Police officers responding to a call of a person approaching a Walmart store with a 10-inch carving knife likely would arrive at the scene prepared for a violent confrontation. They could have similar concerns about a domestic disturbance call or reports of a driver speeding through red lights.
Imagine those same situations when the alleged perpetrator is a person with Alzheimer’s disease.
The Denver Police Department is looking at the skyrocketing diagnosis rates for Alzheimer’s – projected to jump more than 37 percent to 92,000 cases in Colorado by 2025 – and adapting its officer training programs to equip its personnel to deal more effectively with situations like these where the individual involved may not be able to respond rationally to officers’ questions.
The one-hour Alzheimer’s class is part of a comprehensive 40-hour Crisis Intervention Training (CIT)* program that the Denver Police Department (DPD) is undertaking with its 1,400 officers to help prepare them for a broader range of on-the-job challenges. The DPD has 98 percent of its officers trained in the 40-hour course. The DPD also offers an extended eight-hour class on Alzheimer’s that is optional.
“As police officers, we are seeing more and more of these situations,” said Jim Lorentz, Division Chief of the Wheat Ridge Police Department, who is providing Alzheimer’s-specific training to his Denver counterparts through the Alzheimer’s Association of Colorado. “How do we deal with people with afflictions like Alzheimer’s? How do we prevent confrontations? Often, there are better and more effective ways to handle these situations.”
In his training, Lorentz shows cell phone video taken of an actual situation in Ohio involving an 85-year-old woman diagnosed with Alzheimer’s walking gingerly with a cane as she approaches a Walmart store, a 10-inch carving knife in her free hand. Within seconds of police arriving at the scene, she is taken to the ground and left bloodied.
“How might this situation have been handled differently?” Lorentz asked the class of 40 officers in Denver’s District 1. “We know a senior citizen is still capable of causing serious bodily injury or death, but could the officers in this situation have used critical thinking to keep the public away and safe while, perhaps, using a shopping cart as a buffer as they engaged in de-escalation techniques to allow more time to coordinate a nonviolent solution?”
Lorentz and the Alzheimer’s Association advocate the TALK approach to these situations:
- Take it slow
- Ask simple questions
- Limit reality checks (for example, don’t expect the person to know what day it is)
- Keep eye contact
The reality is that more than one in three persons over age 85 is going to be affected by some degree of dementia, and Lorentz noted that an officer responding to a situation with older seniors is likely to encounter at least one person with dementia and one caregiver.
The Risks of Alzheimer’s
Alzheimer’s poses unique challenges to both the families of those affected as well as to law enforcement. For example, an estimated 70 percent of persons with Alzheimer’s wander, meaning that they will set out on foot or in a car or on mass transit, if it’s accessible. The challenge is that they almost certainly do not know how to get where they are going, and will not be able to find their way back home.
“While people think they should wait 24 hours before reporting a person missing, we know that in the case of people with Alzheimer’s, if they are not found within 24 hours, there is a 50-50 chance the person will suffer a serious injury or death,” said Lorentz.
Other situations that police often encounter involving persons with Alzheimer’s include traffic violations, misdemeanor cases including shoplifting and indecent exposure (for stopping in a public place to relieve themselves), as well as cases of domestic violence.
“First of all, as police officers, we have to look at these situations critically,” said Lorentz. “We understand that people with Alzheimer’s can act inappropriately, but we need to look at the law to determine if the offense requires a mandatory arrest, as in the case of domestic violence, or can we use critical thinking to find other options that address the specific issue and solve problems. One of the worst places you can put a person with Alzheimer’s is jail.”
As part of the training program, the officers learned about several technology tools that help locate missing persons with Alzheimer’s. The MedicAlert® + Alzheimer’s Association Safe Return® program is a 24-hour nationwide emergency response service for individuals with Alzheimer’s or a related dementia who wander or have a medical emergency. When the MedicAlert system is activated, a community support network will be engaged, including local Alzheimer’s Association chapters and law enforcement agencies, to help reunite the person who wandered with the caregiver or a family member.
Another is Colorado Life Trak, a radio transmission system offered in a number of counties that is designed to assist law enforcement and rescue agencies in locating lost or missing persons who have been diagnosed with Alzheimer’s, autism, dementia or other disorders. People in the program wear a transmitter, a small circular radio device on a wristband, approximately the size of a wristwatch. The transmitters and wristbands are worn 24 hours a day, 7 days a week and are difficult to remove without the appropriate tools. If the participant becomes lost or missing, emergency response services have specialized tracking equipment to help isolate the location of the transmitter the participant is wearing.
Denver Police Department’s Proactive Approach
“This Alzheimer’s training component is one part of our larger CIT program to give our officers the tools to be effective in their roles while better understanding the challenges our citizens may be facing,” said Denver Police CIT Training Coordinator Susan Gann. “As society and our population change, we need to adapt so that we can live up to our motto of serving and protecting the people. This CIT program is part of our effort to stay one step ahead.”
Training Paying Dividends
Denver police officers already have seen benefits from the training. Gann cited several examples of how officers have been able to utilize the training:
- Police officers were called to meet with an elderly woman who reported that her car, which had been involved in several accidents, had been stolen. After talking with the woman and detecting signs they interpreted as memory lapses, they referred her case to the department’s crisis intervention response team officer. While the woman, who lived alone, reported feeling well and said she was well-fed, the investigating officer discovered that she had no food in the house, had lost significant weight from lack of eating, and was dehydrated. The officer was able to refer her to the department’s Adult Protective Services team for assistance.
- An elderly woman was reported missing by her family after they conducted a search for her. The responding officer recalled from the training that a person with Alzheimer’s may choose to hide from family members, whether out of fear or thinking of it as a game. The officer found the woman hiding in a closet, avoiding a lengthy search in the community.
- An elderly woman was found on I-25 near the Wyoming border, having driven her car – with a flat tire – until it ran out of gas. Based on her responses to inquiries from Colorado State Patrol, they determined that she was suffering from memory lapses and had her transported back to Denver where Denver police engaged her with the Adult Protective Services team. And several off-duty Denver officers who lived in her neighborhood drove up to repair and retrieve her car.
“The key,” said Lorentz, “is to recognize the situation and take action on it. Many times, what might be a relatively minor situation can turn into a life-threatening situation if the officer does not take the time to analyze it. We need officers to think critically and ask ‘how can we solve this problem.’ We believe this training will help them make those decisions.”
Others Adopting the CIT Training
The Denver Police Department is not alone in seeing the value of CIT training. Police departments throughout Jefferson County have partnered with the Alzheimer’s Association since the early 2000s. The county has taken the program a step further, adding several clinicians who can be called to the scene of a police call, follow up with the families, arrange contacts with the Alzheimer’s Association as appropriate, and provide support and resources to the family.
“It’s tough to take a snapshot of a crisis situation and know what is the right thing to do,” said Emily Richardson, CIT coordinator at the Jefferson Center for Mental Health. “First responders are not trained mental health professionals. We don’t want them to be diagnosticians. It’s kind of a balancing act to determine if a situation is a criminal matter or a mental health matter.”
One police officer who took CIT training told Theresa Grill, professional education coordinator for the Alzheimer’s Association of Colorado, “I wish we’d had this training earlier. We recently responded to a call that we would have handled completely differently if we better understood what we were facing.”
Families Play a Role as Well
“Families and caregivers also play an important role in ensuring the safety of their loved one with Alzheimer’s and the responding law enforcement professional,” noted Grill.
“Anyone calling for emergency services involving a person with Alzheimer’s or another dementia should always state to the dispatcher that the individual involved is someone with a progressive dementia,” she said. “They should also request medical transport, and provide those same directions to the responding officer. This can help first responders better interpret the behaviors they will see upon arrival.”
The Alzheimer’s Association of Colorado offers a free, interactive online class for first responders that was developed with input from first responders. To learn more, click here or contact Theresa Grill at 303-813-1669.
* Crisis Intervention Team (CIT) is an innovative first-responder model of police-based crisis intervention with community, health care, consumer and advocacy partnerships, like the Alzheimer’s Association. CIT provides law enforcement-based crisis intervention training for assisting those individuals with a mental illness, and improves the safety of patrol officers, consumers, family members and citizens within the community. CIT is a program that provides the foundation necessary to promote community and statewide solutions to assist individuals with a mental illness. The CIT Model reduces both stigma and the need for further involvement with the criminal justice system. CIT provides a forum for effective problem solving regarding the interaction between the criminal justice and mental health care system and creates the context for sustainable change.