Keeping an eye on Alzheimer's wanderers

One minute, 82-year-old Robert Henline was headed to bed after a nighttime snack of a sandwich and ice cream.The next time his daughter and son-in-law checked on him in their home in Monroeville, Pa., he was gone into the frigid January night without a goodbye.Like the majority of the more than 5 million Americans with Alzheimer's disease or other forms of dementia, Henline is a wanderer. It's a tendency that shows up unpredictably. Equally unfathomable is where the roaming will lead. The only hope is that the wanderers are found in a matter of hours rather than days."The person doesn't know they're lost -- that's the hard thing about this," said Erica Hood, vice president of programs and services for the Greater Pennsylvania Chapter of the Alzheimer's Association. "They may wander into a river and drown. They don't perceive the safety issue of wandering into water or thick brush. They may not cry out for help because they don't understand the situation they're in."Increased focus on Alzheimer's has helped spread the use of devices that identify and track people with memory impairments, and spur a number of states to enact Amber Alert-style laws to enhance public searches for those who go missing.Even with the new interest, the special bracelets are worn by only a small fraction of afflicted individuals, and fewer than one-fifth of states have laws to aid in finding older adults.Henline was discovered by Monroeville public works employees just five hours after police, firefighters, neighbors and other volunteers had begun an intensive search.He had the poor judgment, however, to step outside on one of winter's coldest nights, with temperatures in the single digits. His daughter and son-in-law have a system of door locks and alarms to make it hard for him to leave the house undetected, and one of them is always home with him. But in this case he walked out before they set the devices.Henline ended up on a neighbor's back porch about 500 yards away from his daughter's home, with his coat draped over him like a blanket, oblivious to the risk or community alarm."His remark to (the searchers) was, 'Where have you been? I've been sitting here waiting for you,' " daughter Lorrie recently recalled.He required five days of hospital treatment in January to regain his normal body temperature and health. He went home for several months, but required amputation of two toes -- and eventually his entire left foot -- from either frostbite or from sores he sustained in the early morning of Jan. 21. It could have been worse, and it has been for some Alzheimer's patients, who represent 13 percent of the population over age 65. The disease is the seventh-leading cause of death in the United States.The vast majority of those with Alzheimers die in nursing homes, hospitals or at home. No statistics are kept on those found dead after wandering. Anecdotally, however, it's clear such fatalities are not uncommon. -- The body of a 94-year-old man with Alzheimer's from Somerset, Pa., was found in a ravine near his home Jan. 9 after his wife reported him missing.-- Last November, a 91-year-old Pennsylvanian was found dead on the ground near his car in a rural area four days after he left home.-- In October 2006, hunters found the body of a Herminie, Pa., man in a farmer's field. He had been reported missing by relatives, who said he lived alone and sometimes wandered.-- And in 2005 in Pennsylvania , a North Braddock man's body was found at the bottom of a steep hillside, a West Deer man died on a golf course after several days of exposure to cold temperatures, and an Ohioville, resident was found dead in a lake more than a week after disappearing.The Alzheimer's Association estimates that at least six of 10 people with the disease will wander at some point, though the instances may be sporadic rather than regular. It's not known what triggers the movements, but Hood said it arises more often when people are bored and lacking sufficient activities and exercise.Dr. David Wolk, a University of Pittsburgh professor who treats Alzheimer's patients as a neurologist, said the tendency to wander arises more frequently in the later stages of the disease and is heightened when people are in unfamiliar environments, seeking out something they recognize -- usually to no avail because of their condition."They have trouble knowing the relationship of different places," Wolk said. "They may feel confident going off. And then trying to figure out where they are, they get further lost. ... Even mild patients living alone might have a sense they can do things they're used to, but when they end up in a situation outside their specific routine, they can end up lost and really thrown off."The mental impairments of Alzheimer's patients aren't necessarily matched by physical ailments, which means that instead of staying in the neighborhood, as Henline did, people sometimes walk for miles without stopping.Others with access to a car will drive hundreds of miles, capable of operating the controls but no longer aware enough to use signs, maps or a friendly gas station operator to figure out where they are. Hood said the risk for such people escalates after 24 hours, often because they're on medications for other conditions, which a caregiver would make sure they took if they were at home.E-mail Gary Rotstein grotstein(at)post-gazette.com. For more stories visit scrippsnews.com