Dementia Behaviors: Sundowning, Paranoia & Wandering—What Families Can Do

If you’re caring for someone with dementia, one of the hardest parts is that the changes don’t always look like “memory loss.”

Sometimes they look like anger.

Sometimes they look like suspicion.

Sometimes they look like pacing, fear, repeated questions, refusing care, or trying to leave the house.

And when that happens, families often ask:

“Is this normal?”
“Are they doing this on purpose?”
“Is it time for memory care?”
“What am I supposed to do when nothing works?”

This guide is meant to help you understand some of the most common dementia-related behaviors—especially sundowning, paranoia, and wandering—so you can respond with more confidence and less panic.

Quick note: This is educational guidance, not medical advice. If there is a sudden change in behavior, confusion, agitation, sleep, or safety, contact the doctor. Sometimes pain, infection, medication changes, dehydration, or other medical issues can make symptoms worse.

First: Dementia Behaviors Are Not Personal

This is one of the most important mindset shifts for families:

The behavior may feel personal, but it is often the disease showing up.

Your loved one may say hurtful things.
They may accuse someone of stealing.
They may refuse help from the person doing the most for them.
They may insist they need to “go home” while standing inside their own house.

That doesn’t mean it doesn’t hurt.

It does.

But understanding that dementia can change how a person interprets the world helps caregivers respond with more patience and less emotional damage.

The goal is not to win the argument.

The goal is to reduce fear, protect safety, and move the moment forward.

Behavior #1: Sundowning

What is sundowning?

Sundowning is a pattern where confusion, agitation, anxiety, pacing, restlessness, or irritability often becomes worse in the late afternoon, evening, or nighttime.

Families may notice that mornings feel manageable, but by 4:00 or 5:00 PM, everything changes.

Common signs include:

• more confusion later in the day

• pacing or restlessness

• wanting to “go home”

• repeating questions

• anxiety or fear

• increased irritability

• refusing care

• difficulty sleeping

• nighttime wandering

This can be exhausting because the caregiver is often tired too—right when the hardest part of the day begins.

What May Make Sundowning Worse

Sundowning can be influenced by many factors, including:

• fatigue after a long day

• low lighting and shadows

• too much noise or stimulation

• hunger or dehydration

• pain or discomfort

• a disrupted sleep routine

• unfamiliar surroundings

• caregiver stress in the room

• infection or medical changes

That last point matters.

If sundowning appears suddenly or becomes much worse quickly, it is worth calling the doctor. A medical issue may be adding fuel to the fire.

What Helps With Sundowning

Try to build the day around rhythm and calm.

Helpful steps may include:

• Schedule appointments, showers, and errands earlier in the day.

• Keep meals, waking, and bedtime as consistent as possible.

• Reduce evening noise, clutter, and stimulation.

• Turn lights on before the room gets dim and shadowy.

• Offer a calm activity: music, folding towels, looking at photos, a familiar show.

• Avoid arguing when they say something that doesn’t make sense.

• Use reassurance instead of correction.

• Watch for patterns: What happened right before the behavior started?

Script to use during sundowning

“Something feels off right now, and I can see this is upsetting. You’re safe. I’m here with you. Let’s sit for a minute and have something to drink.”

Short. Calm. Reassuring.

Not a lecture.

Behavior #2: Paranoia, Suspicion, and False Accusations

This is one of the most painful behaviors for families.

A loved one may say:

• “You stole my money.”

• “Someone is hiding my things.”

• “You’re trying to get rid of me.”

• “That caregiver is taking my jewelry.”

• “This isn’t my house.”

• “My spouse is cheating.”

• “People are watching me.”

It can feel insulting and unfair—especially when you’re the one sacrificing your time to help.

But in dementia, confusion and memory loss can cause the brain to create explanations for things it can’t understand.

For example:

• They misplaced a wallet.

• They don’t remember moving it.

• The brain fills the gap with: “Someone stole it.”

To them, it feels real.

That is why arguing usually makes it worse.

What Not to Do With Paranoia

Try to avoid:

• “That’s ridiculous.”

• “You’re wrong.”

• “I already told you.”

• “Nobody stole anything.”

• “Stop accusing me.”

Those responses may be true—but they usually increase fear and defensiveness.

The person is not asking for courtroom evidence.

They are asking to feel safe.

What to Do Instead

Use three steps:

1) Validate the feeling

“I can see this is really upsetting.”

2) Reassure safety

“We’re going to figure it out together.”

3) Redirect to action

“Let’s look in the usual places, and then we’ll have some tea.”

Script for accusations

“I’m sorry this feels scary. I know that wallet is important. Let’s check the kitchen and bedroom together. I’ll help you.”

You are not agreeing that someone stole it.

You are agreeing that the feeling is real.

That distinction matters.

Behavior #3: Wandering and Exit-Seeking

Wandering is one of the biggest safety concerns in dementia care.

It can look like:

• pacing around the house

• trying to leave for “work”

• looking for a deceased spouse or parent

• saying “I need to go home”

• walking outside unexpectedly

• leaving at night

• getting lost in familiar places

Wandering is not always random. Sometimes the person is searching for something:

• a bathroom

• food

• comfort

• a familiar place

• a person

• a sense of purpose

• relief from boredom, pain, fear, or restlessness

But even when the reason is understandable, the risk can be serious.

What Helps Reduce Wandering Risk

A few practical steps can make a big difference:

• Keep a consistent routine.

• Offer supervised walks or movement during the day.

• Reduce clutter and trip hazards.

• Use door alarms or chimes when appropriate.

• Secure car keys.

• Consider ID jewelry or a medical ID.

• Let trusted neighbors know there may be wandering risk.

• Avoid leaving a person with dementia alone in unfamiliar places.

• Watch for patterns: Does wandering happen after dinner? At night? When overstimulated?

Script for “I need to go home”

Instead of:
“You are home.”

Try:
“I know you want to feel comfortable. Let’s sit together for a few minutes, and then we’ll figure out what you need.”

Often, “I want to go home” means “I don’t feel safe right now.”

When Home May No Longer Be Safe

This is the part families struggle with most.

Dementia behaviors do not automatically mean memory care is needed.

But certain patterns should trigger a serious care conversation.

Red flags include:

• wandering outside or at night

• unsafe cooking or stove use

• medication mistakes

• falls connected to confusion

• paranoia causing refusal of care

• aggression or fear that puts anyone at risk

• caregiver exhaustion becoming unsustainable

• needing supervision that family cannot realistically provide

The question is not:

“Can we get through today?”

The better question is:

“Can we keep this person safe consistently for the next 30, 60, and 90 days?”

If the honest answer is no, it may be time to consider more support.

Assisted Living vs Memory Care: The Key Difference

Assisted living may help when the main issue is daily support:

• meals

• medication management

• bathing

• dressing

• socialization

• routine

Memory care may be needed when dementia-related risk becomes the main issue:

• wandering

• exit-seeking

• unsafe judgment

• sundowning

• paranoia

• agitation

• need for frequent cueing and supervision

A beautiful assisted living community may still be the wrong fit if the person needs a secured environment or dementia-trained support throughout the day.

The right question is:

“What level of supervision is actually needed?”

A Simple Dementia Behavior Tracker

For one week, write down:

• What happened?

• What time of day?

• What happened right before?

• Was the person hungry, tired, in pain, overstimulated, or confused?

• What helped?

• What made it worse?

• Was anyone unsafe?

This gives you better information for:

• the doctor

• home care agencies

• assisted living or memory care tours

• family decision-making

Patterns create clarity.

What Families Can Do This Week

Start with these five steps:

1. Pick the top two behaviors causing the most stress or risk.

2. Track when they happen for seven days.

3. Reduce triggers: noise, clutter, shadows, hunger, fatigue, overstimulation.

4. Create a safety plan for wandering, meds, cooking, and nights.

5. Talk with a doctor if symptoms change suddenly or become unsafe.

You do not need to solve everything at once.

You need the next safest step.

If You’re in Kane, DuPage, Kendall, or Will County

If dementia behaviors are becoming harder to manage, I can help you sort through what level of support may be appropriate—home care, assisted living, memory care, or a short-term transition plan.

The goal is not to pressure your family.

The goal is to help you see the situation clearly before crisis forces the decision.

Brad Esposito – Senior Source
Phone: 630-835-0355
Website: ILSeniorSource.com

FAQ

What is sundowning in dementia?
Sundowning is increased confusion, agitation, anxiety, or restlessness that often appears later in the day or at night. It can include pacing, irritability, sleep disruption, or wanting to leave.

What should I do when someone with dementia accuses me of stealing?
Avoid arguing. Validate the feeling, reassure them, and gently redirect. For example: “I can see this is upsetting. Let’s look together.”

Is wandering a sign that memory care is needed?
Wandering does not always mean memory care is required, but wandering outside, at night, or in unsafe conditions is a major safety concern and should trigger a serious care planning conversation.

When should families consider memory care?
Memory care may be appropriate when dementia-related safety risks require frequent supervision, a secured environment, or staff trained to support behaviors like wandering, sundowning, paranoia, or agitation.

Can dementia behaviors be caused by something medical?
Sometimes behaviors can worsen because of pain, infection, dehydration, poor sleep, medication changes, or other health concerns. Sudden changes should be discussed with a doctor.