Wandering & the Israelites

I just returned from wandering with my dog.

We don’t tend to describe our everyday activities, particularly those associated with movement, as wandering. I walked the dog (although clearly, at times, she walked me – but that is besides the point.)

How much of our everyday movement is with purpose, intention, a plan? If there were no preconceived or planned actions or activities, would we just spend our days sitting in one spot?

Wandering and ‘wandersome’ is part of the language, the medical terminology associated with dementia. For the more informed, this term has become anathema, not to the same extent as ‘suffering’ – for which we replace ‘living’ with dementia, yet it is one of those words that when you hear it, yes, when I say it, makes me feel uncomfortable, as if, in some way, I am being disrespectful, derogatory.

Nowadays we have a greater understanding of the internal world of people living with dementia, we understand that when an individual with dementia starts to walk somewhere, there is often a motive, just like us; this is usually because of a need, whether for food, a drink, the toilet, or just to find-out where they are.

We need to look at the movements of people who have dementia within this context, within a construct that the majority of people have an idea or something that has stimulated a need within them that has then led to them moving.

The most common form of wandering on my ward relates to individuals looking for the way-out.

My ward is locked – you can’t get in or out without a special key-fob. This in itself, is something that has evolved over the years and features across the country on many wards and clinical areas for a variety of reasons, for example, some wards are locked to prevent the wrong people entering, such as on neonatal or intensive-care units.

On my ward, the lock is predominantly to stop people leaving, something we sometimes describe amongst ourselves as ‘escaping’; the patients aren’t prisoners, they still possess rights and powers of self-determination, yet, within healthcare we use the terminology, ‘in best interests’ – for example, ‘It is in X’s best interests that she remain on the ward until we have treated the underlying condition which is making her confused.’

We try also to relate to our patients as people – person-centred care is the philosophy by which we live and breathe – within the realm of dementia and delirium, the person trumps everything.

And returning to wandering, or looking for the way-out; the vast majority of people are happy to be reassured or distracted and their movements last as long as the concept of ‘I need to get out of here’ remains in their consciousness. Yet, this is still something that makes us, those providing the care feel very uncomfortable.

Going back to the original point – wandering; sure, the Israelites wandered for 40 years, but as a common phenomenon either within healthcare or life in general, wandering is not something that happens very often – even within the wandering of the Israelites there was purpose, whether one which was divine or purely because they couldn’t find their way out of the Sinai desert.

Wandering is usually not the appropriate word.