Watching someone you love become anxious because of dementia can be incredibly difficult. You may know that they are safe, but they may not feel safe. You may know exactly where they are, who they are with, and what is happening next, while they are confused about all three. Trying to convince them that everything is fine doesn’t always work. In fact, repeatedly telling someone with dementia that they’re wrong about what they believe can sometimes make the anxiety worse.
A better approach is often to look at what helps the person feel secure, even when you can’t change what their brain is telling them. That may mean creating more predictability, paying attention to patterns, changing the timing of activities, or learning when reassurance helps and when it simply turns into another argument.
Start With a Predictable Routine
Routine can be one of the most useful tools when caring for someone with dementia. When a person’s memory and ability to process information are changing, knowing what comes next can provide a sense of security. They may not remember the schedule itself, but familiar activities can become cues that guide them through the day.
This was especially true for someone I cared for who functioned much better when her days followed a familiar pattern. She didn’t always know whose house she was living in or understand when “they” were coming to take her “home.” Those questions could be very real and very upsetting to her. She might not have been able to tell me what day it was or explain where she was, but she knew what came next in her day, and that familiarity made a difference.
The routine didn’t make the dementia disappear, and it certainly didn’t prevent every anxious moment. What it did was give her something familiar to move through when so much of the rest of her world had become confusing.
Build the Routine Around Things They Enjoy
A routine doesn’t have to be made up entirely of caregiving tasks. Some of the best parts of a person’s routine may be things they have always enjoyed, and those activities can sometimes make the less enjoyable parts of caregiving easier to manage.
Summer was the best time of year for the person I cared for because she loved to garden. So gardening became part of our routine. She could spend the morning outside doing something familiar and enjoyable, and it gave that part of the day a purpose. By the time we were finished, she was hot and tired, which changed the way she responded to the shower that could be an absolute nightmare at other times of day.
She was already warm and ready to cool off, so there was far less convincing, redirecting, or arguing involved. The activity came first, and the care that needed to follow naturally made sense. That was a much better strategy than trying to convince her at 10:00 in the morning that she desperately needed a shower when she was perfectly certain she’d already had one.
The lesson wasn’t that gardening magically solved the problem. It was that the right activity at the right time could make the next part of the day easier. Once I stopped looking at each caregiving task as something that had to be accomplished on its own, I started noticing how one part of her routine could naturally lead into another.
Use Familiar Activities as Cues
One thing I learned was that the activity itself could become a cue for what happened next. After the garden came the shower, and after the shower came what she called “fixing herself.” That meant getting dressed, taking care of her teeth or dentures, brushing her hair, and putting on her candy-apple-red lipstick, which she wore ALL. OF. THE. TIME.
Once she was finished “fixing herself,” lunch was waiting for her on the sun porch. And every single time, she could be pleasantly surprised. She might look at the meal and say, What? For me? Who would take the time to make me lunch?
It didn’t matter that I was standing right there eating the same thing. She could still wonder who had been so thoughtful as to remember to make her a meal. I didn’t need to correct that or explain that I was the person who had prepared it. The important part was that she was comfortable, fed, and happy to sit down and eat.
Those little moments can be easy to dismiss because they don’t look like traditional caregiving interventions. But when you’re caring for someone whose sense of time, place, and memory is changing, familiarity can become incredibly valuable. Sometimes the routine itself does some of the work for you.
Don’t Argue With Every Fear
Anxiety related to dementia can sometimes involve beliefs that don’t make sense to the caregiver. The person may believe they need to go home when they are already home. They may believe someone is coming to get them. They may think they’ve been forgotten or that something important is about to happen.
Trying to prove that they’re wrong can turn into an argument that neither of you can win. If someone says, “I need to go home,” launching into a detailed explanation about why this is their home may not make them feel better. Their brain may not be able to process the explanation in the way you expect, and continuing to repeat the facts can leave both of you frustrated.
Instead, you can sometimes acknowledge the feeling behind what they’re saying and redirect their attention toward something familiar. You don’t have to agree with a false belief to respond to the emotion underneath it. The goal isn’t necessarily to convince the person that your version of reality is correct. Sometimes the more useful goal is simply to help them feel less frightened in that moment.
Pay Attention to When Anxiety Happens
Anxiety often follows patterns, even when those patterns aren’t obvious at first. Maybe your parent becomes restless before meals. Maybe they’re anxious when the house gets quiet. Maybe a particular time of day brings confusion or agitation, or perhaps they become more distressed when too many people are around.
Pay attention to when the anxiety happens and what is going on immediately beforehand. Over time, you may start to see connections that weren’t obvious when you were dealing with each episode individually. You may discover that the solution isn’t some complicated intervention. It may be changing the timing of an activity, reducing noise, getting outside, offering a familiar snack, or simply making sure the next part of the day is predictable.
You don’t have to document every minute of the person’s day. You’re looking for patterns that can help you understand what seems to make things easier or harder. Once you recognize those patterns, you can sometimes make small changes that have a surprisingly large effect on how the day goes.
Understand That Sundowning May Be Part of the Pattern
For some people with dementia, anxiety and confusion become much more pronounced later in the day. This is commonly referred to as sundowning, and it can be one of the more difficult parts of caregiving because the pattern may repeat day after day.
For us, the late afternoon was when things really got interesting. After her nap, she would be up around 3:30 and begin pacing and looking out the windows. She would move from window to window, watching and listening, wondering whether “they” were coming. She might say, Is that them? No, and then a few minutes later, I hope they didn’t forget. Eventually she would hear something outside and wonder if it sounded like the people she believed were coming. This could continue for two or three hours.
At first, the obvious answer seemed to be constant reassurance. I would explain that nobody was coming, that she was safe, that she was home, and that there was nothing she needed to worry about. But the explanations didn’t stop the anxiety. If anything, repeatedly trying to convince her that she was mistaken simply kept the conversation going.
Eventually, I stopped trying to make the sundowning disappear and started looking at how I could work with the pattern instead.
Work With the Pattern Instead of Fighting It
Once I understood that those few hours were going to happen whether I liked it or not, I could build the evening around them. When she started pacing and looking out the windows, I would pull the curtains so she couldn’t keep watching for whoever she believed was coming. Then I’d start getting the dinner table ready.
In the beginning, she liked everything set up family-style. She would serve me and then herself, like the good hostess she was. Dinner then led naturally into the rest of the nighttime routine. I didn’t have to convince her of every step because once one part of the routine was finished, she often moved naturally into the next.
The sundowning wasn’t gone, but it became part of a structure that she recognized. That was a much more realistic goal than expecting myself to find the perfect thing that would somehow make the behavior stop.
Sometimes caregiving isn’t about finding the magical thing that makes a symptom disappear. Sometimes it’s about figuring out how to work around what you can’t stop.
Make the Environment Feel Familiar
The environment around someone with dementia can also affect anxiety. Keeping frequently used items in familiar places can make the home easier to navigate. Familiar music, photographs, furniture, routines, and daily activities can provide cues that help the person feel oriented.
That doesn’t mean you need to turn the house into a dementia-themed amusement park. You don’t need twenty signs on the walls telling someone where the bathroom is. Start with the things that already make the person feel at home and try to preserve those familiar cues when you can.
A favorite chair in the same place, familiar music playing at a certain time, photographs that have always been displayed in the house, or a familiar evening routine can all contribute to a sense that the environment is recognizable. When so much inside the person’s mind may feel unfamiliar, those external cues can matter.
Give Reassurance Without Making Promises You Can’t Keep
Sometimes a person with dementia simply needs reassurance. That doesn’t mean you have to promise something you can’t control.
If your parent is worried that someone has forgotten them, telling them, “Nobody is ever going to leave you,” may not be something you can honestly guarantee. But you can sit with them and reassure them that they are safe right now and that you are with them. That distinction matters because you aren’t required to solve every fear or promise that nothing difficult will ever happen.
Sometimes being the calm, familiar person in the room is enough. Your presence, your tone of voice, and the fact that you aren’t treating their fear as ridiculous can provide more reassurance than another explanation ever could.
Look for Changes That Need Medical Attention
Not every increase in anxiety should automatically be blamed on dementia. If someone suddenly becomes much more anxious, agitated, confused, restless, or unlike themselves, pay attention to the change.
Pain, illness, medication changes, lack of sleep, constipation, urinary problems, dehydration, and other issues can affect behavior and cognition. A sudden or significant change deserves discussion with the person’s healthcare provider so potential causes can be evaluated.
You know the person’s usual patterns better than most people do. If your gut is telling you, This isn’t their usual behavior, don’t ignore that simply because the person already has dementia. Changes are worth communicating to the people involved in their healthcare, particularly when the change is sudden, significant, or persistent.
You Don’t Have to Make the Anxiety Disappear
This may be one of the hardest lessons for a caregiver to learn. You cannot always talk someone with dementia out of their anxiety. You cannot always convince them that they are safe, correct the misunderstanding, answer the question, or explain the situation well enough for them to remember it five minutes later.
Sometimes the goal has to change. Instead of asking, “How do I make them understand?”, it may be more useful to ask, “What can I do to help them feel safe right now?”
That might mean changing the environment, redirecting them, moving an activity to a different time of day, or building a more predictable routine. It might mean letting go of an argument you know you cannot win. It might mean recognizing that a particular part of the day is consistently difficult and planning around it instead of spending all of your energy trying to prevent it.
That’s what worked for me with sundowning. I couldn’t make those few hours disappear, so I stopped treating them as a battle I had to win. I pulled the curtains, got dinner ready, and let the familiar routine take over when it could.
You don’t have to fix every symptom of dementia to be a good caregiver. Sometimes you just have to learn the rhythm of the person you’re caring for and find a way to move through the difficult parts with them.