Most families do not notice the day dementia begins. It arrives as small things. Your father calls you by your brother’s name. Your mother puts the keys in the fridge. A relaxed, sociable parent becomes anxious every evening around six.
Then one day the stove is left on, or a parent walks out of the gate and cannot find the way back, and the family realises this is no longer forgetfulness.
This guide covers what dementia care at home actually involves: the two behaviours that worry families most (wandering and sundowning), how to make the house safer, and how to tell when you need a trained caretaker rather than more family effort.
Dementia and Alzheimer’s: what’s the difference?
Dementia is not one disease. It is a group of symptoms: memory loss, trouble with reasoning, language and judgement, and changes in mood and behaviour, serious enough to interfere with daily life. Alzheimer’s disease is the most common cause. Others include vascular dementia (linked to strokes and blood vessel damage), Lewy body dementia, and frontotemporal dementia.
The numbers in India are larger than most families assume. The Longitudinal Ageing Study in India (LASI-DAD), a nationally representative study, estimated that about 7.4% of Indians aged 60 and above live with dementia, roughly 8.8 million people. You can read the findings in the published study. Many are cared for entirely by family, often without a formal diagnosis.
A diagnosis matters. Some conditions can look like dementia or make it worse, including urine infections, thyroid problems, vitamin B12 deficiency, dehydration, depression and side effects of certain medicines. A neurologist, geriatrician or psychiatrist can rule these out. If your parent has not been assessed, start with a doctor consultation before anything else.
How care needs change by stage
Dementia usually progresses gradually, and the right kind of help changes with it.
| Stage | What families usually see | What care looks like |
|---|---|---|
| Early | Forgets recent conversations, misplaces things, struggles with bills or dates, still independent in most tasks | Reminders, routine, medicine supervision, a companion for outings, legal and financial planning |
| Middle | Gets lost, repeats questions, confuses people, needs help with bathing and dressing, sleep and mood changes, wandering and sundowning appear | Supervision for much of the day, hands-on personal care, structured routine, home safety changes |
| Late | Limited speech, difficulty swallowing, mobility loss, incontinence, mostly in bed or chair | Round-the-clock care, nursing support, pressure-sore prevention, feeding assistance. See our bedridden patient care guide |
Not every person follows this pattern neatly, and the stages overlap. Use the table as a rough guide, and let the doctor’s assessment decide.
Wandering: why it happens and how to reduce the risk
Wandering is not aimless. The person usually has a reason that made sense to them: looking for a home they remember from childhood, going to a job they retired from years ago, searching for a person who has died, or trying to find a toilet. Boredom, pain, restlessness and a noisy or unfamiliar setting can also set it off.
The risk is real. A parent who steps out for a “short walk” can get lost within minutes, and heavy traffic, heat or rain make it worse.
Practical steps that help:
- ID that travels with them. A bracelet or pendant with their name, your phone number and a line saying “I have memory loss.” A card in the pocket is easily lost, so a bracelet is better.
- A recent photograph saved on every family member’s phone, in case you need to show it to neighbours, security guards or the police.
- Door alerts. A simple chime or door sensor tells you when someone opens the main door at 3 a.m.
- Locks placed out of the usual line of sight. A bolt at the top or bottom of the door is easier to miss. Never lock the person in alone. In an emergency it is dangerous, and it can increase fear and agitation.
- A GPS tracker worn on the wrist or clipped to a belt, if your parent will tolerate it.
- Tell the neighbours, society security and the nearby shopkeepers. In a Pune housing society, this one step can bring a lost parent home quickly.
- Watch the patterns. If wandering mostly happens at the same time each day, plan an activity or a walk with someone then.
If a parent does go missing, search the immediate area first, because many people are found close to home. Then inform the nearest police station without waiting.
Sundowning: the evening problem
Sundowning is a pattern, not a separate disease. Late in the afternoon or evening, a person with dementia becomes more confused, restless, suspicious or distressed. They may pace, shout, insist they must “go home” (while already at home), or refuse to settle.
Doctors do not fully understand it, but common triggers include tiredness at the end of the day, fading light and shadows, hunger or thirst, pain, overstimulation from a noisy evening household, and disrupted sleep from the night before. Untreated infections can also worsen it.
What families find helpful:
| Try this | Instead of this |
|---|---|
| Morning sunlight and some activity every day | Letting the person doze in a dim room all day |
| Light, familiar surroundings as evening approaches, with lamps on before dusk | Letting shadows build up in the room |
| Tea or coffee only in the morning | Caffeine in the afternoon or evening |
| A quiet, predictable evening routine | Visitors, loud television and a busy kitchen at the same hour |
| A calm, simple snack or meal at a fixed time | Skipping the evening meal or serving it late |
| A short walk or a calming activity such as sorting laundry or listening to old songs | Leaving the person alone with nothing to do |
If sundowning is severe or new, mention it to the doctor. Pain, infections or medicines can be behind it. Please do not give sedatives or sleeping tablets on your own. They can raise the risk of falls and worsen confusion.
Making the home safer
You don’t need to renovate. Most of the risk comes from a handful of everyday hazards.
Kitchen
- Use a gas safety valve or an auto cut-off device, or remove knobs when the person is unsupervised. An induction cooktop with an auto shut-off is safer than an open flame.
- Lock away knives, cleaning liquids and anything that looks edible but isn’t.
Bathroom
- Fit grab bars, a non-slip mat and a shower chair.
- Set the geyser to a safe temperature. People with dementia may not sense when water is too hot.
- Remove locks from the bathroom door, or keep a key outside.
Bedroom and living areas
- Keep walking paths clear and the floor free of loose rugs and wires.
- Use night lights from the bedroom to the toilet.
- Keep a clock and a calendar visible. Label doors with simple words or pictures.
Medicines
- Keep all medicines locked. Give each dose yourself or have a caretaker give it, rather than leaving tablets out for the person to take.
Balconies and stairs
- Make sure balcony grilles are secure. Add a gate at the top of stairs.
Falls are a major risk for people with dementia, and many of the fixes above overlap with our room-by-room fall prevention guide. As needs grow, you may also need equipment such as a hospital bed, a commode chair or a wheelchair. Our medical equipment page lists what is available, and our post on types of hospital beds for home use explains the options.
Everyday communication that makes care easier
How you speak matters as much as what you do.
| Instead of | Try |
|---|---|
| “I told you this morning!” | Answer the question again, calmly, as if it were the first time |
| “That’s wrong, your sister is not here.” | “Tell me about her.” Then gently redirect |
| “Why won’t you eat?” | “Shall we have chai together?” |
| Long instructions | One simple step at a time |
| Arguing about facts | Responding to the feeling behind the words |
Keep a daily rhythm: meals, bath, walk and rest at roughly the same time each day. Familiar routines reduce anxiety, and simple activities help too. We’ve listed ideas in our post on activities for elderly patients at home. For other neurological conditions with overlapping needs, see why Parkinson’s patients need a caregiver at home.
Do the legal paperwork early
This part is easy to postpone and hard to fix later.
Under Section 201 of the Indian Contract Act, 1872, an agency (which includes a power of attorney) ends when the person who granted it becomes of unsound mind. And under Section 59 of the Indian Succession Act, 1925, only a person of sound mind can make a valid will. In practice, this means that if your parent is still in the early stage, with a doctor’s confirmation of capacity, that is the time to sort out a will, a power of attorney, bank mandates, and health and insurance details.
Once capacity is lost, these matters often need a court process and become slow and stressful. Families with a member abroad should read our guide on setting up home care remotely as an NRI, which covers power of attorney, payments and monitoring. Please consult a lawyer for the exact documents your family needs.
When should you hire a trained caretaker?
Most families wait too long. They manage with a tired spouse, a sibling taking leave or a house help who was never trained for this. Here are signs that it is time for professional support:
- Your parent cannot be left alone safely, even for an hour
- There have been wandering episodes, or near misses
- Nights are broken. Your parent is up, restless or confused after dark, and the family is exhausted
- Medicines are being missed or doubled
- Bathing, toileting or eating needs hands-on help
- Weight loss, dehydration or repeated infections
- Agitation or aggression that the family finds hard to manage
- The main caregiver is showing signs of burnout (poor sleep, irritability, health problems of their own)
- The family lives in another city or country
If any of these sound familiar, a trained caretaker is not a luxury. It is a safety measure. A good caretaker keeps the routine steady, supervises medicines, watches for changes in behaviour and health, handles personal care with patience, and reports back to the family.
Not every situation needs the same kind of help. Early dementia may only need a companion for part of the day. The middle stage often needs a full-time caretaker, including nights. When there are medical tasks such as injections, wound care or catheter care, a nurse may be needed in addition. Our guides on elderly caretaker vs home nurse vs attendant and nurse at home vs caretaker at home explain how to decide.
Questions to ask any agency before hiring:
- Does the caretaker have experience with dementia specifically?
- What is the process for background and police verification?
- What happens if the caretaker is absent or needs replacing?
- How will the family receive updates?
- Can the caretaker handle night shifts?
If you live abroad, our guide on choosing a caretaker for your parents as an NRI has a fuller checklist.
Looking after the caregiver
Dementia care is long. Family members who give everything often end up ill or resentful, and that does not help the patient either. Share the load, take regular breaks, and accept professional help sooner rather than later. If you are struggling with a difficult day, our post on handling difficult caregiving situations gracefully may help.
How Quixi Healthcare can help
Quixi Healthcare provides caretaker services at home in Pune, nursing services, doctor consultations and medical equipment on rent or purchase. If you are not sure what your parent needs, contact us with a short description of the stage, daily routine and main worries, and we will help you work out the right level of support.
This article is for general information and does not replace medical or legal advice. Please consult your parent’s doctor and a lawyer for decisions specific to your family.
FAQs
Can a person with dementia be cared for at home?
Yes, in many cases, especially in the early and middle stages, with a safe home, a steady routine and trained support. Late-stage care often needs nursing input as well. The doctor’s assessment should guide the decision.
What is sundowning?
Sundowning is increased confusion, restlessness or distress in the late afternoon or evening. It is common in people with dementia and often improves with a calm routine, good lighting and attention to sleep, pain and infections.
How do I stop a parent with dementia from wandering?
You can’t remove the risk entirely, but you can reduce it with ID bracelets, door alerts, a recent photo, informing neighbours and security, supervised walks and a consistent routine. Do not lock them inside alone.
When should I hire a caretaker for dementia?
When the person can’t be left alone safely, nights are disturbed, medicines are being missed, personal care needs hands-on help, or the family caregiver is exhausted.