Responding Gently to a Cruel Disease : Deputies Learn to Identify, Handle Alzheimer’s Patients

On a darkened street late at night, a stranger raps loudly on the front door of an elegant, two-story home. As the rapping becomes more insistent, the stranger begins to scream, howling into the darkness, begging to be admitted to the home he thinks is his.

Jolted from his sleep, the owner of the home calls the police, who send a pair of armed officers who handcuff the man and take him away. In the back of the squad car, the terrified “suspect” just keeps wailing, and then sobs like a baby.

He’s home, he mutters softly, so why not let him go upstairs . . . to his bed and sleep? No one seems to notice how the man is dressed--in suit and tie, with bright, polished shoes, as if ready for a breakfast meeting.

The stranger in the night is no burglar, no one’s worst nightmare come true. He is one of 4 million Americans who have Alzheimer’s disease and who pose a problem for law enforcement.

More and more Alzheimer’s patients are finding themselves in confrontations with police who, initially, are often helpless in sorting out such a complex issue.

“It’s difficult for everyone involved,” said Lt. Ron Wilkerson, spokesman for the Orange County Sheriff’s Department. The agency has entered into a program with the Alzheimer’s Assn. of Orange County to help law enforcement officers and the public distinguish people with Alzheimer’s from drug offenders or would-be intruders who wind up on doorsteps.

“Most of these people are extremely disorganized and have no idea who they are,” Wilkerson said. “People are very sensitive to someone rapping on their door, even in the middle of the day. They can easily mistake them for drug-crazed individuals or burglars and, if we’re not careful, we can make the same mistake. We haven’t had anything bad happen, but the potential is always there. So we wanted to do something.”

To enlighten police and the public they serve, Wilkerson said the program, “Safe Return,” is part of a national endeavor that seeks to identify Alzheimer’s victims within minutes and return them home unharmed.

“Safe Return” began in 1994 with the stated purpose of pinpointing and returning memory-impaired victims to their appropriate destination. Registrants pay a one-time fee of $25 that will enter their name and that of their caregiver into a national database, whose toll-free telephone number is then stenciled on a bracelet worn by the person with Alzheimer’s.

For the registrant who removes his or her bracelet, necklaces and clothing ID labels are also available. The national program has signed up more than 21,000 people with Alzheimer’s and claims a 98.5% success rate in returning its members unharmed. The national hotline is (800) 572-1122.

Jewelry, wallet ID cards and refrigerator magnets also are available for caregivers, in case something happens to them, leaving behind only an Alzheimer’s patient who may not know his name, much less that of his guardian.

“When our patients get lost in the community at large, they’re at risk for all manner of disasters,” said Kim Robinson, spokeswoman for the Orange County Alzheimer’s Assn. “They have no inner mechanism to tell them when to drink or eat.

“They may become terribly dehydrated. Our patients sometimes wander till they drop. The police sometimes pick them up thinking they’re drunk, or they’re taken to psychological units. Sometimes, for a while, they end up living among the homeless.”

The Orange County Alzheimer’s Assn. has made available two videotapes, which are mandatory viewing for sheriff’s deputies.

Quoting medical experts, as well as Scott Harshbarger, the attorney general of Massachusetts, the tapes document the common mistakes made by police or the public in assuming that people with Alzheimer’s are criminals.

Some Alzheimer’s patients are mistaken for shoplifters, others for potential child abusers because of the forward way in which they sometimes converse with children. Still others have been arrested for “flashing” or drunk driving, particularly those in the early stages, whose caregivers haven’t yet banned them from driving.

Alzheimer’s is a brain disease that affects impulse control and destroys a person’s short-term memory so that they forget where they live and who they are. Doctors estimate that one out of 10 people over 65 is at risk of developing Alzheimer’s; for people over 80, the figure jumps to one out of five. Former President Ronald Reagan is among the more prominent people with the disease.

Alzheimer’s typically afflicts people in their 70s and 80s, but 10% of people with it are in their 40s and 50s, according to the American Medical Assn., which notes that 70% of Alzheimer’s patients are cared for at home and thus vulnerable to periodic wandering and brushes with the law.

Elaine--who asked that her real name not be published--is the Fullerton caregiver and wife of a man once known for his contributions to the space program. He assisted in several moon flights, she said, and helped build the space shuttle.

Today, he believes he is still a member of the space program and recently wandered off in a Brea mall. An afternoon of panic ensued before Elaine and the police found him.

“It’s so overwhelming,” she said. “It starts out as a little bitty hill, but then things start piling up, and pretty soon it gets to be a mountain. Then you don’t even know where to start to dig out.”

Wilkerson said the Orange County Sheriff’s Department hopes to help by easing the pain for wanderers who get mistaken for criminals. Tapes and other efforts attempt to caution the police that middle-aged or elderly people who appear, at first glance, intoxicated or overtly sexual, or who resemble homeless drifters, may in fact have Alzheimer’s.

In confronting such a person, police are urged to look for a bracelet, necklace or clothing identification. After confirming that a person has Alzheimer’s, police are urged to approach him or her from the front, speak slowly and simply, identify themselves several times if necessary and, if possible, avoid restraints.

A person’s tone of voice is critical, experts say. Police are warned not to reprimand people suspected of having Alzheimer’s but rather to be gentle and calmly reassuring, and to contact the caregiver as soon as possible.

Robinson said people in the later stages of Alzheimer’s are “usually at risk for wandering, but they all want to go home as well. The problem is, home usually isn’t a physical place. It may be the place they remember as a child. When they say ‘home,’ they mean a psychological home. They only want to go back to a different time, as well as a different place. They’re not trying to hurt anyone. They’re not criminals. They’re not even dangerous. They only need . . . a little tenderness.”