Get your dad to see a “functional medicine” doctor or do a virtual consult to start ASAP. Please. That’s what I did and my parents have zero pain now. No more leg and joint pain, no more hand arthritis pain, no more hip, back, foot pain ... nor more yo-yo diabetes blood sugar either and no more agitation from high blood pressure either and no more medication. Except for a little Metformin as insurance when my dad goes to parties or I can’t control the meals . No elder should be on a cocktail of drugs without a variety of health guidance and nutritional guidance. Food = Mood.
My mother also used to walk out the door . Once I got her to a doctor that knew the root cause of diseases, everything changed .
Or once I began to analyze first if the diet was optimal or not and his environment was engaging and fulfilling enough, then the meds are also addressed if not firstly.

Also get a male companion his age or younger disguised as housekeeper that will eventually begin chatting with your dad and get him to talk which will be a catalyst into doing other activities eventually.
what you can do in the meantime is calculate how much hydration he gets of “electrolytes” in his water and food choices. Check If he’s dehydrated (pinch the skin above his wrist and if it sticks together and doesn’t go back down fast, then he’s dehydrated) Buy super C or Emergecy C electrolyte drink at CVS and give half the dose to see if he calms down . You can also try CALM with calcium or by itself just CALM Magnesium but just 1/3 of the portion.
if you don’t have time to try these things which has helped too many people and elders and you can read about it in medical journals and the symptoms of dementia becoming unmanageable due to too many drugs and other lifestyle and nutrition factors.

Look online for the functional medicine practitioner website . Many MDs have switched to incorporating functional or integrative medicine into their practice but they might have stopped taking insurance because they focus or the root cause of disease instead of using drugs merely to stop symptoms .
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Does dad have access to car keys, checks, paper money and credit cards/wallet? Important info that someone can take. They dont have to mug him. If he's outside on the sidewalk somewhere confused, a person can say I can help you.... You don't want him walking out of the house with these items. Or having them in the house, where he can get to them and give credit card info over the phone.
Id also get him an id bracelet. U can get from Amazon. You can get a ring or other security an app that tells you if someone is at the door, or if he leaves. U need wifi.
I would try to get a companion or a carer to come in and watch him.. House stripped down if he's alone. But if he's got moderate dementia he shouldn't be alone. Make sure keys are gone and distributor cap off the car. Dont say your taking the keys and your not leaving! That will make him furious and more determined than ever. And sometimes they can have a long memory when they are mad.
And if he keeps trying to go, its time for a facility or someone needs to be there 24/7. My dad wondered off in the woods. Wasnt found for sev hrs. I didnt hear about it until months later. My mom was having cognitive issues of her own. Just didn't see situations that were dangerous.

I would say for safety reasons he needs a higher level of care. You dont know if he turns stove on, microwaves the oven mit with the food or starts a fire, leaves door wide open. He can also wander off in the cold and not be found for several days. I've heard of people in bad shape or not found until too late. If you can't afford a higher level of care then you need to get family involved or figure something out. Hes already wandered off several times. The 1st time should have been the last time. And of course you can say all the reasons why he can't go. Or tell him he's not going. He'll just be more determined.
Gold luck.
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RichCapableSon Jan 2021
She said it's mild dementia, not mid or late stage.
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With only mild dementia, why is he wanting to run away? If things are in his favor, he’s treated with dignity, has privacy & nothing is forced on him, if he’s eating his favorite foods, watching his tv programs & his caregivers let him be in peace, then he wouldn’t want that. Look at his environment. If you were him, would you want to run away? Maybe things at home need to be altered so he feels more happy & content ❤️
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RichCapableSon Jan 2021
Mom and I were taking hell. It was she who suggested we just leave. So we did. We left all the interference and wrong opinions behind and lived free as the birds on the coast of Florida and Alabama in beautiful condos for two years. She was considered late stage AD. After that two years gone, she lived another 8 years. She was turned 90 the first few months we were gone. With mild dementia, he may be facing an over-reaction by others. Social engagement, vitamins, minerals, going out every day to where they like to go, to their church, see their brothers and sisters out of town. Let them use the store wheelchairs to shop. Everything like that will keep them going and even improve their behavior and mental outlook.

Mom's gerontologist gave her 5 years to live in 2004 and 100 other patients that same year. They all died. In 2009 he called us in to tell me they all died and said mom's in the same condition and they had investigated all the records, but all were treated the same, but nobody had a son or daughter like me. What? you do this, that, take her here, there, etc etc. and all you do for her with her, every day, day after day, is why she's in the same condition, exact condition as five years ago. I'm supposed to give you the five-year speech again, but I know you now and she's going to be living a lot longer than five years from now. Since 2004, a hundred of his AD patients died every year like clockwork. 100 x 16 years. Just one gerontologist? 1600 patients my mom outlived. Multiply that by all the gerontologist patients across the city, state, country.

It was worth every moment. You only have one mom and one dad. If not for them, none of us would even be alive. Period.
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What happened when he did run away before?

I can’t imagine him being on his own now with COVID.

What reason does he give for running away?

What were his reasons for the last runaways?

Is he on meds? If so, do you think his meds need adjusting?
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Sometimes the planning of a trip can be as much fun as the adventure itself. While you don't know where he is planning to go, maybe you could suggest some places and plan a trip. I did this with one of my clients who wanted to go visit long-gone relatives in Italy. What about getting maps of any place or a road atlas. Spend time choosing routes, and change the final destination often. Sounds like he liked fishing, maybe plan a trip to a great fishing river.
Then bog it all down in the details! Get a couple guidebooks, look for interesting side trips. Choose a date of departure well in the future, then change it with some excuse. "Wait, we can't go there in February, it will be too cold. Let's go in August".
Make endless lists of clothes to bring, food to pack, fishing gear to repair, lures to buy. Peruse sporting goods catalogues together. Then change it from a fishing vacation to biking excursion. New lists, new maps, new destination, new departure date!
Hopefully you can get him so hooked on the planning that the trip itself never materializes. And planning a great trip together can be a fun activity to do with him.
Meanwhile do all the research necessary to plan his future arrangements.
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RedVanAnnie Jan 2021
I often plan trips for myself, sometimes just for the pleasure of the planning and anticipation, so your comment struck home. I love road trips, so I "plan" the roads I'll travel, I choose motels and campgrounds and restaurants and local attractions.
You're right. Even the planning is a lot of fun. When I don't really go on tjat trip, I save a lot of money!
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Is there someplace in particular he is wanting to go? Maybe a road trip with just the two of you. It might be possible to do it by train and get a room in the train for extra covid precaution. You go to the destination, take a cab to a hotel and then make the trip home.

If this isn't possible and you think he may try it alone, he will need money and or tickets for a trip. Can you prevent him from getting the things he needs for a trip? If he has access to these things, watch for the signs he is preparing. If he still has a lot of time alone without supervision, it may be time to get some inhome caregivers to go in each day to clean, fix food, and have a set of eyes on him each day.
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You got some good suggestions here (and some good questions. It might be that it is time for him to move to a secured (locked) MC unit in either an AL or a LTC provided he has be diagnosed with dementia. Not sure if finances are an issue but AL's generally do not have a lot of Medicaid beds so payment is private out of the individuals pocket. Many LTC facilities have secured units but you ideally want to have a unit that is certified. It means that the staff has to continuously take dementia related training and that the resident-staff ratio may be a little better.

In any event, trying to get placement anywhere in the midst of a pandemic is problematical so (without knowing where you live) I would suggest that you get in touch with your local Sheriff's Office and/or your state office on Aging to see if they have a monitoring program available. Mercer county in NJ has such a program and the tracking devices are available free of charge provided you have a verified doctor's diagnosis of dementia. The Office is run by the Sheriff's department. They come to the house, meet with the dementia patient and a family member, ask some questions, take a photo and then present the dementia patient with a lovely "bracelet" in honor of something they have made up. Thing is waterproof and goes on and doesn't come off without a special tool. Needs a new battery which they will come and replace every 60 days or so (my Mom used to look forward to their visits!). Although it has a fairly short range 3-5 miles, it has located a number of wandering folk here very quickly saving taxpayers, police and families a lot of worrying and anguish.
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Sometimes go along a little bit with his planning of this trip. This way you can find out where he's "planning" on going and when he wants to leave.
Then when you know this information start talking to him about going somewhere else and that you'd really love to get away and go somewhere yourself, and how would he feel about going together on a family trip. Then his mind will be on a different trip.
This might work. Like you said, he had mild dementia. He refuses to do basic things because of being in pain. It could be that he just wants some attention and maybe a change of scenery with family that's closer than 700 miles away would do wonders.
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Probably a silly question, & wildly expensive, but are there escorted holidays for those with memory problems? With hired Aides? (They would have to have a very high staff ratio 🙄).

Someone suggested that for my relative instead of her plan of a totally unrealistic trip to an unsafe part of the world. A nice supported holiday somewhere else, more local.

She was actually happy with some days trips instead.

What does Dad like to do?
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BurntCaregiver Jan 2021
I've been an elder caregiver for near to 25 years and there is not one of us who is going to travel on a holiday with a client suffering from dementia. That's not going to happen.
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It's so interesting that he is now planning this next trip in secret. I would interpret that as meaning he *does* remember something about his prior trip and that he has some understanding that this new trip must be kept quiet so it isn't thwarted. Is it possible he is suffering from some sort of mental illness rather than dementia? Based on his prior excursion that nearly did him it he seems like a candidate for MC.

When I was in 9th grade I remember a girl who was regularly called out of class so that she and her entire family could go search for her grandmother, who had dementia and lived with them, and would pack her suitcase and leave. No one was able to be home to care for her for a while. I remember the stress it caused this girl and her family.
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Seems it is time to make sure dad has round the clock care:

Home health aides can keep track of him round the clock - if there are finances available for this,

Residential facility - I'm thinking memory care unit - can also keep track of him. Most memory care units have different methods to keep their residents from fleeing.

Figure out why or where your dad wants to leave. Maybe he wants a trip to a specific location or he is tired of all the COVID restrictions. A short trip with a trusted family member may cure the desire to flee.
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Does IL = his own home or is it part of a facility?
Does he have a car (sounds like no if he used a bike and got a ride from someone)?
Does he live alone (sounds like yes.)

Would he accept having aides in his place? If not and if he can't afford 24/7 or a live-in, it sounds like he really needs to be in a MC unit. He can still go out, with supervision, but not alone.

You don't need the stress and worry if he does "take off", nor do you need the call that they've found him... too late. He will likely say NO if you ask him to move. He will likely make a fuss when you do move him, but the choices really have come down to status quo or MC.

IF he's the type to make a big fuss if you plan to move him, make up a reasonable excuse for why he has to move, temporarily (you know it isn't, but he can think that), such as repairs needed on the home, etc. Blame others when you can (doc says..., repairman says... ) If the excuse isn't working, make plans for a nice meal out, arrange with the facility to have this meal, go to the area after the meal, make excuse for yourself, like having to use the bathroom and leave. The facility we moved mom to knew our situation (refusal to consider moving anywhere), so they said just get her here, we'll do the rest! They did use some anti-anxiety, mildest dose, initially, but only for that transition period (and once later for UTI sun-downing.) They suggested staying away for a week, better to stay away 2, to give it some adjustment time.

If you do get him to move and do take him out, make sure to watch him like a hawk and if you can get a tracking device on him, just in case, that would be good too!
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