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The Boston Globe Online

ALZHEIMER'S WANDERERS STIR CONCERNS

Author: By Ellen Barry, Globe Staff Date: 12/25/1999 Page: A1 Section: Metro/Region
SALEM, N.H. - From the warmth of her living room, while the tangled woods outside her house become inky and icy, Julianna Morawski is praying to St. Anthony, patron saint of lost objects.

Morawski, who is 66, turned her back for five minutes on the sixth of October and lost her husband into those woods. Over the five years since Joseph Morawski began to display symptoms of Alzheimer's disease, she had learned to play the games that kept him within the bounds of normal life: hiding his clothes until he bathed in the morning; coaxing him out of his daughter's leather skirt; emptying the stones nightly from his pockets. But her husband, who grew leaner and craftier every year after his diagnosis, slipped out the door that day while she was hanging laundry.

Almost three months later, neither his family nor the local police can bring themselves to stop looking for him, and a small army of outside investigators have tried to solve the riddle of Morawski's mind. Three weeks ago, when all the leaves were off the trees, a helicopter whipped at the air over World End Pond, where, before he disappeared, neighbors had reported seeing the 72-year-old man standing in the swamp.

Julianna Morawski feels alone, watching nightfall outside her window, but 150 miles to the south, Massachusetts State Police helicopters were hovering over White's Woods, looking for James Garris, an 80-year-old Alzheimer's patient who walked out of his Litchfield, Conn., convalescent home on July 5. Disappearances like these repeat themselves all over the country, as Alzheimer's patients slip out of safe enclosures into the dark with their own mysterious agenda.

Thirty-two thousand wandering Alzheimer's patients are now reported to police annually, estimates Robert Koester, a Virginia search and rescue researcher who has devoted much of the last decade to collecting and studying their habits. There is a particular urgency to his project: If an Alzheimer's patient is found within 24 hours, they usually return home safe. After that, their chances of survival fall to 46 percent, and search teams begin to find them tangled deep in briar patches, or drowned in a shallow trickle of water, or frozen at a fence line in an open field.

A small network of experts on Alzheimer's wanderers - including several in the Boston-area - are trying to decode the behavior before it overtakes society's ability to find them. Already, searches for people with dementia make up 12 percent of search and rescue operations in the Mid-Atlantic states, according to Koester. And as average lifespans increase and the baby boomers move toward old age, the Alzheimer's Association projects that the number of people with the degenerative brain disease will increase from 4 million currently, to 14 million by the year 2040. That burden will fall squarely on the shoulders of local police and fire departments.

"Really, it's a time bomb," said Nina Silverstein, who has researched wanderers at the University of Massachusetts at Boston's Gerontology Institute. "On the level of society, I really do believe there's been denial."

Although wandering behavior is as old as dementia itself, the disappearances have rarely been addressed as a national phenomenon, and even advocacy groups are unable to supply mortality statistics. Silverstein, who is collaborating on an upcoming book called "Deadly Mix: Dementia, Wandering, and the Lost Elder," has attempted to compile statistics through searches in local press, and concluded that "any number you get will be an underestimate."

What search and rescue experts have begun to realize over the last decade, as local agencies begin to compare notes on wandering Alzheimer's patients, is that they behave very much like each other, and unlike any group of people that searchers know well. They don't call out for help or respond to shouts; 67 percent of lost Alzheimer's patients cross right over roads or paths and continue in a straight line until they can't go any farther, shows Koester's research, which is based on 100 disappearances so serious that the Appalachian Search and Rescue Conference was called in.

When they die - as 22 of Koester's 100 cases did - it's usually at the point where they could not go farther. Eighteen percent of his subjects were found in creek or drainage areas, and another 29 percent were deeply entangled in briars or bushes. Searchers sometimes find bodies in spots so dense that bloodhounds can pass within feet of them without getting a scent, said Gerald Flaherty, director of the Safe Return program for the Alzheimer's Association's Massachusetts chapter. Flaherty has participated in almost 700 searches over the last eight years. Of those, about 24 were found dead.

"They're very, very frightened, and they're trying to find a place to hide, and they go into places that are terribly dangerous," he said.

The gradually gathering statistics portray a journey whose main goals are primal. Koester's strangest finding was that 15 out of 19 of his subjects moved south. He doesn't know why this would be, but suggests two "working hypotheses." It could be because the wanderers were moving toward the light in the sky; or - the "less glamorous" explanation - it could be because in the rural areas where Koester does his work, most of the doors face south, and wanderers tend to move steadily in one direction.

This kind of information hasn't always penetrated the local agencies who do most of the searching. Curt Rudge, chief park ranger with the Massachusetts Department of Environmental Management, has a particular sense of urgency about training searchers: He recalls joining a search for a missing Alzheimer's patient that had dragged on for five days. Using Koester's research, he directed his energies toward a thick tangle of brush. He found the body in five hours.

Handled chiefly on a local level, procedures for locating wandering elderly people with dementia are "a chink in the armor of the system," he said. "We don't do this well."

Silverstein also urged a national emphasis on preventive strategies like Safe Return, which supplies identification for elderly wanderers and enters elderly people in a national database, she said. She also recommended that dementia sufferers be assigned "walking buddies," so they can relieve their restlessness safely.

In a 1996 paper titled "He Comes Back Eventually. . .," Silverstein documented the measures that elderly caregivers were using to prevent their loved ones from escaping from their homes - posting stop signs on doors, writing notes reminding them not to leave, removing batteries from cars or disguising doors with curtains. One man slept at the threshold of the door, so he could feel his wife stepping over him when she tried to leave. Others sent dogs out with their relatives with the mistaken confidence that "the dog knows the way home."

Although the cost remains high, some envision a day when law enforcement will be able to track Alzheimer's patients individually. Spurred by a 1997 case of an 83-year-old man who wandered away from his Strafford home, sheriffs in Vermont's Windham and Orange counties have begun supplying Alzheimer's patients with tiny transmitters which emit a signal that authorities can pick up from land or air.

Meanwhile, the stress of controlling a chronic wanderer is absorbed into families. Marianne Dickerman Caldwell's 83-year-old mother disappeared into the woods near Rindge, N.H., in 1991, and it wasn't until 1994 that hunters came across her remains. For that time, Caldwell said, she was so fixated on the search that a counselor asked her to leave a grief support group because she was upsetting the other members.

"There's just something dreadful about being unfound and out in the woods," said Caldwell, who wrote a memoir of her mother's disappearance called "Gone. . .Without a Trace." "Bed is where people belong. Being outside with the elements - it was so dark that night, and it dropped 40 degrees."

Those are the thoughts that bother Julianna Morawski, who can still crinkle up her eyes and laugh when she recalls meeting Joseph for the first time, when she was a kerchiefed 21-year-old. Lately, when she can sleep at all, she has nightmares that she's lost herself.

She's not the only one who can't stop thinking about it. When he drives around the streets of Salem, Captain Alan Gould, who headed up the search, still scans the faces of men over 65 for Morawski's Slavic cheekbones and white fuzz of hair. He keeps a photograph. He describes himself as "haunted."

For more information, call the Massachusetts chapter of the Alzheimer's Association at 617-868-6718.

 

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