From Wandering to Sundowning: Real Answers for Caregivers Managing Dementia

Caring for a loved one with dementia at home involves many challenges. One of the most difficult is managing changes in behavior. When a loved one experiences new or sudden behaviors such as wandering, sundowning, aggression, or hallucinations, it can be overwhelming and frightening for caregivers and the person with dementia.

Although these behaviors can be alarming, understanding why they occur and how to respond is the first step toward managing them with compassion and patience.

Let’s explore why these behaviors happen, practical tips for managing them, and how to create a safer, calmer environment for yourself and your loved one.

Understanding Dementia Related Behaviors

Dementia is about more than just memory loss. It affects the brain’s ability to process information, control emotions, and respond to the environment. Having dementia is like waking up in an unfamiliar world where you can’t find the right words or remember familiar faces.

Many of the challenging behaviors are your loved one’s way of communicating their needs, fears, and frustrations, especially when they can’t express their selves with words. Every behavior is a voice, and as a caregiver, your job is to figure out what that voice is saying.

Common Dementia Behaviors and Tips for Managing Them

Certain behaviors are common in various types of dementia, while others may be more prevalent depending on the specific diagnosis.

Wandering

Wandering is one of the most distressing behaviors associated with dementia. It can be a response to boredom, restlessness, confusion, a need for purpose, or a search for something meaningful.

Tips for Managing Wandering:

• Create a structured daily routine with engaging activities.
• Secure your home with door alarms, motion sensors, or child-proof covers on doorknobs.
• Provide safe spaces to walk, such as a secure outdoor space, park, or mall, to exert extra energy.  
• Use identification technology, such as a medical bracelet or a wearable GPS tracker.
• Know your loved one’s patterns and triggers, such as speaking about going somewhere, and take necessary precautions.

Sundowning

If your loved one becomes more confused, anxious, or agitated in the late afternoon or evening, or when seasons change, they may be experiencing sundowning. Sundowning affects up to 20% of people with dementia. It may be related to changes in the internal body clock, fatigue, or how lighting changes at sunset.

Tips for Managing Sundowning

• Keep evenings calm and well-lit with soft natural lighting or LED lights
• Close curtains before dusk to reduce confusion caused by reflections or shadows
• Stick to a daily routine
• Make sure your loved one gets plenty of exercise
• Avoid late naps and stimulants such as caffeine, sugar, and large meals, which can cause insomnia
• Encourage calming activities, such as listening to soft music or reading

Aggression and Agitation

Aggression can be one of the most frightening behaviors to manage, especially when it comes out of nowhere. It often arises when your loved one is experiencing discomfort, fear, unfamiliar situations, or overstimulation. Individuals with dementia frequently struggle to process the stimuli around them, leading to aggression or agitation.

Tips for Managing Aggression and Agitation

• Stay calm and use a soft, reassuring voice
• Step away and give them space and time to de-escalate
• Check for signs of physical discomfort such as hunger, thirst, or pain
• Never argue. It only makes things worse

Hallucinations & Delusions

Seeing or hearing things that aren’t there can be distressing for caregivers and the person with dementia. These behaviors are more common in certain types of dementia and may be caused by urinary tract infections, dehydration, or medication side effects.

Tips for Managing Hallucinations and Delusions

• Validate their experience.
• Don’t correct or argue with them. Ask them about what they’re experiencing
• Redirect their attention with comforting activities
• Create a calm environment with soothing music, calm colors, and familiar objects
• Reduce noise and clutter to reduce sensory overload
• Maintain good lighting, shadows can cause fear and confusion
• Consult a healthcare provider if hallucinations cause severe distress
• Walk through your home from their perspective. Look for confusing reflections or loud appliances

Caregiver Q&A with Dawn Platt

Dawn answers questions from listeners and the caregiving community about managing challenging behaviors at home.

Question: My mom tends to wander at night. I’ve tried locking the doors, but I feel bad restricting her movements. What can I do to keep her safe without making her feel trapped?

Answer: Install door alarms and motion sensors to alert you if she tries to leave. Provide secure walking areas. Address the reasons behind the wandering. Is she thirsty? Does she have to use the bathroom? Is she restless? Is she having trouble sleeping? Make her feel safe, not imprisoned.

Question: My dad gets really agitated during bath time. He screams, refuses, and sometimes lashes out. How can I make this easier for him and for me?

Answer: Bathing can be distressing for someone with dementia. It often feels cold, vulnerable, and confusing. Establish a bathing routine. Offering a choice between a bath and a shower can give him a sense of control. Make sure the room is warm, and the water temperature is comfortable. Explain each step in a calm and soothing tone and consider sponge baths if needed.

Question: How do I respond when my husband accuses me of stealing from him? It's heartbreaking, and I don't know how to handle it.

Answer: Don’t take it personally. It’s the disease talking, not him. Validate his feelings, not the facts. Try saying, “I can see your wallet is not where you thought it was. Can we try looking for it together?” Create a lost and found drawer with his important items to prevent future accusations.

Question: My mother-in-law talks to people who aren’t there. Should I correct her or just go along with it?

Answer: Go along with it unless it causes fear or distress. If she’s comforted by these conversations, there’s no harm in acknowledging them. If she’s afraid, redirect her attention to something pleasant, such as music, a snack, or a favorite activity.

Question: What is the best way to handle sudden aggression?

Answer: Stay calm, step back, and avoid confrontation. Access the environment for triggers such as loud noises or too many people? Speak slowly and reassure them. I'm sorry you're upset. I’m here to help. After things calm down, reflect on potential triggers so you can avoid them in the future. Seek professional help if your safety is at risk.

Wrap up

Managing difficult dementia behaviors requires understanding, creativity, a lot of love, and patience. If your loved one is giving you a hard time, they're having a hard time. Step back, assess the situation, and come up with a solution.

Caregiving is not a one-person job. Reach out, ask for help, and take care of yourself. Your well-being is just as important as the care you provide.

To learn more, listen to the “Aggression to Wandering: Decoding Difficult Dementia Behaviors” episode of The Disappearing Mind, an award-winning podcast hosted by National Dementia Coach Dawn Platt that helps listeners navigate along their personal journey with dementia through exclusive and direct perspectives of people diagnosed with the disease, their caregivers and experts in the field.