Q: A younger, robust person who is constantly roaming is very different from an older person with memory impairment. Our staff can’t keep up and we need to curb this behavior. What do we do?

A. It is important to recognize how roaming is distinct from wandering in order to develop effective interventions.

Roaming is more routinized, repetitive and purposeful activity. There seems to be a need for the pacing in FTD. Trying to stop or prevent a person with FTD from pacing or walking (i.e., restrain them to eat) often results in spontaneous vocalization or other disruptive behaviors. For someone who has had a physically active lifestyle, pacing can be a release of tension and stress. If it is taken away, the tension and restlessness increase. Effective interventions will focus on finding ways to shape the behavior in adaptive ways over time that allow the person to remain active and safe.

Arrange for the person with FTD to walk outside and to go where they want to go as much as possible. Ensure that he has proper walking shoes that fit well and monitor feet for blisters. Incorporate daily walks into the care plan and enlist volunteers and family to help. One assisted living found a new resident’s disruptive pounding on the exit door was greatly reduced by walking with him in the community for two hours each day. Staff hesitated at first, but found it was a good way to engage him and get exercise themselves!

Within the facility, decreased social judgment and disinhibited behavior can contribute to unintended issues with other residents, such as “running into them” or walking into rooms at the end of a hallway. Facilitate routine patterns for walking that minimize disruption to other residents who may be older or physically frail. Track the time of day the person is most active, where they naturally pace and their intake of food and beverages and use of the bathroom. Alter visual cues for areas you don’t want the person to enter, such as Velcro signs saying “Turn Around” on doors, wallpaper on doors so they do not look like doors, or cover door knobs with cloth or a picture.

Roaming is a form of compulsive behavior in FTD. Redirect the person’s route or activity to maintain structure, reduce stress and ensure safety. If roaming stops unexpectedly, assess for pain.