Is My Senior Parent Depressed or Just Lonely? How to Tell the Difference

Seniors who become confused or agitated at night may be experiencing sundowning syndrome, a common symptom associated with dementia. This condition can trigger a range of behaviors, including anxiety, disorientation, and restlessness. Understanding why sundowning occurs helps caregivers provide better support and comfort to their elderly loved ones.

Alzheimer’s disease and other forms of dementia cause cognitive changes that can lead to sundowning, also referred to as sundowning syndrome. While the exact cause is not fully understood, sundowning is not a disease itself but rather a recognizable pattern of symptoms that often appears in the late afternoon or evening.

What Is the Difference Between Nighttime Confusion and Sundowning?

Nighttime confusion broadly refers to disorientation, agitation, or restlessness that appears after dark. Sundowning is a dementia-related form of nighttime confusion where symptoms worsen specifically in the late afternoon or evening.

A simple distinction:

  • Nighttime confusion = the symptom
  • Sundowning = dementia-related cause of those symptoms

What are symptoms of sundowning?

Confusion and anxiety can arise in older adults diagnosed with dementia when the sun sets. In addition to acting confused, they may cry, pace, rock in their chair, or hallucinate. Trouble distinguished dreams from reality is another common symptom of sundowning.

Aging people experiencing sundowning may shadow their caregiver (follow them around wherever they go). Wandering, difficulty sleeping, and yelling are also symptoms. As the sun dips below the horizon, the dementia patient may even lash out violently at caregivers and other individuals.

What Time Does Sundowning Usually Start?

Most families notice symptoms beginning in the late afternoon or early evening, typically between 4 p.m. and 8 p.m. As outdoor light fades, fatigue increases and the environment becomes quieter, which can intensify confusion.

Can Nighttime Confusion Happen Without Dementia?

Yes. While sundowning is strongly linked to dementia, seniors without dementia may also become confused at night due to:

  • Medication side effects
  • Sleep apnea
  • Dehydration
  • Infections such as UTIs
  • Hospital environments
  • Anxiety or loneliness
  • Vision changes after dark

If you’re unsure whether these changes reflect normal memory loss or a form of dementia, this guide on the differences between memory care and dementia care offers clear explanations and signs to look for: Memory Care vs. Dementia Care

What triggers confusion in the elderly?

As mentioned, the cause of sundowning is unknown. However, experts believe the symptoms worsen when seniors are sleep deprived. Older adults need less sleep, but poor sleep quality contributes to sundowning. Dreaming during sleep can disorient them, causing confusion between dreams and reality.

Dementia affects the brain’s internal clock, disrupting their circadian rhythm and causing them to confuse day and night. Nighttime shadows and low light can strike fear and confusion in the elderly and increase their confusion. Sleep apnea, a condition that reduces oxygen, is also a culprit.

Confusion may arise when the older adult navigates or sleeps in an unfamiliar place, such as a hospital. If the senior is bored or lonely, the lack of stimulation can worsen symptoms. Urinary tract infections (UTIs) and other underlying health conditions also create confusion in aging people.

A senior who is hungry, tired or has other unmet needs may respond with confusion at night. Similarly, confusion can develop when the older adult needs to use the toilet and, due to dementia, they forget where the bathroom is located or are unable to process their urge to urinate.

Some medications, like sedatives, also create confusion in seniors. This is due to side effects or the drug wearing off closer to bedtime. Certain statins prescribed to control cholesterol levels as well as common heart medications disrupt sleep and cognitive function, leading to confusion and delirium.

Dehydration is a known but easily overlooked contributor to confusion in elderly individuals. Due to naturally decreased thirst sensations, older people may not recognize that they are thirsty and become dehydrated. Or mobility challenges can interfere with their access to daily fluids.

How Long Does Nighttime Confusion Last?

Episodes may last anywhere from a few minutes to several hours. In dementia, sundowning may happen some evenings but not others. Consistency in routine, lighting, and sleep patterns can reduce the duration.

When Should Families Call a Doctor?

Contact a healthcare provider if nighttime confusion:

  • Appears suddenly
  • Worsens quickly
  • Includes fever, pain, or hallucinations
  • Causes aggressive or unsafe behavior
  • Prevents the senior from eating, drinking, or sleeping

How do caregivers lessen seniors’ confusion at night?

1. Avoid Caffeine

Confusion and other effects of sundowning can be mitigated with the right support. Caregivers help their elderly care recipients reduce symptoms by not serving caffeinated beverages after morning. Caffeine disrupts sleep, overstimulates the aging brain, and prevents seniors from relaxing.

2. Ensure Hydration

Hydration is critical to maintaining brain function and preventing confusion. Dehydration, conversely, worsens cognitive health and leads to increased confusion, especially at night when the elderly drink less fluids. Ensure the senior remains hydrated to support clear thinking and combat confusion at night.

3. Stick to Routine

Establish a schedule with regular times for waking up, eating meals and going to bed. A predictable routine reduces anxiety and signals to the body when to wind down. Daily structure offers the older adult comfort, security, and minimizes disorientation in the dark.

4. Arrange Daytime Activities

A senior with dementia is more alert during the day. Caregivers should schedule doctors’ appointments and activities in the morning hours to leverage dementia patients’ increased alertness. While at the physician’s office, ask about the best times of day for the senior to take medications.

5. Spend Time Outdoors

Caregivers can further reduce the elderly care recipient’s restlessness by taking leisurely walks outdoors. Sunlight is beneficial as it provides clear day and night cues, thereby reducing the senior’s disorientation and other sundowning symptoms. It also promotes daytime alertness and nighttime sleep.

6. Increase Indoor Lighting

Since nighttime shadows provoke confusion in seniors with dementia, keep the home well-lit in the evening. Identify and pursue calming activities with the older adult, like flipping through a family photo album, watching a beloved movie, or listening to soothing music.

7. Promote Nighttime Rest

If sleeping restfully at night is difficult, limit the senior’s daytime naps. In the evenings, create a relaxing environment to promote sleep. Reduce stimulations, such as loud music, television and screen time, which can distract the elderly person and create more confusion.

Overnight Care from A Place At Home

Nighttime can spur confusion in seniors with dementia. Reduce their symptoms with the help of compassionate caregivers from A Place At Home. Our reputable home care agency supports the unique needs of the elderly with a comprehensive range of non-medical in-home care services.

Families may prefer overnight care, where providers assist the senior with bedtime tasks. We help with personal hygiene, including toileting and dressing for bed. Our overnight caregivers are ready to provide mobility support when the senior needs to use the bathroom at night.

Arrangements may be made so overnight caregivers sleep in the same room with the older adult or occupy a nearby space with quick access to the senior. Caregivers are also trained to respond appropriately and swiftly to emergencies or urgent needs that develop at night.

Overnight care is the solution for seniors with dementia who experience confusion. Care options are flexible and can be scheduled for a few nights per week or regularly depending on needs.  Older people with vision impairment or who’ve returned from a hospital stay also benefit from our services.

A Place At Home is dedicated to providing dependable senior home care to older adults living in Carrollton, Texas. If the senior in your life needs support to achieve a quality night’s rest, we can help. Schedule a free in-home consultation today to learn more about our highly rated services.

FAQs

Yes. Shorter days, earlier sunsets, and less natural light during winter months can intensify sundowning symptoms. Many families notice more confusion, agitation, and restlessness in the late fall and winter.

Excessive or late-afternoon naps can disrupt a senior’s sleep cycle and contribute to restlessness or confusion in the evening. Short, early naps are usually better tolerated.

Sugary snacks, heavy meals, and caffeinated beverages especially in the afternoon may overstimulate seniors, cause indigestion, or interfere with sleep, contributing to confusion at night.

Yes. Fast-paced visuals, loud sounds, and screen light can overstimulate the brain, making it harder for seniors with dementia to wind down. Calming music or quiet conversation is a better alternative.

Yes. Disorientation and restlessness in the evening can cause seniors to walk aimlessly or attempt to leave the home. This is why close supervision and secured environments are important during sundowning periods.

What’s the difference between memory care and dementia care?

Family Caregiver Giving Company to Dementia Senior Parent

If you are facing the difficult decision of whether your loved one needs memory care in a facility or dementia care at home, understanding the differences between these options is essential for making the right choice.

The main distinctions between memory care and home-based dementia care involve the level of care provided, the environment in which care is delivered, and the associated costs. Both options offer assistance with activities of daily living, meals, and household tasks. However, memory care facilities provide a secure, structured environment with highly trained staff specialized in dementia care. Home-based dementia services allow seniors to remain in the comfort of their own home, but costs can increase as care needs grow.

In this article, we’ll explore the key differences between memory care facilities and home-based dementia care, helping you make an informed decision for your loved one.

What is Memory Care and Dementia Home Care?

Both options—memory care facilities and in-home dementia care—focus on supporting seniors living with memory loss, but they differ in setting, structure, and how care is delivered. Below, we break down what each type of care involves to help you determine which may be the best fit for your loved one.

Dementia Facts

Memory Care Facilities That Provide Dementia Care

Memory care facilities may operate as standalone centers or as part of a larger senior living community that offers multiple levels of care. These facilities provide specialized support for seniors experiencing memory loss, often due to Alzheimer’s disease or other forms of dementia.

Dementia care facilities typically offer services similar to those found in assisted living communities, including:

  • Activities of daily living (ADLs)
  • Management of medications
  • Dining options
  • Full-time supervision
  • A high staff-to-resident ratio
  • Staff that are highly trained in dementia care techniques
  • Assess to on-site nursing care services as needed

Home Care Services for Seniors with Dementia

In-home care for individuals with dementia, often called in-home memory care, provides companionship, practical support, and peace of mind for family members. The level of care depends on the individual’s needs and can range from a few hours per week for meal preparation and light housekeeping to 24-hour supervision.

In a memory care community, caregivers assist with activities of daily living (ADLs) and encourage social interaction. However, forming a strong, personal bond between caregiver and senior is often easier in the familiar surroundings of home.

The specific memory care services are determined when a care plan or contract is created. These services typically include:

  • Companionship which may include conversations, enjoyable activities, and companionship
  • Driving the client to doctor’s appointments or physical therapy and helping with errands
  • Help with dressing, bathing, and grooming
  • Meal prep or delivery
  • Washing dishes, doing laundry, and other housekeeping tasks
  • Helping the senior with bills and managing finances
  • Help with managing usual dementia symptoms

Memory Care vs. Home Care Cost

The national median cost of memory care is $6,450 per month, though prices vary depending on the state and specific community.

For in-home care, the national median rate is $33 per hour, but this also varies by location and the number of hours of care provided. For example, full-time in-home care at 44 hours per week would cost approximately $6,292 per month based on the national median. Costs may be higher if the home care aide has specialized dementia training, and lower if fewer hours of care are needed. As dementia progresses and care needs increase, the overall cost will rise accordingly.

Environment and Safety

Memory care requires your loved one to transition to a new community, while in-home care allows them to remain in the comfort of their own home. Since many seniors have lived in their homes for years, moving to a smaller space can be emotionally challenging. However, as care needs increase over time, home care may become insufficient or more costly.

The benefits of memory care communities often include:

  • 24-hour availability of trained staff
  • Secured entrances and exits for safety
  • Accessibility features such as open floor plans

For those receiving dementia care at home, safety precautions may require certain modifications, including:

  • Alarmed doors and windows to prevent wandering
  • Locked cabinets, stove locks, grab bars, and replacing carpets for safer mobility
  • Clear, clutter-free pathways throughout the home
  • Sensory stimulation spaces, such as rooms designed for touch, light, or sound therapy

Properly Trained Staff

The training and expertise of caregivers can vary significantly depending on whether care is provided in a memory care facility or at home.

Memory Care Facilities

Caregivers in memory care communities typically receive extensive, specialized training in dementia and Alzheimer’s care. This includes recognizing and managing behavioral changes, supporting cognitive function, and providing structured activities designed to engage residents. Staff are often trained in emergency response, mobility assistance, medication management, and safety protocols specific to secure memory care environments. Because these caregivers work as part of a team, residents benefit from consistent care and a network of professionals who can respond to complex situations around the clock.

In-Home Care

Home caregivers may also receive dementia care training, but the scope and depth can vary widely depending on the agency or individual. Training often focuses on companionship, daily living assistance, medication reminders, and creating a safe, supportive environment in the home. While one-on-one attention can help build strong personal bonds, home caregivers may not have immediate access to the same specialized resources or backup that facility staff enjoy, and additional training may be required as care needs become more complex.

Understanding these differences in caregiver training can help families make an informed choice about which type of memory care will best support their loved one’s safety, comfort, and quality of life.

Activities and Amenities Offered

Activities and therapies for individuals with dementia can take place at home or in a community setting. However, memory care facilities often offer specialized programs in purpose-built environments designed to meet the unique needs of residents.

In a memory care community, staff encourage residents to stay active, maintain independence, and feel like themselves within a safe, supportive space. These facilities provide areas equipped with the right materials, supplies, and assistive devices to ensure residents are comfortable, safe, and engaged.

Common spaces for activities in a memory care community may include:

  • Arts and crafts rooms
  • Raised garden beds or therapeutic gardens
  • Movie theaters
  • Game rooms
  • Beauty salons
  • Indoor and outdoor walking paths

Games and Activities For Seniors With Dementia

For home care, aides can also incorporate dementia-friendly activities designed to stimulate memory and engagement. While these activities can be highly beneficial in the familiar surroundings of home, the cost may increase as the disease progresses and additional support or specialized programs become necessary.

Deciding Between Memory Care Facility and Home Care

Choosing between a memory care facility and home-based dementia care is a deeply personal decision that depends on your loved one’s needs, preferences, and the resources available. Both options provide essential support, but the right choice often comes down to the level of care required, safety considerations, social engagement, and cost.

Memory Care Facilities

Memory care communities are designed to provide a structured, secure environment with 24-hour trained staff. They offer specialized programs, social activities, and therapeutic spaces that help residents stay active and engaged while ensuring their safety. For families, memory care facilities provide peace of mind knowing that professional caregivers are always on hand. This option can be particularly beneficial as dementia progresses, and care needs become more complex.

Home Based Dementia Care

Home care allows seniors to remain in the comfort and familiarity of their own homes, preserving independence and routine. Caregivers provide companionship, assistance with activities of daily living, and tailored dementia-focused programs. However, as the senior’s needs grow, home care may require more hours or specialized aides, which can increase costs. Safety modifications and additional support may also be necessary to create a secure environment.

Making the Choice

When deciding, consider your loved one’s stage of dementia, daily care requirements, social and emotional needs, and the family’s ability to provide support. Visiting memory care communities, consulting with healthcare providers, and exploring in-home care options can help families make a thoughtful, informed decision that balances safety, quality of life, and comfort.

Supportive In Home Dementia Care from A Place At Home -Carrollton

Deciding between a memory care facility and home-based dementia care is never easy, but the right choice depends on your loved one’s unique needs, preferences, and level of care required. While memory care facilities provide structured environments and 24-hour trained staff, home care offers the comfort, familiarity, and personal attention of remaining in one’s own home.

If your loved one is best supported in their own home, A Place At Home – Carrollton can provide compassionate, professional dementia care tailored to their individual needs. Our trained caregivers assist with activities of daily living, offer companionship, provide safety and supervision, and incorporate memory-stimulating activities into their care to help seniors live comfortably and safely at home.

With flexible care plans ranging from a few hours a week to around-the-clock support, we work closely with families to ensure their loved ones receive the highest level of care while maintaining independence and dignity.

Take the first step today. Contact A Place At Home – Carrollton to schedule a complimentary consultation and learn how our in-home dementia care services can support your family.

Commonly Asked Questions

If you’re exploring dementia or memory care options for your loved one, the following FAQs provide clear, expert answers to help you understand what type of care may best fit your family’s needs.

The average stay in a memory care facility is typically 2 to 3 years, although this can vary depending on the progression of dementia and the individual’s overall health.

Studies show that residents with Alzheimer’s disease often remain in memory care communities for about 18 months to 4 years. Factors that influence the length of stay include:

Stage of dementia at the time of admission

  • Level of medical and behavioral care required
  • Family involvement and ongoing support
  • Physical health and coexisting medical conditions

In some cases, seniors transition into memory care later in the disease’s progression, leading to shorter stays. Early placement, on the other hand, allows residents to benefit from structured routines, therapies, and social interaction, which can help maintain cognitive function longer.

The average cost of a dementia care home in the U.S. typically ranges from $5,000 to $8,000 per month, depending on location, level of care, and amenities offered. According to the 2024 Genworth Cost of Care Survey, the national median for memory care—which provides specialized support for individuals with Alzheimer’s or other forms of dementia—is about 20–30% higher than standard assisted living costs.

Here’s a breakdown:

  • Assisted living: Around $4,500/month (national average)
  • Memory care: Between $5,600–$7,500/month
  • Private memory care suites or high-demand metro areas (like Chicago, Los Angeles, New York, or Austin/Houston, Texas): Costs can exceed $9,000/month

These costs typically cover housing, meals, medication management, daily assistance, and access to specially trained staff 24/7. However, additional services such as medical care, transportation, or specialized therapies may increase the total monthly rate.

For families looking for a more affordable option, in-home dementia care can be a flexible alternative, allowing seniors to remain in familiar surroundings. Hourly rates for in-home care range between $30 and $45 per hour, depending on the caregiver’s qualifications and the individual’s care needs.