“Albert” had never left the house on his own before. Living with moderate dementia, his usual routine involved sitting quietly, watching television, and drifting in and out of sleep in the living room armchair. Apathy had become his “norm,” his baseline. So when Albert suddenly left the house without telling anyone, it shocked his wife, “Eunice,” and their daughter, “Jackie.”
The panic that followed was immediate and understandable. They began to talk about whether a care home was now the safest option for Albert. Both Eunice and Jackie were concerned about whether it would happen again, and if they could not find him.
As a Dementia Consultant for over 25 years, I hear stories like this often. Whenever a sudden and unexplained behaviour change is described, especially something completely out of character like wandering, my first thought is not to change the care plan, but to ask: Could this be delirium?
Delirium or Dementia? Why It Matters
Delirium is a sudden and severe change in mental status, often triggered by illness, infection, pain, dehydration, or medication side effects. It is not part of the normal progression of dementia. It is a medical emergency.
Unlike dementia, which progresses gradually, delirium develops quickly. Sometimes changes in behaviour show up within hours. It can cause confusion, agitation, hallucinations, lethargy, or dramatic shifts in behaviour. It is very common in older adults, especially those who already have symptoms of dementia, but it often goes unrecognised and untreated.
Why does it matter?
It matters because delirium is treatable—but only if it is caught in time. Left untreated, it can lead to hospitalisation, long-term cognitive decline, or even death.
So when Eunice told me about Albert wandering, my immediate question was: “Could he have a urinary tract infection (UTI)? Could he be feeling unwell?”
Sure enough, when Eunice checked his temperature that evening, he was running a fever. They gave him some medication. Within a few days, Albert was back to his “normal” self. No more wandering.
A Change in Behaviour Is a Message
Albert’s wandering was not the start of a new behavioural pattern. It was his body sending out a signal: something’s wrong. Because he could not express that he felt ill, it came out in his actions.
Too often, families and even professionals interpret behaviour changes in people with dementia as signs of progression or as “dementia getting worse.” But behaviour is communication. In the case of someone with dementia, it may be their only way of telling us they are in pain or unwell and need help.
A Call to Look Closer
Sudden changes in behaviour is a reminder to a caregiver to look closer.
Albert did not need to be moved to a care home because that would not have addressed the real issue. His sudden behaviour was not a sign of needing more supervision, but a response to an underlying infection that required medical treatment, not relocation.
He needed help with his fever. His behaviour told a story; one that could have been missed if we had not looked closer and asked “why?” Why the sudden change in Albert’s baseline behaviour?
Understanding the difference between dementia and delirium can change the course of someone’s care, as well as their life. It can mean the difference between crisis and comfort, unnecessary transition or continued independence.
That is why education matters. Families, friends and health professionals alike need to recognise that behaviour is a clue, not just a challenge. When we take time to understand the meaning behind the behaviour, we respond not with fear, but with clarity and compassion.
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DISCLAIMER:
This article is based on a true story; however, names, locations, and certain events have been altered to protect the privacy and confidentiality of the individuals involved. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.
The contents of this blog are provided for information purposes only. They are not intended to replace clinical diagnosis or medical advice from a health professional.
