How does the provider support people who wander or experience sundowning?

How does a provider support participants who wander or experience sundowning?

A good aged care provider should first try to understand why the person is walking, attempting to leave or becoming distressed later in the day.

These behaviours should not automatically be treated as disobedience or controlled through locked doors, sedation or physical restraint.

Wandering may be connected to:

• boredom or lack of activity

• a desire to follow a familiar routine

• looking for a person, place or object

• pain or physical discomfort

• needing food, water or the toilet

• anxiety, restlessness or confusion

• excessive noise or stimulation

• wanting to leave an unfamiliar environment

• medication effects, illness or delirium.

What is sundowning?

Sundowning describes increased confusion, restlessness or distress that occurs in the late afternoon or early evening for some people living with dementia.

The person may:

• become anxious, upset or suspicious

• repeatedly ask to go home

• pace or attempt to leave

• find it harder to concentrate

• become more impulsive

• experience hallucinations or mistaken beliefs

• have difficulty settling for the evening.

Not everyone with dementia experiences sundowning, and a sudden or severe change should not simply be attributed to dementia. Pain, infection, medication changes or delirium may require medical assessment.

The provider should develop an individual plan

The provider should work with the participant, family and relevant health professionals to identify:

• when the behaviour usually occurs

• what happens immediately beforehand

• where the person may be trying to go

• familiar routines from earlier life

• known triggers

• early signs of distress

• strategies that help the person settle

• risks such as traffic, falls or becoming lost

• when clinical or emergency help is required.

For example, a person who repeatedly says they need to “go home” at 4 pm may believe they need to collect children from school or finish work. Correcting or arguing with them may increase distress. A better response may be reassurance, conversation about the underlying concern, a familiar activity or an accompanied walk.

Supporting safe movement

Walking itself is not necessarily a problem. It can provide exercise, relieve restlessness and give the person a sense of purpose.

A provider may support safe movement by:

• arranging regular accompanied walks

• providing access to a secure garden or safe walking route

• reducing clutter and falls hazards

• ensuring suitable footwear and mobility aids are available

• offering meaningful activities throughout the day

• helping the person maintain familiar routines

• using clear signs and visual cues

• making sure the person can easily find the bathroom, bedroom and common areas

• checking whether pain, hunger, thirst or toileting needs are contributing.

The aim should be to make walking safer, not automatically prevent it.

Reducing sundowning distress

Useful strategies may include:

• maintaining a predictable daily routine

• scheduling appointments and personal care earlier in the day

• providing daytime exercise and meaningful activity

• avoiding excessive daytime sleeping where appropriate

• reducing noise, crowds and household activity late in the day

• improving lighting before shadows and darkness increase

• offering food, drinks and toileting before the usual period of distress

• using familiar music, photographs or calming activities

• avoiding arguments or repeated correction

• speaking slowly and offering simple reassurance

• maintaining a calm evening environment.

Sleep routines, daytime activity, reduced late-day stimulation and appropriate lighting can all be relevant when supporting restlessness and disrupted sleep.

What should Support at Home providers do?

For a person receiving care at home, the provider should create a written care and risk plan covering:

• what workers should do if the person tries to leave

• safe walking and supervision arrangements

• communication and calming strategies

• who to contact

• medication and health risks

• how unfamiliar or replacement workers will be briefed

• what family members can realistically provide

• what happens if the person cannot safely be left alone.

The provider should assign workers with relevant dementia experience and aim for continuity. Frequently sending unfamiliar workers can increase confusion and distress.

If contractors or subcontractors are used, the registered provider remains responsible for ensuring they understand the participant’s care plan, risks and agreed response strategies.

What should happen in residential aged care?

A residential provider should offer an environment that allows safe movement, meaningful activity and appropriate supervision.

Where changed behaviour creates risk, the home should assess patterns and develop a behaviour support plan. Residential aged care providers are required to have a behaviour support plan where a resident experiences relevant changed behaviour or may require restrictive practices.

The plan should be known by workers across all shifts—not left in a file that casual or agency workers have not read.

Can doors, tracking technology or alarms be used?

Safety technology may sometimes help, including:

• door alerts

• movement sensors

• identification devices

• GPS location technology

• monitored entry systems.

These measures should be discussed with the person and their authorised supporters, based on the actual level of risk.

Locking someone inside, blocking movement or using equipment primarily to prevent them leaving may amount to environmental, mechanical or physical restraint.

Restrictive practices must be a last resort, used in the least restrictive form and for the shortest possible period, with the required assessment and consent.

What if the person goes missing?

The provider should have a missing-person response plan.

This should include:

• immediately checking the home and nearby areas

• contacting family or nominated emergency contacts

• identifying what the person was wearing

• checking familiar destinations or walking routes

• contacting police promptly where the person may be at risk

• providing police with a recent photograph and relevant health information

• reviewing the incident afterwards and updating the care plan.

Do not delay contacting police merely because the person has wandered before. The risk depends on factors such as weather, traffic, mobility, medication needs and how long the person has been missing.

Call 000 where there is an immediate threat to life or safety.

When should medical advice be sought?

Contact the person’s GP or clinical team if there is:

• a sudden increase in confusion or agitation

• a marked change from usual behaviour

• fever or signs of infection

• suspected pain

• a recent fall or head injury

• changes after starting or changing medication

• hallucinations or distress that are new or severe

• significant sleep disruption

• risk of harm to the participant or others.

A sudden change may be delirium or another treatable health problem rather than progression of dementia alone.

Specialist dementia support

The provider can seek specialist advice rather than expecting the family or individual worker to manage complex behaviours alone.

Dementia Australia’s National Dementia Helpline provides information and support on 1800 100 500, 24 hours a day.

Providers can also seek specialist dementia behaviour support where strategies are not working or risks are escalating.

Questions to ask the provider

Ask:

• How do you identify the reason the person is trying to leave or becoming distressed?

• Will there be a written dementia and risk-management plan?

• What dementia-specific training have the proposed workers completed?

• Will the same workers usually attend?

• How are casual or contractor workers briefed?

• What safe walking opportunities will be provided?

• How do you respond when the person asks to go home?

• How do you manage late-afternoon distress without sedation or restraint?

• What technology or door-alert systems do you use?

• What is your missing-person procedure?

• Who provides clinical oversight?

• When would you contact family, a doctor or emergency services?

• How often will the plan be reviewed?

The practical standard is:

The provider should understand the reason behind the behaviour, support safe movement, reduce predictable triggers and maintain a clear response plan. Wandering or sundowning should not automatically lead to confinement, sedation or restraint.

What should I do next?

Confirm the details with My Aged Care or the relevant provider, write down your questions and ask for important information in writing before making a decision.

Helpful Local Home Help resources

• Start with Liz

• Find your home care style

• How to choose a home help provider

• Find home care providers