Part 3 · Mind, senses and communication
When they see things, accuse, or get upset at dusk
Content under professional review before publication.
1When they see or hear things that are not there
The problem
The person may see, hear, or feel things that are not there: someone in the room, an animal on the wall, a voice calling them. To them they are completely real, and arguing about it only frightens them more.
What is happening underneath
Those visions come from the change in the brain, and they appear more as evening falls. Sometimes they are triggered by poor light, shadows, reflections in mirrors or windows, or by mistaking what happens on TV for reality.
Step by step
- Do not argue about whether what they see is real or not. To them, it is.
- Respond to the emotion: if they are afraid, give them calm and company ("I'm here with you, you are safe").
- If the vision does not frighten them and is not dangerous, sometimes it is enough to stay with them and change the subject or activity.
- Check the environment: turn on more light to erase shadows, cover reflections from mirrors or windows, and turn off the TV if it confuses them.
- Take care of glasses and hearing aids: seeing and hearing badly feeds the confusions.
What you must never do
- Never argue or tell them there is nothing there: you leave them alone with their fear.
- Never mock them or play along with things that increase their fear.
- Never leave the room dark and full of shadows at dusk.
When to ask for help
If the visions appear suddenly, change a lot, or distress them, tell the doctor: they may come from an infection, a medication change, or another cause. Do not give or change medicines on your own.
2When they accuse or distrust
The problem
It is very common for the person to accuse you of stealing, of hiding things, or of wanting to harm them, often the very one who cares for them most. It hurts, but it is not against you: it is the disease.
What is happening underneath
The person puts things in safe places and then does not remember where. Since they cannot find the object, the explanation left to them is that someone took it. They are not lying: it is their memory that fails.
Step by step
- Do not take it personally and do not get defensive.
- Respond to the feeling: "how awful to feel that something disappeared, I'll help you look for it."
- Look for it with them, without fighting over who is right. Finding it together calms more than arguing.
- Learn their favorite hiding spots (drawers, handbags, under the mattress) to locate what disappears.
- Keep spares of what gets lost most (glasses, keys) to lower the distress.
What you must never do
- Never argue to prove that you did not steal it: you cannot win, and it hurts them.
- Never call them a liar or take offense: it is the memory, not the person.
- Never leave them alone with the distress without helping them look.
When to ask for help
If the accusations are very frequent, very distressing, or come with intense fear, mention it to the doctor. And lean on a support group: hearing that the same happens to others brings relief.
3Sundowning and wandering
The problem
Many people with dementia become more confused, restless, or anxious as evening falls. It is so common that it has a name: sundowning. And that restlessness often leads to pacing without stopping or wanting to go out.
What is happening underneath
At the end of the day, fatigue, the off-kilter internal clock, and the shadows that grow with the low light all come together. All of that confuses a brain that is already working overtime even more.
Step by step
- Care for the routine: waking, meals, and sleep at steady times. Put the demanding activities (bathing, outings, doctor) in the morning.
- During the day, natural light and movement; avoid long, late naps and caffeine from mid-afternoon on.
- Before it gets dark, turn the lights on well to erase shadows and close the curtains. At night, lower the noise and the stimulation (loud TV, chores) and play soft, familiar music.
- In the middle of an episode, do not argue: give them calm, stay with them, and steer them to something quiet (looking at photos, music, something nice). If they want to walk, let them do it in a safe place.
- For wandering: make the exits safe (a high latch, a buzzer or small bell on the door), have them carry an ID with a phone number, and tell trusted neighbors. Attend to what they are looking for: bathroom, hunger, or "going home."
What you must never do
- Never restrain them by force to make them stop walking: it increases fear and the risk of injury.
- Never leave them at dusk in a room that is dark and full of shadows.
- Never lock them in a way that would be dangerous in a fire: secure, but never trapped.
When to ask for help
If the sundowning is very intense, if they cannot sleep, or if the wandering becomes dangerous, tell the doctor to look for the cause and the best way to manage it. A sudden change can also be pain or an infection.
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- Every person and every form of dementia is different. Diagnosis, treatment, and the management of behaviors (including hallucinations and agitation) must be defined with the health team. Never give or change medication on your own.
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