1. Helping the Lost Become Found

2. The Problem ‘elderly man killed by train…man wandered from personal care home’ ‘Hawthorne woman..found dead..found in a heavily shrubbed area exposed to rain, heat and chill’ ‘man killed by fire truck sent to assist him’ ‘man found dead by pond..bled to death from alligator bites’

3. Clinical Problem persons with dementia become lost in the community under what circumstances do they become lost where are they found who finds them what are signs someone needs help what circumstances are linked to deaths after becoming lost

4. Study design reviewed documentation Safe Return program Safe Return program administered by national Alzheimer’s Association similar to ‘medic alert’ 24 hour operators provide information on residence and contacting caregiver types of data registrant information missing person information details of the discovery

5. Data reviewed univariate descriptive design discoveries recorded 1-97 through 1-98 in USA 675 records 625 discoveries 55 missing reports with no report of discovery

6. Characteristics of dementia person age range 48-102 mean 78  9.0 gender males 353 (52%) females 317 (47%) months after registration range 0-56 mean 14.9  13.1

7. Living Situation N=570

8. N=583 Primary Caregiver

9. Caregivers for persons living alone

10. How they became lost At daycare, nursing home, or other facility Outside home with caregiver Agitated/difficult behavior in the home setting Caregiver distracted Normal outing alone and didn’t return Home alone Caregiver asleep Out driving alone Being transported by professional services

11. How they left method of transportation (n= 507) walk - 88% own car - 6.3% public transportation - 4.5%

12. When found N=413

13. Who found N=411

14. Who found

15. Where found

16. Time Gone much missing data less than 6 hours most common (44%) 187 less than 24 hours 40 greater than 24 hours 24 walking 13 driving own car 2 public transportation males more likely to be gone longer (  2 =6.9, p<.01) living situation did not effect time gone

17. Injuries

18. Individual Stories …was found by police around 4:30 am in lower Manhattan …found on a sidewalk close to hospital…laceration on the back of his head …had been found wandering around the street…he was completely naked (5:45 am - Nov. 11 Michigan)

19. Individual Stories …found wandering through the streets…officer suspected she is intoxicated …found searching through the garbage in Brooklyn …wandering down the street wearing a turtle neck shirt, pajama pants and socks …walking down sidewalk completely naked

20. Individual Stories ….badly decomposed remains were found last night near the New Orleans airport…someone had called the police reporting a woman matching ____ description was seen being pursued by a vagrant male… preliminary autopsy reveals no foul play ….body found in the corn field behind the NH where he disappeared

21. Individual Stories ….______ reported that she was found dead hit by a train (left from a NH) …._______was found in the woods, under a brush 1/2 mile from the NH where he lives … gone from NH ~ 5 days

22. Individual Stories …was found in Mexico driving his car…customs in Mexico stopped him …apparently drove into San Bernadino county on his way to New York… stopped and asked a couple for directions to NY

23. Conclusions unattended wanderings significant and deadly problem ~60,000 people registered in Safe Return many communities have no search and rescue plan for demented elders three pronged approach caregivers general public law enforcement

24. Caregivers PREPARE BEFORE A WANDERING EVENT OCCURS 1. Register with Safe Return and keep contact information updated. Ensure the Safe Return jewelry is worn or clothes are tagged. 2. Use all your resources so that an Alzheimer’s patient is not left in the home alone. 3. Inform your neighbors that your relative has Alzheimer’s disease and if the person is seen alone in the neighborhood, the neighbor should escort him/her back home to a caregiver.

25. Caregivers 4. Prepare a search plan in case of wandering. Identify several other people who can help you search. Identify a person who can wait at the home for telephone calls or return of the Alzheimer’s patient. Identify potential search areas/strategies. 5. Don’t rely on past behavior to predict what will happen next with regard to becoming lost in the community.

26. Caregivers CONDUCT A SEARCH IMMEDIATELY Alzheimer’s patients often cannot negotiate their own way home even from a short distance. Don’t waste valuable time waiting for them to return. Call your law enforcement agency first. Enact your search plan: Get help searching and assign a section of the neighborhood to each searcher Search neighbors’ front and backyards Go into stores and other public buildings as you are searching Search these areas starting at the home and extending out to 5 miles if necessary

27. Search any wooded areas or fields near your neighborhood within a mile of the home. Pay particular attention to thickly wooded areas that are close to the sidewalk or street. Must be searched at close range. Often will not respond to voice. Often will not seek help.

28. General Public Increase awareness about the problem using media. Prepare ‘good samaritans’ to be helpful Education How to identify someone with dementia who may be lost How to communicate with someone with dementia Safe Return program Get help REMAIN with individual

29. Law Enforcement Understanding of dementia and behavioral problems that occur Empathetic and supportive of caregiver Enact sound search strategies

30. Search Strategies identify a search strategy to cover an increasing circumference of where last seen start with 1 mile go out to 5 miles > 5 mi unusual, but not usually associated with death, so less focus needed cover all possibilities within that range streets, highways residential yards easily accessible buildings convenience stores, hospitals continue through night

31. reconsider search strategy after ~ 6 hours identify natural areas within 1 mile range conduct shoulder-to-shoulder search increase circumference to about 5 miles REFER TO ALZHEIMER’S ASSOCIATION ENCOURAGE SAFE RETURN REGISTRATION

32. Thank you and Questions