It is not defiance, and it is not aimed at you
Around five or six in the evening everything comes apart: your mother gets anxious, wants to leave, keeps saying she has to go home — while she is at home. At night your father gets dressed and walks out the front door. This is not defiance and it is not aimed at you.
When agitation builds toward the end of the day it is called sundowning; when the person walks without purpose or tries to leave, wandering or exit-seeking. Both are common in Alzheimer's and other dementias: the day's fatigue, fading light, hunger, pain and slipping orientation combine into something the person can no longer manage.
Rule out a physical cause first
Before deciding "the dementia is progressing," rule out what can be treated. Agitation that appears suddenly over a few days is almost never the normal course of the disease. The usual causes:
- a urinary tract infection — in older adults it often shows up as confusion alone, with no fever and no pain;
- pain that is not being expressed: arthritis, constipation, a tooth, a pressure sore starting;
- a new medication or an interaction;
- dehydration, poor sleep, or uncorrected hearing or vision.
A doctor's visit and a simple urinalysis sometimes save months of behavior wrongly blamed on the dementia.
What genuinely helps at home
- Light before dusk. Turn lamps on early and close the blinds so reflections do not frighten. Darkness arriving is the single most common trigger.
- A steady routine: same times, same order, same faces. Surprises exhaust.
- No late naps, no caffeine after mid-afternoon.
- Do not argue with the reality. "Your mother died years ago, you can't go home" causes real distress; "we'll go later — come sit down, I made coffee" settles things. Joining the feeling instead of correcting the fact is not lying; it avoids needless suffering.
- Fill the late afternoon: folding laundry, setting the table, a walk before dinner. Walking spends the agitation instead of containing it.
- Make the home safer without locking someone in: slide bolts placed high on the door and out of the line of sight, motion sensors, door chimes, a GPS tracker or shoe insole — and tell the neighbors. Many people are found because someone nearby knew. Keep a current photograph and a written list of the places the person might head for, so police have it in the first ten minutes rather than the first hour.
When home is no longer enough
The question is not "am I abandoning them." It is: can I guarantee safety at night? If the person leaves while everyone is asleep, if they have already been found outside, if you have not slept properly in weeks, the honest answer is often no — and that is not a failure.
What you need then is not just any facility but memory care: a secured unit where residents can still walk freely indoors, with an enclosed courtyard and staff trained in dementia behaviors.
Questions to ask on the tour
- Is the unit secured, and can residents walk a loop inside and get outside into an enclosed courtyard?
- How many caregivers overnight, for how many residents? It is the number that matters most and the one least often volunteered.
- What do you do when a resident wants to leave at three in the morning? ("We walk with them" is a better answer than "we take them back to bed.")
- What is your policy on physical restraints and on antipsychotic medication? Federal rules require that residents be free from unnecessary restraints and chemical restraints, and antipsychotics carry a boxed warning for people with dementia — ask who decides, and how often it is reviewed. You can look up a facility's antipsychotic use and staffing on Medicare's Care Compare before you tour.
- How do you shape the late afternoon — lighting, activity, mealtimes — for residents who sundown?
If you need to move quickly
Finding a place with a genuinely open bed in memory care is much harder than finding an ordinary room — and it is exactly what families worn down by sleepless nights need. Curalune Care Help ($89) puts together, usually within 24 business hours, a shortlist of 3 to 5 facilities that fit — memory care included where needed — with direct contacts and the questions to ask.
*General information, not medical advice. Any new or sudden agitation should be evaluated by a physician.*