Dementia often leads to restlessness and disorientation, creating a serious risk of falls or wandering when a patient attempts to leave the bed unsupervised. This behavior presents a significant safety challenge for caregivers, especially during nighttime hours. The primary goal is to ensure the individual’s comfort and physical security without resorting to physical restraints, which are generally discouraged and frequently cause increased agitation. Effective management depends on identifying the cause of the restlessness and implementing person-centered, non-pharmacological interventions.
Determining Why the Patient is Trying to Get Up
The impulse to get out of bed is rarely random; it is often an expression of an unmet need they are unable to articulate due to cognitive decline. Identifying the specific trigger is the foundational step toward a solution. Caregivers should first investigate physical sources of discomfort, such as acute pain or chronic pain conditions like arthritis, which may be exacerbated by lying still.
A biological need is another frequent cause, most commonly the need to use the restroom, which can be prompted by incontinence issues or simply a confused understanding of time and place. Thirst or hunger are also simple, easily overlooked triggers that cause the individual to seek something from the kitchen. Medications must also be reviewed with a physician, as side effects or drug interactions can increase confusion, restlessness, or insomnia.
Behavioral patterns should be tracked meticulously in a diary, noting the time of the restlessness, what activity immediately preceded it, and the physical state of the individual. This documentation may reveal a consistent pattern, such as attempting to get up an hour after a specific evening medication or always around 2:00 AM for the bathroom. Psychological factors, including anxiety, boredom, or a general sense of disorientation, also contribute to the urge to move.
Non-Pharmacological Strategies for Bedside Safety
Once potential triggers are identified, environmental and behavioral modifications can be implemented immediately to enhance safety and reduce the risk of injury. One effective physical modification is to lower the bed as close to the floor as possible, minimizing the distance of a potential fall. Using a hospital-style low bed or simply removing the bed frame can achieve this safer height.
Placing thick, impact-absorbing floor mats beside the bed cushions the landing should a fall occur, significantly reducing the likelihood of a fracture or head injury. These mats should be non-slip to prevent trips when the individual is walking around. Ensuring that necessary items, such as a glass of water, eyeglasses, or a remote control, are within easy reach can eliminate the need to exit the bed.
Redirection and distraction are preferred behavioral strategies over attempts at physical containment when a person becomes restless. Offering a comforting object, a gentle snack, or engaging in a simple, calming activity like listening to music can redirect the individual’s focus away from the urge to wander. The environment should be clutter-free and familiar, as confusion caused by an unfamiliar setting or objects can increase agitation.
Managing Restlessness During Sleep and Sundowning
Restlessness is often tied to disruptions in the sleep-wake cycle, which are common in dementia due to changes in the brain that affect the internal biological clock. The phenomenon known as “sundowning” involves increased confusion, agitation, and anxiety occurring in the late afternoon and evening hours. This late-day confusion is a major contributor to nighttime wandering and difficulty staying in bed.
Maintaining a strict, predictable daily routine is a powerful tool for regulating the body’s circadian rhythm and combating sundowning. This consistency should include fixed times for waking up, meals, and going to bed, providing a sense of security and familiarity. Limiting daytime naps, or keeping them short—ideally less than 30 minutes—helps ensure that the individual is tired enough to sleep soundly at night.
Exposure to natural light during the day, particularly in the morning, helps reinforce the sleep-wake cycle. Reducing stimulating activities in the evening is also beneficial. Caregivers should avoid loud television, heavy chores, or emotionally charged conversations before bedtime. Instead, engaging in soothing activities, such as quiet reading or listening to calming music, can help create a peaceful transition into the night.
Monitoring Tools and When to Consult a Physician
Technological tools provide an important layer of safety monitoring that allows caregivers to intervene promptly without being physically present every moment. Pressure-sensitive bed alarms, which are thin pads placed under the mattress or on top of the sheet, trigger an alert when the patient’s weight is lifted from the bed. Cordless floor mats placed beside the bed function similarly, activating a remote monitor when stepped on.
Motion sensors placed outside the bedroom door or in a hallway can also alert a caregiver to wandering. These monitoring technologies are preferred because they alert the caregiver to the attempt to exit the bed, allowing for timely intervention. Physical restraints, such as four-side bed rails or specialized vests, are highly discouraged because they can increase panic, cause injury as the person attempts to climb over them, and are often prohibited by regulations.
A medical review should be sought immediately if agitation or restlessness is a sudden change or is severe and unmanageable with non-pharmacological methods. A doctor can investigate underlying medical conditions, such as a urinary tract infection, pain, or a new case of delirium, which can worsen confusion and agitation. Reviewing all current medications is also paramount, as new symptoms could be side effects or drug interactions, requiring an adjustment to the regimen.