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When Elders Go Missing

Each year, hundreds wander away from their homes. Too many are never seen again

En español | A loving husband disappears

Maria Russo stands on her front stoop, the smoke from her cigarette hovering above her. It's January, and a gentle but freezing rain is falling on her Queens, N.Y., street. She looks up the block, then down. She's without a coat but doesn't seem to feel the cold.

Social change and missing elders

Giuseppe Russo. — Cynthia Ramnarace

Two months ago her husband walked out that same door and was never seen again. Whether he went up the street, or down, Russo does not know. But she does know that the day he left, it was raining. She knows it was cold. And she knows that Giuseppe Russo, 72 and suffering from Alzheimer's, had nothing on him but a sweat suit and a hat — no coat, no money, no wallet.

"You wonder where he is, what is he wearing, why did he do this?" says Russo, 56, sitting at her kitchen table, her baggy work uniform giving a hint of how much weight she's lost since her husband went missing. In a thick Italian accent, her voice cracks. She wipes tears from her eyes and shakes her head. "I still think about what he did that day, what he said, because I can't find him."

In May, the Russo family learned why Giuseppe, an Italian immigrant who devoted his life to providing for his three children, had become so different. He was constantly looking for things he had misplaced, such as his wallet. He was agitated and would start to yell, which was completely out of character. He was prone to strange behavior: washing the car in the middle of the night; showering and making breakfast at 3 a.m., as if he were getting ready to start his day.

"Dementia," the doctor said. He handed Giuseppe, known also as Joe, a prescription for a sedative. There was no doctor-family meeting, which in retrospect Russo and her daughter, Maria Ingrassia, desperately wish they'd had. They had no idea that Giuseppe's new habit of making breakfast and showering in the middle of the night were signs Giuseppe might start to wander. They had no idea that wandering was even something they should worry about.

"The doctor assumed we understood what was going on, but we didn't," says Ingrassia.

On Nov. 4, 2010, Maria Russo left the house at 1 p.m. for her job as a bus matron ensuring that special education children make it home safely. She remembers Giuseppe watching TV. He expressed concern that she hadn't eaten lunch. She had a migraine; she would eat when she came home.

Four hours later she returned to an empty house. Russo searched for an hour before calling her daughter, who immediately called 911. Police arrived quickly. A search dog picked up a scent but lost it. For three days there were helicopter and harbor searches. Ten days later, volunteers searched 80 acres of surrounding marshes. Search teams went out into the nearby marshes. Nothing.

Ingrassia believes her father hopped onto one of the several bus lines that run just a couple of blocks from her parents' house and could have taken him anywhere in New York. Or maybe Giuseppe, who loved sitting by the water, wandered into the nearby bay. No one knows, and that's the hardest part.

"I wake up in the morning and I'm not breathing," says Ingrassia. "He was so involved in our lives. He was such an active grandfather. And now there's just this empty void."

A growing problem

Giuseppe Russo is one of the more than 300 people over age 65 with a mental condition such as dementia who go missing each year, according to the FBI. After a period of decline in the early part of the last decade, the number of missing persons in this category started a steady rise in 2004. That year, 235 people over age 65 were reported missing. In 2009, the number rose to 354, a 51 percent increase. The numbers mirror the rise in Alzheimer's diagnoses — from 411,000 new cases in 2000 to 454,000 in 2010, according to the Alzheimer's Association. Currently, 5.1 million Americans over age 65 are living with the disease.

The vast majority of people reported missing in this category are found — most alive — but a small percentage never are. Over the past 10 years, the FBI reports, 41 people in this category — over 65 with a mental condition that includes dementia — have never been found. The Russos pray that Joe doesn't become another such statistic.

"We just don't know what to do," says Ingrassia, mother of three. "We want a funeral if there is one. We want to find him if there is a way to find him. We want closure."

An unavoidable consequence

Wandering is a common symptom of Alzheimer's and other forms of dementia, says Amy Ehrlich, M.D., interim division chief for geriatrics at Albert Einstein College of Medicine in New York. "The medications aren't going to keep you from wandering," she says. "Wandering is a behavioral symptom that's extremely hard to control."

Wandering occurs when people start losing sense of time and space. They get days and nights mixed up, as it seems Giuseppe did when he started eating breakfast in the middle of the night. They talk about wanting to go "home," which for them means a childhood home or some other place they lived long ago. Patients will seem agitated and unable to settle down. Pacing is common. A change in medical status can trigger the wandering also. For example, something as seemingly benign as ear wax impaction that compromises a person's ability to hear can worsen confusion and send a person out the door, Ehrlich says.

"It's very scary because they're motivated, they're strong, they're able to get dressed," Ehrlich says. "To keep track of someone like that is just incredibly difficult."

Wandering can happen at any time, under varied circumstances. In a 2004 Mayo Clinic summary of research of people with dementia who became lost, 18 percent were supposedly being supervised at adult day care, a nursing home or other caregiving facility when they went missing. An additional 13 percent became lost while out alone on an outing. Eleven percent were home alone, and 7 percent wandered off while their caregivers were asleep.

Missing older people need to be found quickly

If an older person goes missing, time is a crucial factor in getting them home safely. The more time that goes by, the less likely the person will be found alive. In the Mayo Clinic review, the longest a person went missing and was found alive was four days.

"The greatest risk is that they're not found quickly," says Beth Kallmyer, senior director of constituent services at the Alzheimer's Association. In fact, she says, 50 percent of people who wander who aren't found within 24 hours suffer serious injury or even death.

"It's 1 degree [in Chicago] today with a minus 20 wind chill," she says. "Someone could die very, very quickly under those conditions. In warm climates, dehydration and other really awful things can happen."

When older people have been found dead, they were most likely to have wandered into ditches or wooded areas. Nineteen percent of deceased wanderers were found in urban areas; they'd been hit by a vehicle or were found hiding in places such as abandoned buildings. Exposure to the elements — either too hot or too cold — was the leading cause of death.

Drowning was a significant factor, too. How could a person wander into the water? Visual processing problems that accompany Alzheimer's are likely to blame.

"They may walk into water, and they don't recognize that it's water," says Kimberly Kelly, founder and executive director of Project Far From Home, a national law enforcement educational program that focuses on finding missing older people. "They may think it's a flat parking lot. They may not think it's that deep. They may be so fixated on getting to whatever's on the other side that their brain isn't processing that they're in water."

Much the same happens when dementia patients wander into the woods. They keep walking until they can walk no more, and Kelly says it's not uncommon to find people stopped at a tree or rock that they couldn't figure out how to walk around.

In most cases, they don't make it very far. In the Mayo study, most wanderers did not go farther than a mile from their home. But finding a missing older person presents particular challenges, says Kelly. Elders won't respond to their name when called. They might hide when a search party approaches, which is especially true with Holocaust survivors and military veterans. Or they might find their way home, only to wander off again when they see police vehicles filling the driveway.

What to do if an older person is missing

Because speed is so important to bringing an older person home safely, Kelly recommends spending no more than 15 minutes searching your house and yard for your loved one. After that, call 911.

  • When you call 911, don't just say you can't find your spouse or parent — tell them that the parent has dementia and is at grave risk of danger. "Law enforcement's understanding and knowledge have increased exponentially over the past decade," says Kelly. So if you tell officials that dementia is involved, more than likely you'll get a speedy and calculated response. When Ingrassia called 911, police responded quickly with tracking dogs. A search team, including an equine unit, was dispatched and helicopters circled the area, all on the hunt for Giuseppe.

  • While waiting for law enforcement to arrive, locate a recent photo of the missing person and write down a list of what he or she was wearing, medical history and any medications.

  • Think about conversations you had recently — was there a mention of someplace your loved one wanted to go?

  • Ask police to issue a Silver Alert. Similar to an Amber Alert for missing children, a Silver Alert (available in nearly all states) uses radio and television announcements to alert citizens to be on the lookout for your loved one.


The search for Giuseppe continues

In Howard Beach, Queens, pictures of Giuseppe Russo are plastered on telephone booths, in grocery stores and restaurants. Because her father loved the water, Ingrassia fears he might be in one of the waterways that surround the piers and marshes in the area. Police tell her they have to wait for warmer weather before doing any dredging. In the meantime, the family continues to jump each time the phone rings. Their hearts ache with each wintry blast of air. They try to find words to explain to Ingrassia's 6-year-old son why his grandfather is no longer around. And most of all, they try to hold on to their faith.

"We will know," says Ingrassia. "Whether he's alive or dead, we will know. That's all I keep saying. Nobody could disappear from the face of the earth like that. It's not possible and it's not going to be possible in this situation. My good vibes and energy and prayers are going to bring him back."

Cynthia Ramnarace writes about health and families. She lives in Rockaway Beach, N.Y.