Searching for Missing people with Dementia

This is part one of my week-long series of posts on issues relating to dementia and SAR.
In Part 2 I address some of the government response to the growing instances of dementia in the population and how there does not seem to be a component to address wandering.
In Part 3 I talk about some of the technology used to find people who wander.
In Part 4 I talk about alerting systems to let the public know when a vulnerable senior is missing.

2013-02-02 10.21.09Many people don’t know this, but wilderness SAR teams are often called to search for subjects with dementia in BC, and it is one of the hardest parts of our job.

Dementia is a general term used to mean any cognitive impairment that a subject might have that would affect their memory, ability to reason, or even to call for help. It can be a fixed brain injury from trauma, or a degenerative process brought on by a disease such as alzheimer’s, or old age.

People with dementia are often cared for family, or placed in a care facility. The issue happens when someone “walks away” from their home and does not return. The police recieve a report of a missing person and then make a determination on how to find them. For areas where a SAR team exists, the police have the option to call them for help.

Police (and SAR for that matter) usually use a scoring matrix to determine the urgency of a missing person report in order to decide how to respond to it. Factors like medical conditions, medication, bad weather, and local hazards can increase the urgency for a search to be initiated. That is usually when SAR is called.

Urban Difficulties

The figure of speech used to describe something difficult to locate is needle in a haystack. If looking for a person in the wilderness is like a looking for a needle in a haystack, then looking for a person in the urban environment is like looking for a needle in a stack of needles — that is, there are more places to hide, it is easier to travel long distances, and there are people everywhere — places to blend in, or to hide in plain sight.

As a specialist in wilderness SAR, how do I deal with the complexity of the urban landscape?

Our current methods, which we communicate to the police and other tasking agencies, is we look in places where the subject could have become “stuck” and there are no people around. This is the scenario where someone could die from exposure or other hazards (cliffs, water hazards, swift water, animal encounters).

We use as our guidance the chapters from Lost Person Behaviour on dementia (made available for free by the author as a sample), information on the types of behaviours the person has done in the past, and other research (including by some local SAR people).

Ultimately, these searches are frustrating because we rarely find the subject. Most of the time they are found by members of the public, or they turn up at a hospital, or are found riding transit.

The fact is that wilderness SAR groups have no special training to conduct urban searches; most of our training involves wilderness SAR techniques, navigation, and technical rescue skills. The only skills applicable to the urban environment are SAR Management, organizational structure, communications, and first aid.

Anecdotes:

To give a picture of a few anecdotes of dementia searches we’ve done as a team in just the past few years, the searches have resulted in the subject being found;

  • On a train crossing the border to the US
  • On the floor of a different patient’s room in the care facility
  • Made their way back home on their own (about 6-7 of these)
  • Walking down the road 7km from where they were last seen
  • Up to their waist in a swamp (found by SAR)
  • Hiding in a culvert on a construction site (found by SAR)

I should backtrack a little on my statement that we rarely find the subject. When compared with our success rate at finding people in the wilderness (95%-98%), it feels like we rarely find missing subjects with dementia. In fact, the “success” rate is quite high – most missing dementia are found, just not by SAR.

Changing Demographics

Canada’s population is ageing, and what this means is that there are more people with dementia now than 10 years ago. It also means this trend will continue into the future, with projections showing this increasing for the next 20 to 40 years.

The Alzheimer Society of BC states that the number of people with the dementia in BC is around 70,000, with 10,000 of them being under age 65. They project that this number increase by 50% in 5 years, and double in the next 25.

What’s clear from this data is that the occurrence of missing dementia subjects will only increase in the near future, and for the next 20 years.

Huge Resources

The main issue with a missing subject with dementia is where to look. Often all we start with is a point last seen (PLS) which is usually their residence or care facility. From there the subject could have taken a cab, transit, or have walked into a mall. Often we are told that the subject has no money or ID, but in practise this does not stop someone from taking transit.

Unlike in the wilderness, most of the urban searching requires very little skills, but a huge number of person hours.

A specialized resource?

Is there a place for a team that specializes in responses for subjects with dementia?

I think there is, for the following reasons:

Training

SAR teams in spend a lot of time training for wilderness rescue, and most of our tasks are in this area. Urban searches are, in my opinion, so different and so resource intensive compared to a wilderness search that a normal BC SAR team has trouble covering the area to anyone’s satisfaction.

For our wilderness SAR teams to start adding on specialized training for dementia responses I think would reduce our effectiveness at our other, more dangerous and sometimes more demanding forms of rescue. We already have a very full schedule training in the techniques that make us safe and effective in the wilderness.

Education

SAR also has an educational component, sometimes called “SAR Prevention”. We train members to deliver several programs geared toward making people safer in the wilderness. There is no such program targeted toward keeping people with dementia safe.

Technology

Finally, there is technology designed to assist searchers to find a missing subject with dementia. These are various forms of GPS transmitters that the subject wears. They are required to have the fit checked and batteries changed every month. There is specialized equipment and training involved in locating these transmitters, but most of the SAR groups in the Metro Vancouver area don’t have the time or resources to add another rescue technique to their tool kit for these types of searches.

Growing numbers

Ultimately, the number of searches for missing dementia for any one SAR team is quite low – 2 or so a year, on average. Not enough to justify specialized training, equipment, or a larger number of volunteers, or training in specialized techniques for every team.

However, the number of missing in the Metro Vancouver entire region could be 10-15 a year – more than enough work for a group of dedicated people. Given the predictions of the number of cases increasing in the future, this seems to be an opportune time to get a project started.

At least tracking the number of cases per year would be a start.

Defining the Resource

What would a specialized Urban SAR team look like? There are lots of examples from elsewhere in North America.

Any team specializing in searching for missing dementia subjects would have to develop the following skills.

  • Command
    Volunteers trained in SAR management, and in the use of the Incident Command System (ICS)
  • Leaders
    10-20 “team leader” trained members who would function as the search leaders for groups during an incident.
  • Members
    20-60 “regular members” who would be called for actual missing persons as soon after the person is reported missing as possible. These members would be trained in basic techniques, and would be chosen for their willingness to be available. No technical skills necessary, just reliability.
  • Communications
    It would be possible to organize around cellular communications, but more useful would be a command net system where everyone has a VHF radio. It would be very easy to build a web site to organize a search; similar to Facebook where location tagged status updates would be used to indicate events and updates from the field searchers.
  • First Aid
    Each member should be trained in basic first aid. No specialized rescue or advanced care would be needed because volunteers would only be operating in the urban environment.
  • Social Media
    To engage the public early and notify people of potential life saving event. Social media provides
  • Public Awareness
    The non operational efforts of such a group would be to educate the public on the issues around walk-aways and the life threatening situations they get into.
  • Technology
    The group would build an expertise in various tracking technologies that can assist people it preventing their lives ones from wandering.

A team like this could train a core group of leaders, a larger group of regular members, and would be able to incorporate “convergent volunteers” into the effort quite easily. Postering, alerting authorities, and becoming a clearinghouse of information, and a centre of expertise in searching for missing dementia subjects.

The expertise could be easily applied to Autism, and missing children.

Going Forward

If someone is interested in taking on this kind of challenge I would be willing to talk to them, and offer my insight or assistance. I’ve personally managed several SAR tasks searching for missing dementia subjects and I can tell you it is one of the most heartbreaking things I have to do; on three occasions they have ended with us not finding anything. We need to get a handle on this issue before the rates of walk aways increases.

 

 

 

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3 comments on “Searching for Missing people with Dementia
  1. Dan says:

    Nice article explaining the challenges of searching for subjects with dementia -shared with my SAR team: Niagara Frontier SAR.

  2. Rob Braun says:

    The stereotype perception of an alzheimer’s patient is of a frail, elderly person that “couldn’t go far”, wandering aimlessly.
    From personal experience, the patients are often of hi energy, (care homes at times drug them to keep them more sedate so they don’t bother other patients.), have an ability to ignore things like pain, hunger, and fear, and can travel at a remarkable determined pace, often with singular purpose (at least to their minds) unaware it seems of the hazards around them. Understanding this difference between perception and reality is a key component I think in recognizing an alzheimers/dimentia patient in the public.

  3. Dave says:

    As a SAR and LEO K-9 trainer and handler, I have had the opportunity to use K-9’s to track and trail people in urban areas. Some dogs are exceptional at it. A scent item is critical. Teaching them to cross busy streets takes some time, following a persons’ track across a steet after many cars have passed over it is not very difficult foer a good dog. Stray cats can be an issue with very prey driven dogs.

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