How to talk so she can follow, what to do about sundowning, bathing and hallucinations, what non-drug care really does, how to protect your own health, and what to expect at the end.
Last reviewed
16 min read
9 studies cited
Most of what happens day to day with Alzheimer’s is not about pills. It is about how you speak, how the day is shaped, and whether small causes of distress get noticed. This page covers what the evidence says works, what probably does not, and what is simply kind and low-risk to try.
How to talk with her
Behavior is a form of communication. When words get harder, feelings still come through, and actions start to carry messages that words used to carry. A few principles help almost everywhere:
Respond to the feeling, not the facts. If she is upset that her mother has not visited, the fear and loneliness are real even if the facts are not. Comfort the feeling.
Don’t argue or correct. Logic stops working as the disease progresses. Winning the point costs her dignity and you both peace.
Use a calm voice and gentle touch. Short sentences, one question at a time.
Redirect. Move to a different room, a snack, a walk or a task she enjoys.
This approach, sometimes called validation, is echoed in the Alzheimer’s Association guidance on repetition. Research on formal validation therapy has not been checked for this page, so treat it as sound practice, not proven treatment.
DICE: finding the cause of a behavior
Major medical groups recommend trying non-drug approaches first for behavior and mood symptoms. DICE is a step-by-step method from dementia specialists Helen Kales, Laura Gitlin and Constantine Lyketsos, published in the Journal of the American Geriatrics Society in 2014. It is an expert framework built on the evidence, not a single tested treatment.
Describe. What happened, when, where and with whom? Replay it “as if in a movie”. What came right before and right after?
Investigate. Look for causes in three places. In her: pain, infection, constipation, medicine side effects, poor sleep, hearing or vision loss, depression. In the caregiver: tone, expectations, stress. In the surroundings: too much noise or too little to do, no routine.
Create a plan with the care team. Treat medical causes, simplify tasks, change how you communicate, add meaningful activity, adjust the room.
Evaluate. Did you try it? Did it work? Any side effects? Adjust and try again.
Common situations
The same question, again and again
Look for the need behind the question. It is often worry, boredom or a specific fear. Answer the feeling with a calm voice and a gentle touch. Give the same answer each time, or write it on a note, whiteboard or calendar she can see. Then redirect into an activity. If the repetition is harmless, it can simply be accepted.
Sundowning
Sundowning means confusion, agitation or pacing that gets worse late in the day. Keep a steady routine. Get daylight and activity earlier in the day. Book appointments for the morning or early afternoon. Cut evening noise and TV, and turn the lights on before dusk. Keep a note of what seems to set it off. Ask the doctor to check for a urine infection, sleep apnea and the timing of her medicines. The Alzheimer’s Association sundowning page has more.
Agitation and aggression
Work through DICE. Check first for pain, infection, hunger, needing the toilet, and too much going on around her. People in later stages often cannot say they hurt; agitation may be the only sign.
Refusing to bathe
Refusal is often fear: of deep water, of the cold, of feeling exposed. Get everything ready and warm the room first. Test the water temperature. Say “let’s wash up” rather than “time for a bath”. Offer choices and something to hold, and coach one step at a time. If it is not working, stop and try again later. Sponge baths, no-rinse products, washing one part of the body each day, or a paid aide are all fine alternatives. See the Alzheimer’s Association bathing guide.
Hallucinations
Get a medical check first, including her eyes and hearing, since other causes are common. Reassure her: “I’m here, I’ll keep you safe.” Don’t argue: “I know you see something. I don’t see it.” Move to a brighter room. Remove shadows, or cover mirrors if her reflection upsets her. Try non-drug steps first. See the Alzheimer’s Association page on hallucinations.
When medicines are used for behavior
Medicines for behavior are meant for emergencies: severe depression with suicidal thoughts, psychosis that is causing harm, or aggression that risks injury. They are also used when serious effort with behavioral and environmental changes has not helped. That decision belongs to you and the doctor together.
In May 2023, brexpiprazole (Rexulti) became the first drug approved by the FDA for agitation in Alzheimer’s dementia. It carries the same boxed warning. The medicines page covers it and the newer options.
Since 2012, a Medicare program, the National Partnership to Improve Dementia Care in Nursing Homes, has pushed nursing homes toward non-drug care and has significantly reduced antipsychotic use where it was not needed. If your parent lives in a nursing home, you can ask: “Is she on an antipsychotic? Why? When will it be reviewed for reduction?”
Keeping quality of life
Meaningful activity
Structured, meaningful activity during the day helps prevent the boredom that drives wandering and repeated questions. Folding laundry, sorting, gardening, looking at photos, a walk. Adult day centers offer music, exercise and company, and give caregivers a break.
Music
A favorite playlist is cheap, safe and can lift her mood. The best current review found music probably eases low mood a little. It likely does not calm agitation, and the benefit fades once the sessions stop.
Promising4/5Public / nonprofit
Music-based therapy for people with dementia
van der Steen JT et al., Cochrane Database of Systematic Reviews 2025 Read the study
Design
Systematic review of 30 randomized trials
People
1,720 people, mostly in nursing homes
Length
Five or more sessions
Result Music probably lifts depressed mood slightly (moderate certainty) and may improve overall behavior and social behavior (low certainty). It likely does not reduce agitation or aggression, and showed no clear effect on anxiety, memory or quality of life. Benefits did not clearly last once the sessions stopped.
Who paid: Not reported in our notes (Cochrane is a nonprofit)
Conflicts: Not reported
Exercise
For people who already have dementia, exercise programs seem to help most with everyday tasks such as dressing and getting around. Supervised programs also lower fall risk. For exercise as prevention, see lowering your risk.
Promising3/5Public / nonprofit
Exercise programs for people who already have dementia
Result Exercise helped with everyday tasks such as dressing and moving around (very low certainty evidence). No clear effect on memory and thinking, behavior symptoms or depression.
Who paid: Not reported in our notes (Cochrane is a nonprofit)
Conflicts: Not reported
Company and social contact
Visits, phone calls, familiar photos and time with people she knows all keep her connected. Adult day centers and support programs can fill the gaps when family can’t.
Hearing and vision
Get both checked. Poor hearing or sight can drive hallucinations and behavior problems, and it makes conversation harder for everyone. Whether hearing aids slow the disease once it has started has not been confirmed in our research. For hearing aids and dementia risk in people without dementia, see this prevention trial:
Keep an eye on her weight. Later on, soft foods and finger foods help, as does sitting upright during meals and for 30 minutes after. Liquids may need thickening. Brush her teeth after meals, because good mouth care lowers the risk of pneumonia. Yearly flu shots for her and for you, and a pneumonia vaccine, are recommended.
Sleep
Daytime light and activity and calm evenings help (see sundowning above). Morning light has some trial support for fewer night-time awakenings; see the non-drug section below.
Falls
Good lighting, grab bars, no throw rugs or loose cords, and sturdy chairs with armrests.
Delirium in the hospital
A hospital stay can bring on delirium, a sudden bout of severe confusion. The Hospital Elder Life Program (HELP) was designed to prevent it. Bring her glasses, hearing aids, familiar objects and a written schedule. Ask whether the hospital has HELP.
Promising4/5Funder not confirmed
Hospital Elder Life Program (HELP): preventing delirium in the hospital
Inouye SK et al., New England Journal of Medicine 1999 (Yale summary) Read the study
Design
Controlled clinical trial
People
852 hospital patients aged 70+
Length
The hospital stay
Result New delirium fell from 15% to 9.9% of patients, about 5 fewer cases per 100 people, a relative drop of about 40%. The program used orientation, mental activity, walking three times a day, sleep help without pills, glasses and hearing aids, and fluids. Patients were older adults generally, not only people with dementia.
Who paid: Not reported
Conflicts: Not reported
Non-drug approaches, rated honestly
Many non-drug approaches are safe and pleasant. Only a few have strong trial evidence behind them. Here they are, from strongest to weakest.
Cognitive Stimulation Therapy
Cognitive Stimulation Therapy (CST) is a series of themed group sessions, usually 14, with activities and conversation designed to keep people thinking and talking. It has the strongest evidence of any non-drug approach for people with mild to moderate dementia. Ask local memory services or the Alzheimer’s Association whether groups run near you.
Solid5/5Public / nonprofit
Cognitive Stimulation Therapy: group sessions of themed activities and conversation
Woods B et al., Cochrane Database of Systematic Reviews 2023 Read the study
Design
Systematic review of 37 randomized trials
People
2,766 people with mild to moderate dementia
Length
Usually about 14 group sessions
Result A small benefit to thinking and memory, about 2 points on the 30-point MMSE memory test, which is roughly six months’ worth of usual decline. Clear gains in communication and social interaction (high-quality evidence). A small gain in quality of life. No harms reported. Recommended by NICE, the UK’s health guidance body.
Who paid: Not reported in the review summary we read (Cochrane is a nonprofit)
Conflicts: Not reported
Reminiscence
Talking through past memories with photos, music and keepsakes is safe, though it can stir up sad memories. The effects in trials were small and inconsistent.
Promising3/5Public / nonprofit
Reminiscence therapy: talking through past memories with photos and keepsakes
Result Effects were inconsistent and often small. Little or no effect on quality of life overall, with a slight benefit in care homes. A tiny gain in thinking. Group sessions probably help communication a little; one-to-one sessions may help mood a little.
Who paid: Not reported in our notes (Cochrane is a nonprofit)
Conflicts: Not reported
Bright light
Morning light and time outdoors in the daytime are low-risk and may mean fewer night-time awakenings. Light did not help agitation or depression in the trials.
Promising3/5Funder not confirmed
Bright-light therapy for sleep and mood in dementia
Fong et al., American Journal of Alzheimer’s Disease & Other Dementias 2023 Read the study
Design
Meta-analysis of 11 randomized trials
People
648 people with dementia
Length
Varied by trial
Result Fewer night-time awakenings. No meaningful effect on agitation or depression. An older Cochrane review had found too little evidence to judge.
Who paid: Not reported
Conflicts: Not reported
Massage and touch
Hand massage is safe and may calm agitation in the short term, but the evidence comes from very few studies.
2 small rigorous studies (numbers not in our notes)
Length
Short-term
Result Hand massage may calm agitation in the short term. The reviewers called the evidence too limited to generalize, and the review is now old.
Who paid: Not reported in our notes (Cochrane is a nonprofit)
Conflicts: Not reported
Doll therapy
Some people with dementia, often in later stages, find comfort in caring for a life-like baby doll. Published reviews are mostly of small, uncontrolled studies, and we have not been able to confirm their findings, so treat it as unproven. There is honest debate over whether it deceives people or affects their dignity. If you try it, offer the doll and never force it, and let her decide what the doll is. Interest can fade.
Weighted and fidget blankets
No dementia trials were found. A frail person may not be able to push off a weighted blanket, and there are risks of getting trapped or overheating.
Your own health
59% of dementia caregivers report high or very high emotional stress. Caregiving raises the risk of distress and of poorer mental and physical health. You are allowed to get help.
Respite (a break for you): adult day centers, in-home aides and short stays in a care home. Medicare’s GUIDE Model pays up to $2,500 a year, Medicaid waivers may cover it, and hospice includes short respite stays. See the first 30 days for how to pay.
Two structured programs for family caregivers have held up in controlled trials. Ask your local Alzheimer’s Association chapter, Area Agency on Aging or a GUIDE provider whether either is offered near you.
Promising4/5Public / nonprofit
REACH II: skills and stress training for family caregivers
Belle SH et al., Annals of Internal Medicine 2006 (NIH news release) Read the study
Design
Randomized trial
People
642 Hispanic, White and African American caregivers
Length
9 home visits, 3 phone calls and 5 phone support-group sessions
Result Caregivers who got the program were more likely to have a meaningful rise in quality of life: 45% vs control groups’ 7–13% among Hispanic caregivers, 40% among White caregivers and 28% among African American caregivers. Clinical depression was 12.6% vs 22.7%. The drop in nursing-home moves was small and not statistically clear.
Who paid: National Institutes of Health
Conflicts: Not reported
Promising4/5Funder not confirmed
NYU Caregiver Intervention: counseling and support for spouses
Long KH et al., The Gerontologist (analysis of the Mittelman NYU trial) Read the study
Design
Long-term controlled trial, with a later cost analysis
People
Spouse caregivers (trial size not confirmed in our notes)
Length
6 counseling sessions in 4 months, then an ongoing support group and phone help
Result Compared with usual care, the program cut the risk of a nursing-home move by 28.3%. A model built for Minnesota Medicaid projected cost savings.
Who paid: Not yet confirmed
Conflicts: Not reported
A third program, Savvy Caregiver, teaches caregivers about the disease and practical skills over a few weeks, including by video. Its own research page reports lower caregiver burden and better knowledge and skills. We have not confirmed the size of those effects in the original trials.
Late stage and end of life
Hospice
Medicare pays for hospice when a doctor certifies that life expectancy is 6 months or less and the person chooses comfort care over treatment aimed at a cure. It covers the care team, pain and symptom control and emotional support. Prescriptions cost up to $5 each, and short inpatient respite stays cost 5% of the Medicare-approved amount. It does not pay for room and board. Hospice is approved in two 90-day periods, then unlimited 60-day periods. It can be given at home, in assisted living or in a nursing home. See Medicare’s hospice coverage page.
For dementia, Medicare’s rules (local coverage determination L34567) look for FAST stage 7 or beyond, which includes being unable to walk without help (stage 7c), plus other conditions such as delirium or pressure sores that point to a 6-month outlook. You can ask for a hospice evaluation earlier. A “no” now can become a “yes” later.
Eating and feeding decisions
In the late stage, families are often asked about feeding tubes. This is a major decision. Ask the care team and hospice what the evidence shows for people with advanced dementia before choosing. Comfort-focused feeding looks like this: sitting upright for meals, soft foods, finger foods she can manage herself, and good mouth care.
Comfort through the senses
When words are mostly gone, connection still works through the senses: favorite music, photos, hand lotion, gentle hair brushing. Watch for signs of pain she can’t name, such as agitation, trembling, changes in sleep or in her face and skin. Revisit the advance directive and POLST form with the doctor as things change.
Words used on this page
FAST
Functional Assessment Staging Tool: a scale doctors use to stage Alzheimer’s by what a person can still do day to day. Stage 7 is the most advanced.