Where this guidance comes from

Sources & real help

The short answer

Every claim that carries weight is sourced here, by topic. (Each entry says what it supports.)
Dates are shown. (When it was published or reviewed, and when we read it.)
Thin evidence is called thin on the page that uses it.
Found something out of date? Tell us.

This guide puts well-settled dementia-care advice into short steps, in our own words.

Helplines: verified

Alzheimer's Association 24/7 Helpline: 1-800-272-3900. Free, every day, around the clock, in more than 200 languages. Read 23 October 2026: the first person who answers is a helpline agent; a care consultation is with a master's-level clinician. alz.org/helpline
Eldercare Locator: 1-800-677-1116 (Mon–Fri). Connects you to your local Area Agency on Aging for respite, day programs, meals, transport. eldercare.acl.gov
988 Suicide & Crisis Lifeline: call or text 988. For dark moments of your own, anytime.
NIA's ADEAR Center: 1-800-438-4380. The National Institute on Aging's Alzheimer's education and referral line.
Wandering response: MedicAlert's Safe & Found: ID jewelry plus a 24/7 response team. Enrollment is through MedicAlert itself, 1-800-432-5378 or medicalert.org (a paid plan). The Alzheimer's Association remains MedicAlert's named partner, but its helpline no longer enrolls you.

Behavior, agitation & sundowning

National Institute on Aging: Coping with agitation, aggression, and sundowning (light, routine, calm, lowered stimulation; the basis of our sundowning and agitation steps).
Alzheimer's Association: Sleep issues and sundowning.
NIA: Managing personality and behavior changes (don't argue, reassure, redirect).

Sudden confusion: the "call the doctor today" rule

Cedars-Sinai: How UTIs can trigger delirium and worsen dementia.
Systematic review: UTI-induced delirium in elderly patients (sudden-onset confusion is frequently infection or medication, and treatable: the single rule this guide repeats most).

Hospital stays & discharge rights

Medicare: Fast appeals (the "Important Message from Medicare," the day-of-discharge deadline, coverage during the review, and the BFCC-QIO reviewers: the basis of the discharge guidance on the hospital page).
Medicare: Skilled nursing facility care (the 3-day qualifying inpatient stay, why observation and ER time don't count, and the waivers worth asking about).
National Institute on Aging: Taking a person with Alzheimer's disease to the hospital.
Poison Help: poison.org, 1-800-222-1222, free and answered around the clock (the emergency-page guidance, including too many pills while the person is awake).
CDC: Signs and symptoms of stroke (page dated 19 May 2026: sudden trouble walking, seeing, numbness or weakness on one side, confusion or trouble speaking, or a sudden severe headache. Call 911. Do not drive). American Heart Association: heart attack warning signs (chest discomfort, pain in the arm, back, neck, jaw, or stomach, shortness of breath, cold sweat, nausea: call 911). American Red Cross: life-threatening bleeding (blood that keeps flowing or spurting: call 911). Read 23 October 2026. These are the signs added to Call 911 now and the printed booklet.

Late-stage decisions

American Geriatrics Society: Feeding tubes in advanced dementia: position statement (careful hand feeding is at least as good as tube feeding for survival, aspiration, and comfort; tube feeding carries real burdens: the basis of our "comfort feeding" guidance).
Alzheimer's Association: Feeding Issues in Advanced Dementia (free, and the source of the four findings on the feeding tube section: tube feeding does not improve nutrition, does not prevent aspiration pneumonia, has no evidence of reducing pressure sores, and shows no average difference in longevity; also the Association's position that withholding artificial nutrition is ethically permissible in the end stages, and that the decision belongs to the family).

The Bredesen protocol (ReCODE)

Journal of Alzheimer's Disease: Precision Medicine Approach to Alzheimer's Disease: Successful Pilot Project (2022, PMID 35811518. The peer-reviewed study behind the protocol: 25 people, nine months, no comparison group: mean MoCA 24.6 to 27.6, with 19 of 25 improving and 3 declining; 21 of 25 improved on the computer test; no serious adverse events).
Alzheimer's Research & Therapy: Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer's disease (Ornish et al., 2024, PMID 38849944. A randomized controlled trial, 51 people, 20 weeks: the lifestyle group improved on thinking and daily-function measures while the control group worsened; the authors conclude it "may significantly improve cognition and function" in many patients).
Journal of Alzheimer's Disease: Observed Improvement in Cognition During a Personalized Lifestyle Intervention in People with Cognitive Decline (Sandison et al., 2023, PMID 37355891. 34 people, six months, no comparison group: mean MoCA rose from 19.6 to 21.7).
Preprints.org: Precision Medicine Treatment of Alzheimer's Disease: Successful Randomized Controlled Trial (Toups, Bredesen and others; posted 30 December 2025, version 3 on 20 April 2026, doi 10.20944/preprints202512.2694.v3; registered as NCT05894954. 73 people, nine months, 50 on ReCODE and 23 on usual care, testers blinded: overall computer-test score 92 to 106 on ReCODE vs 97 to 92; MoCA rose in both, the difference not significant; mostly mild stomach and diet-adjustment side effects; 7 of 50 stopped early. Read 2026-10-03).
Biomedicines: ReCODE: A Personalized, Targeted, Multi-Factorial Therapeutic Program for Reversal of Cognitive Decline (2021, PMID 34680464. 255 people in ordinary ReCODE practice; of the 151 starting at MoCA 19 or higher, 50% improved, 23% held steady, 27% declined).
The Lancet: FINGER (2015, PMID 25771249. 1,260 at-risk people aged 60 to 77, two years: a multi-part lifestyle programme beat general health advice on a thinking test battery).
JAMA: US POINTER (2025, PMID 40720610. 2,111 at-risk sedentary people aged 60 to 79, two years: both groups improved, the structured programme more than the self-guided one).
Apollo Health: the ReCODE practitioner locator and its program FAQ (below): the source for the first visit, the one-year contract, the ReCODE Report and the follow-up schedule on the guide.
PubMed: all indexed publications by Bredesen DE (checked 2026-10-03: the 2025 randomized trial is posted in full online and not yet in a journal. This is the search to repeat).
Apollo Health: ReCODE program FAQ (every cost figure we quote, from the seller's own published numbers: the $945 lab panel, the six-month retest cadence, and the $150 to $450 monthly supplement range).

The Phoenix-area doctors we name

Apollo Health: ReCODE practitioner locator (counts per town, never names; checked 1 October 2026, and again 14 October 2026 from Phoenix: within 200 miles, 4 physicians, all Scottsdale; nurse practitioners in Scottsdale, Chandler and Gilbert, the Chandler and Gilbert listings flagged for Medicare; coaches and nutritionists in six towns. The page also says ReCODE requires a physician, and that trial subscribers see names in the dashboard).
Licences and board orders: the Arizona Medical Board and the Arizona osteopathic board, each tested against a doctor who has an order.
Board certification: the emergency medicine and family medicine boards' own directories.
Medicare: the CMS opt-out list, what opting out means, and enrolling only to order and refer.
Mayo Clinic Arizona (read in a browser 3 October 2026; its pages refuse scripts): integrative medicine in Arizona (what is offered, 5881 E. Mayo Blvd., Phoenix), requesting an appointment (no referral in most cases, 480-301-8484), costs and insurance (massage and yoga paid by card), insurance questions (Original Medicare yes, non-contracted Medicare Advantage no) and the Alzheimer's treatment clinic (Rochester now, Scottsdale "in the future"). Medicare: acupuncture coverage (chronic low back pain only, up to 20 visits a year).

Choosing and checking a doctor

American Board of Medical Specialties: Is my doctor board certified? (ABMS's own free lookup, and the reason we tell people to read a certification precisely: it shows what a doctor is certified in, and a certificate from a private institute is a different thing).
National Institute on Aging: Find an Alzheimer's Disease Research Center (the NIA-funded centers, listed state by state with phone numbers, which help with diagnosis and management and not only research: the "deepest bench" pointer on the doctor page. If this link moves, search nia.nih.gov for "Alzheimer's Disease Research Center").
CMS: Open Payments (the free federal database of payments from drug and device companies to individual providers, searchable by name. With it, the doctor page's "do you have a financial interest in this?" can be asked of a conventional prescriber as readily as of a clinic that sells what it recommends. Data shown currently runs January 2019 to December 2025).
State medical boards: not linked to an aggregator. Every state runs its own free license-and-discipline lookup; the one national front door we checked (docinfo.org) blocks automated verification, so we cannot vouch for it. Search your state plus "medical board license lookup".

The dementia medicines

National Institute on Aging: How is Alzheimer's disease treated? (the line "no known intervention cures Alzheimer's"; the cholinesterase inhibitors and memantine, what they do and that they lose effectiveness as the disease advances; the bathroom-independence example we quote; the dosage and side-effect list including falls; lecanemab and donanemab for early disease only, with PET or spinal-fluid confirmation, MRI monitoring and Medicare Part B partial coverage. Note: its stated review date is older than some of the drugs it describes, which is why the anti-amyloid facts were cross-checked below).
Alzheimer's Association: Medications for memory, cognition & dementia-related behaviors (the cross-check, and the fair two-sided framing of ARIA we use: common, usually symptomless, usually temporary, and capable of being serious; plus the FDA-encouraged ApoE ε4 testing before treatment).
Lewy Body Dementia Association: When to consider antipsychotic medications in LBD (no date shown; read 2026-10-14: "Many LBD experts prefer quetiapine or clozapine"; first-generation antipsychotics "should NOT be prescribed"; cholinesterase inhibitors "can be a good first choice"; lowest dose, shortest time).
Neurology: DLB Consortium fourth consensus report (McKeith and others, 2017; read 2026-10-14: avoid antipsychotics whenever possible; low-dose quetiapine "may be relatively safer" and is widely used, though its small trial was negative). Movement Disorders: MDS evidence review for Parkinson's (Seppi and others, 2019: clozapine and pimavanserin efficacious; quetiapine insufficient evidence, possibly useful).
New England Journal of Medicine: Relapse after stopping risperidone in Alzheimer's (Devanand and others, 2012; read 2026-10-14: people who had responded relapsed 60% on placebo versus 33% staying on the drug over 16 weeks. Risperidone, not quetiapine).

Bedbound care: skin, moving, mouth & feeding

Alzheimer's Association: Late-stage caregiving (repositioning at least every two hours, never lifting by the arms or shoulders, not massaging lotion into bony areas, range-of-motion movement two or three times a day while the muscles are warm, and the oral-hygiene-to-pneumonia link: most of when they can't get up anymore).
National Institute on Aging: Care in the last stages of Alzheimer's disease (the body mechanics for moving someone without injuring yourself, the washcloth-to-hold trick, standing on the weak side, dry-mouth comfort measures, and reading pain in a person who cannot report it).
MedlinePlus: Preventing pressure ulcers (the head-to-toe map of danger spots, floating the heels with a pillow under the calves and never under the knees, the thirty-degree head-of-bed limit, draw sheets instead of dragging, and no donut cushions).
Agency for Healthcare Research and Quality: Skin assessment (the US source behind the three checks that don't depend on skin color: extra light for heels and sacrum, knowing the person's normal tone and comparing left with right, and pressing to see whether a discolored area blanches. States outright that changes in coloration may be particularly difficult to see in darkly pigmented skin).
MedlinePlus: How to care for pressure sores (stage 1 is a reddened area that does not turn white when pressed; a deep tissue injury reads dark purple or maroon).
NHS: Pressure ulcers (the plain red-on-white, purple-or-blue-on-black-and-brown wording we use alongside the US sources above).
Medicare: Home health services coverage (you pay nothing; covered skilled nursing explicitly includes wound care for pressure sores and caregiver education; the homebound rule that does not count adult day care or religious services against you; and the limits: no 24-hour care and no custodial-only care).
Medicare: Durable medical equipment and hospital beds (Part B, doctor's order for use at home, 20% of the approved amount after the deductible, and why you ask a supplier about assignment first).
NICE (UK): Pressure ulcers: prevention and management (CG179) (read 2026-10-14: change position at least every 6 hours if at risk, every 4 hours if at high risk; "significant cognitive impairment" and being unable to reposition are named risk factors).
Journal of the American Geriatrics Society: the TURN trial (Bergstrom and others, 2013; read 2026-10-14. 942 nursing-home residents, 72.5% with dementia, on high-density foam mattresses: new sores in 2.5% turned every 2 hours, 0.6% every 3 and 3.1% every 4, no real difference; three weeks of observation).

Placement, hospice & time off work

Long-Term Care Ombudsman program: ltcombudsman.org (free, federally mandated resident advocates covering nursing homes and assisted living; the locator behind the guidance on choosing a care home).
Medicare: Care Compare (inspection results for nursing homes and hospices; assisted living and memory care are state-licensed and not listed there, which is why our guidance says inspection reports over star ratings).
Medicare: Hospice care coverage (eligibility, the two-doctor certification, recertification past six months, costs, respite, and the right to change providers: the mechanics on the last season page).
U.S. Department of Labor: Family and Medical Leave Act (the 12-week job-protected leave, intermittent use, and who is covered: the basis of the money page's FMLA section).
CMS: GUIDE Model FAQ (read 2026-10-14: as of July 2026, people living in a memory care unit are not eligible; from July 1, 2026 participants need an approved partnership to serve residential care communities). Banner Health: Dementia Care Partners (read 2026-10-14: free in Maricopa and Pima counties with Original Medicare through GUIDE; outside a nursing home; 623-832-6500, option 6).
Journal of the American Geriatrics Society: Care settings of older adults with moderately severe dementia (Harrison and others, 2019; read 2026-10-14: 64% at home, 19% in residential care, 17% in a nursing facility, 2012 to 2016 national sample).
CareScout: Cost of Care Survey 2025 (released 2026-03-02, data July to November 2025; read 2026-10-14, the Phoenix lookup in a browser: assisted living $6,000 a month, nursing home $9,003 semi-private and $12,167 private, home aide $38 an hour; national: assisted living $6,200, nursing home $315 a day semi-private, in-home care $35 an hour).
AHCCCS (Arizona Medicaid): ALTCS and the fee-for-service provider billing manual, chapter 21 (rev. 2026-05-04; read 2026-10-14: ALTCS pays assisted living services except room and board).

Keep looking for causes

CMS: Cognitive assessment and care plan services (code 99483) (read 2026-10-14: about 60 minutes with an independent historian; staging, high-risk medicine review, behavior, safety, advance care planning, a written plan; MD, DO, NP, CNS or PA; telehealth allowed; Part B coinsurance applies).
Barrow Neurological Institute: Alzheimer's and Memory Disorders Program (read 2026-10-14: "mild to severe"; not "diagnose and adios"; 602-406-6262). Industry payments to individual doctors: CMS Open Payments.
Dignity Health Yavapai Regional Medical Group: Cunningham Center for Compassionate Aging (read 2026-10-14: team members, GUIDE, 928-775-5567).
Banner Health: Banner Alzheimer's Institute (602-839-6900) and Dementia Care Partners (read 2026-10-14). CMS GUIDE FAQ (not for hospice, Medicare Advantage or memory care units).
Longevity Neurology Center: services (Tasha Powell, MD; read 2026-10-14). Medicare status: CMS opt-out list.
Isaac Health: myisaachealth.com (read 2026-10-14: virtual, neurologist-led, medication management and reconciliation, in-network with Medicare). Geriatric Solutions: geriatricsolutions.org (house calls, medication review; read 2026-10-14).
Arizona Revised Statutes: 32-1501 (naturopathic scope; prescribing excludes antipsychotics; read 2026-10-14). Naturopathic Physicians Group: cognitive health ("mild to moderate dementia"). Sonoran University: geriatrics.
Banner Health: Banner Health Clinic, Payson (928-596-4500). Central Arizona Aging: caaging.org (Area Agency on Aging for Pinal and Gila, 800-293-9393). Both read 2026-10-14.
Alzheimer's Association, Arizona Chapter: alz.org/arizona (alz.org/dsw redirects here). 24/7 Helpline 800-272-3900. The chapter page calls it the Arizona Chapter. Read October 20, 2026.
Banner Alzheimer's Institute: bannerhealth.com, 901 E. Willetta Street, Phoenix, (602) 839-6900. Read October 20, 2026.
Arizona Area Agencies on Aging, county by county: des.az.gov. Eldercare Locator 1-800-677-1116.
Arizona Adult Protective Services: des.az.gov, 1-877-767-2385.
ALTCS, Arizona Long Term Care System: AHCCCS ALTCS offices, 888-621-6880. Read October 20, 2026.
Arizona legal aid: Community Legal Services clsaz.org, (602) 258-3434 or 1-800-852-9075. Southern Arizona Legal Aid sazlegalaid.org, (520) 623-9461. DNA People's Legal Services dnalegalservices.org, 1-928-871-4151. Read October 20, 2026.
Arizona Statewide Crisis Hotline, any resident: AHCCCS crisis lines, 1-844-534-4673 (1-844-534-HOPE). Text 4HOPE to 44673. Read October 20, 2026.

Comfort first: palliative care and hospice

National Institute on Aging: What are palliative care and hospice care? (reviewed 2021-05-14; read 2026-10-14: palliative care at any stage, dementia named, treatment can continue "if you wish," hospital, nursing home, clinic or home).
Center to Advance Palliative Care: What is palliative care and its FAQ (read 2026-10-14: "based on the needs of the patient, not on the patient's prognosis"; keep treatment; covered by Medicare and Medicaid like other medical care; "Ask for it!"; the provider directory).
Medicare: Doctor and other health care provider services (read 2026-10-14: Part B pays doctor and nurse practitioner visits at 20% after the deductible, which is how palliative visits are paid; Medicare has no separate palliative benefit page).
Medicare: Medicare costs, 2026 (read 2026-10-14: Part A deductible $1,736; Part B deductible $283; 20% coinsurance).
Medicare: Medicare Hospice Benefits (CMS Product No. 02154, March 2026; read 2026-10-14: the team and 24/7 on-call, what is $0 and what is not covered, room and board, the one-time consultation with a hospice doctor, Original Medicare pays hospice for Advantage members, "no one should ask you to sign" a revocation, the fast-review notice, and the fraud warnings about gifts and "free" housekeeping).
Medicare: Hospice care coverage (read 2026-10-14: up to $5 a prescription; the 5% inpatient respite copay can't exceed the inpatient deductible, $1,736 in 2026, applied per hospice coinsurance period under 42 CFR 418.400(b); no room and board).
Code of Federal Regulations (eCFR, current to 2026-10-08): 42 CFR 418.24 (a representative may elect hospice; under 418.24(b)(6), (c) and (d), added by the FY2027 hospice final rule and effective 2026-10-01, the hospice must give a written list of non-covered items, services and drugs, with reasons, within 5 days of election, and the quality organization can advocate at once).
eCFR: 42 CFR 418.28 with the Medicare Benefit Policy Manual, chapter 9 (Rev. 13664, 2026-03-05), sections 20.2.2 and 20.2.3 (revoking is in writing only, by the person or representative; remaining days are lost; no waiting period to return; a hospice cannot revoke for you or ask you to).
eCFR: 42 CFR 418.26 (discharge when no longer terminally ill, the physician order, and re-election at any time).
CMS: Hospice Monitoring Report (April 2026; read 2026-10-14: in FY2025, routine home care 98.8% of hospice days, general inpatient 0.8%, respite 0.3%, continuous home care 0.1%; live discharge 19.1%. Its largest diagnosis group, 21.9% of users, is the category "Alzheimer's, Dementia, or Parkinson's", which the pages do not cite).
eCFR: 42 CFR 418.204 and 418.302, the Benefit Policy Manual chapter 9 sections 40.1.5 and 40.2.1, and Medicare's levels of care page (the four levels every hospice must offer; continuous care at least 8 hours, possible in a facility, not for caregiver exhaustion alone; inpatient care not for broken-down caregiver support alone; respite up to 5 days, occasional, day 6 paid as routine care, not for facility residents; the wedding and graduation examples).
eCFR: 42 CFR 418.22 (two-doctor certification, spoken certification within 2 days, periods of 90, 90 then 60 days, face-to-face visit before the third).
eCFR: 42 CFR 418.54 (nurse assessment within 48 hours, sooner if asked; full plan within 5 days).
JAMA: Hospice eligibility guidelines in advanced dementia (Mitchell and others, 2010; read 2026-10-14: 606 nursing home residents; Medicare guidelines identified 20% of those who died within six months; care "should be guided by their goals of care").
Journal of the American Geriatrics Society: Live discharge among hospice patients with dementia (Luth and others, 2020; read 2026-10-14: 2,629 New York patients; hospice at home linked with far higher odds of live discharge).
CMS: Period of enhanced oversight for new hospices (MLN7867599, February 2026; read 2026-10-14: new Arizona hospices under extra checks since 2023-07-13 after "numerous reports of hospice fraud, waste, and abuse").
Medicare Care Compare: Family caregiver survey rating (read 2026-10-14: what the stars measure; a missing rating means too few surveys, and one star does not mean poor care).
CMS Provider Data Catalog hospice datasets (General Information, Provider Data and Provider CAHPS, August 2026 refresh, defined in the hospice data dictionary, queried 2026-10-14; each hospice's page is on Care Compare, for example Hospice of the Valley Central: 157 Maricopa County hospices, 106 listed for-profit and 4 nonprofit; 24 with a star rating; Arizona average 85% "definitely recommend"; Hospice of the Valley 1.7% to 2.4% of days at crisis levels against 0.2% for Arizona).
Hospice of the Valley: Supportive Care for Dementia and GUIDE (read 2026-10-14: in-home, any stage, no cost to families through a federal grant, 24/7 nurse or social worker line, dementia educator visits; GUIDE part for Original Medicare only; 602-636-6363).
Hospice of the Valley: FAQ and refer a patient (read 2026-10-14: one call to 602-530-6900 starts admission; anyone may refer; no need to tell the doctor first; follow-up within 24 hours; 501(c)(3) nonprofit).
Hospice of the Valley: Locations and Levine Home (read 2026-10-14: nine inpatient care homes; Levine Home, 10 private rooms with dementia expertise, 3811 N. 44th St., Phoenix).
Hospice of the Valley: Banner Health to close hospice operations (from the Phoenix Business Journal, 2023-12-04) and Banner's hospice page, which now serves Northern Colorado (both read 2026-10-14).
Banner Health: Dementia Care Partners (read 2026-10-14: GUIDE, no cost in Maricopa and Pima counties with Original Medicare, outside a nursing home, respite may be available, 623-832-6500 option 6).
HonorHealth: Palliative care, and Banner: Banner University Medical Center Phoenix palliative care (read 2026-10-14: hospital consult teams; HonorHealth at six hospitals; Banner main line 602-839-2000; no HonorHealth hospice or home program found).
VA: Carl T. Hayden VA Medical Center (read 2026-10-14: palliative care, hospice and palliative care in the Community Living Center and at home, referral through VA primary care, 602-277-5551).
Arizona law: A.R.S. 36-3251 (read 2026-10-14: the Prehospital Medical Care Directive on orange paper, the orange bracelet, the agent or guardian signing, direct-care workers following it under a hospice plan of care).
Arizona law: A.R.S. 36-3231 (read 2026-10-14: the surrogate order when there is no agent or guardian).
Alliance for Care at Home (CaringInfo): Choosing and finding hospice care, and the Alzheimer's Association: Hospice care (read 2026-10-14: call a hospice directly; questions on dementia experience, years open, accreditation, how fast care starts, inpatient and respite places).
New England Journal of Medicine: The clinical course of advanced dementia (Mitchell and others, 2009; read 2026-10-14: 323 nursing home residents; families who understood the prognosis saw far fewer burdensome treatments in the last 3 months), and the triggered palliative care pilot trial (Hanson and others, 2019: 62 families, more goals talks, no fall in hospital or ER visits).
eCFR: 42 CFR 418.30 (change of hospice once per benefit period is not a revocation).
Journal of Pain and Symptom Management: Patients dying with dementia: experience at the end of life and impact of hospice care (Shega and others, 2008; read 2026-10-14: hospice families far more likely to say the person died where they wanted; pain reports similar with or without hospice).
CMS: GUIDE Model FAQ (read 2026-10-14: Original Medicare only; not Medicare Advantage, hospice or long-term nursing home residents; since July 2026 not memory care unit residents; assisted living residents get no GUIDE respite).
Payson: Compassus Payson (seven-bed inpatient unit, "the only provider in the region with an in-patient unit", 928-256-4738), Medicare's hospice data for ZIP 85541 via Care Compare (nurse-visit gaps 24.0% against Arizona's 58.4%; 85% definitely recommend), Banner Health Clinic Payson, Banner Home Care Payson and Central Arizona Aging (all read and independently re-checked 2026-10-14).
Statewide, for the same kinds of help: Alzheimer's Association, Arizona Chapter, alz.org/arizona, 24/7 Helpline 800-272-3900, and the Area Agency on Aging locator, county by county, or the Eldercare Locator, 1-800-677-1116. Read October 20, 2026.

Comfort medicines

Interior Health: PAINAD scale, with the development study (Warden and others, 2003; read 2026-10-14: five items watched for 5 minutes, scored 0 to 10).
National Institute on Aging: Providing care and comfort at the end of life (reviewed 2022-11-17; read 2026-10-14: pain "easier to prevent than to relieve," do not fear giving the prescribed amount, morphine for breathlessness, head up, a window and a fan, turning for noisy breathing and that it rarely upsets the person, fever care).
BMJ: Treating pain to reduce agitation in dementia (Husebo and others, 2011; read 2026-10-14: 352 residents; in the treatment group, 120 of 175, about 69%, needed only acetaminophen 3 g a day; 17% less agitation over 8 weeks).
DailyMed: acetaminophen 500 mg label (Walgreens, effective 2026-10-07: no more than 6 tablets in 24 hours unless a doctor directs; liver warning).
Journal of Pain and Symptom Management: Dying with dementia: symptoms in the last week (Hendriks and others, 2014; read 2026-10-14: Dutch nursing homes; 77% received opioids on the day of death; 21% palliative sedation).
Journal of Palliative Medicine: A hospice emergency kit for veterans (Bailey and others, 2014; read 2026-10-14: 63% of families used the kit; morphine concentrate used by 30%, lorazepam by 21%, an antibiotic by 16%; families uniformly positive).
DailyMed: morphine sulfate oral solution 100 mg/5 mL label (SpecGx, effective 2026-07-28: for opioid-tolerant adults; mixing up mg and mL "can result in accidental overdose and death"; use the marked syringe; older people more sensitive; slowed breathing the chief risk).
Journal of Alzheimer's Disease: New opioid use and mortality in dementia (Jensen-Dahm and others, 2025; read 2026-10-14: Danish registry, observational; 27% of new users against 6% of non-users died within 180 days, hazard ratio 5.06; "the opioid, the indication or both").
BMC Medicine: Short-term mortality after opioid initiation in dementia (Hwang and others, 2025; read 2026-10-14: observational; new users compared with existing opioid users, not non-users; twice the 14-day risk in an academic health system, 1.22 times in community care, settling after day 30).
Clinical Interventions in Aging: Buprenorphine patch tolerability in dementia (Erdal and others, 2018; read 2026-10-14: 52.3% stopped for side effects against 13.3% on placebo).
Cancer Nursing: Sublingual compared with swallowed morphine (Dyal and others, 2021; read 2026-10-14: 10 people, similar blood levels and relief; under the tongue for those who cannot swallow).
Journal of Pain and Symptom Management: A handheld fan for breathlessness (Galbraith and others, 2010; read 2026-10-14: 50-person crossover trial).
Cochrane: Opioids for refractory breathlessness (Barnes and others, 2016; read 2026-10-14: 26 small trials, low-quality evidence of benefit by mouth or injection, none for nebulized).
Journal of Pain and Symptom Management: Oxygen near death (Campbell and others, 2013; read 2026-10-14: dying patients without distress at the start; 91% showed no change in comfort when oxygen was stopped or swapped for air; routine oxygen not supported).
Journal of Pain and Symptom Management: Sublingual atropine for death rattle (Heisler and others, 2013, run by Hospice of the Valley; read 2026-10-14: 137 patients; improved in 37.8% on atropine against 41.3% on placebo, no difference).
DailyMed: atropine sulfate ophthalmic 1% label (Alcon: eye-only uses, so mouth use is off-label).
DailyMed: glycopyrrolate tablets label (Par: "not recommended in geriatric patients").
DailyMed: scopolamine transdermal label (Padagis, 2025-11-17: confusion and hallucinations in older people; overheating, including a fatal case).
Cochrane: Interventions for noisy breathing near death (Wee and Hillier, 2008; read 2026-10-14: no intervention shown better than placebo).
JAMA: The SILENCE trial (van Esch and others, 2021; read 2026-10-14: scopolamine butylbromide given before a rattle began, 13% against 27%; DailyMed searched the same day lists no human US label).
New England Journal of Medicine: The clinical course of advanced dementia (Mitchell and others, 2009; read 2026-10-14: over 18 months, fever 52.6%, pneumonia 41.1%).
Archives of Internal Medicine: Pneumonia treatment in advanced dementia (Givens and others, 2010; read 2026-10-14: antibiotics linked with longer survival but not better comfort).
VNS Health: Hospice comfort pack (read 2026-10-14: one nonprofit's kit list and uses; use only when the nurse or doctor says; storage).
DailyMed: lorazepam tablets label (ANI, 2026-07-15: anxiety indication; sedation and unsteadiness rise with age; boxed warning with opioids).
JAMA Network Open: Psychotropic starts after hospice enrollment in nursing home residents with dementia (Gerlach and others, 2025, full text PMC12522007; read 2026-10-14: 13.4% started an antipsychotic; 47.8% started a benzodiazepine, median 3 days after enrollment; higher 180-day mortality, observational, possible confounding by severity).
DailyMed: haloperidol tablets label (Upsher-Smith, 2026-08-05: not approved for dementia-related psychosis; boxed warning for increased death in older people with dementia).
JAMA Internal Medicine: Risperidone or haloperidol for delirium in palliative care (Agar and others, 2017; read 2026-10-14: 247 patients, mostly cancer; worse than placebo with treatment of causes; haloperidol linked with shorter survival).
JAMA: Lorazepam added to haloperidol for agitated delirium in the last days (Hui and others, 2017; read 2026-10-14: advanced cancer; caregivers rated their person comfortable 84% against 37%).
Lewy Body Dementia Association: When to consider antipsychotic medications in LBD, and the fourth DLB consensus report (McKeith and others, 2017; both read 2026-10-14: haloperidol and other typical antipsychotics should not be prescribed; quetiapine or clozapine preferred when a drug is needed; quetiapine's small trial negative).
DailyMed: Seroquel (quetiapine) label (revised 04/2025; read 2026-10-14: no approved use in dementia; boxed warning; receptor binding that makes low doses mainly antihistamine; falls, dizziness on standing, swallowing problems).
Cochrane: Antipsychotics for agitation and psychosis in dementia (Mühlbauer and others, 2021: slight effect on agitation, negligible on psychosis, more sleepiness; sedation in severe situations to be discussed openly), with drug treatments for sleep problems in dementia (McCleery and Sharpley, 2020: no quetiapine trial), CATIE-AD (2006) and Ballard and others (2005: faster cognitive decline). All read 2026-10-14.
JAMA Psychiatry: Antipsychotics and mortality in dementia (Maust and others, 2015: quetiapine about 1 extra death per 50 treated over 180 days), with Kales and others, 2012 and Huybrechts and others, 2012 (lower risk than risperidone). All read 2026-10-14.
BMJ: Antipsychotic use and adverse outcomes in dementia (Mok and others, 2024: pneumonia, stroke, fractures), and Drugs and Aging: low-dose quetiapine for insomnia in older adults (Hui and others, 2025: more falls than trazodone). Both read 2026-10-14.
American Psychiatric Association: Patient and caregiver guide to antipsychotics in dementia (read 2026-10-14: severe, dangerous or distressing symptoms only; start low; check at 4 weeks).
Medicaid: NADAC drug acquisition costs (effective 2026-09-23, queried 2026-10-14: generic quetiapine 25 mg about 2 cents a tablet).
Journal of Palliative Medicine: Hospice medication kits (Bishop and others, 2009; read 2026-10-14: kits vary; 86% of hospices said kits often avoided ER or hospital trips), with Walker and McPherson, 2010.
American Academy of Hospice and Palliative Medicine: Statement on palliative sedation (2014, not updated; read 2026-10-14: the definition, last resort, proportionate, intent to relieve, "usually does not alter the timing or mechanism" of death, not irreversible in all cases).
Palliative Medicine: Revised European framework on palliative sedation (Surges and others, 2024; read 2026-10-14: lowest dose keeping interaction, intermittent before continuous, planned pauses, midazolam first).
Journal of Clinical Oncology: Palliative sedation and survival (Maltoni and others, 2012; read 2026-10-14: cancer patients only, no randomized trials; 1,807 patients, no shorter survival; delirium the commonest reason, median 57%).
JAMDA: Continuous palliative sedation in nursing home residents with dementia (Veldwijk-Rouwenhorst and others, 2021; read 2026-10-14: 3 residents, qualitative).
Alzheimer's Association: End-of-life decisions (2022; read 2026-10-14: withholding or withdrawing treatment "is not assisted suicide").
Catechism of the Catholic Church: paragraphs 2278 to 2279 (read 2026-10-14: pain relief for the dying at the risk of shortening their days, when death is "not willed as either an end or a means").
eCFR: 42 CFR 418.106 (the hospice provides drugs for the terminal illness; no section requires a kit by name).

Where care happens: home or a facility

CareScout: Cost of Care Survey 2025 and its median cost tables (released 2026-03-02; read 2026-10-14, Phoenix metro figures, not Arizona statewide: Phoenix aide $38 an hour, $7,245 a month at 44 hours a week; assisted living $6,000; nursing home $9,003 shared and $12,167 private; Arizona adult day $95 a day. The $27,700 round-the-clock figure is our arithmetic).
Medicare: Long-term care (read 2026-10-14: "Medicare doesn't pay for long-term care," also called custodial care).
Medicare: Skilled nursing facility care (read 2026-10-14: 3 inpatient days in a row, observation and ER time do not count, about 30 days to enter, 100 days; 2026: $1,736 deductible, $217 a day for days 21 to 100; some plans waive the 3-day rule).
Medicare: Inpatient mental health care (read 2026-10-14: 190 lifetime days in a psychiatric hospital; 2026 $1,736 deductible and $434 a day for days 61 to 90).
Medicare: Home health services (read 2026-10-14: skilled visits at $0; not 24-hour or custodial-only care).
Medicare: Hospice care and the Medicare Hospice Benefits booklet (read 2026-10-14: hospice wherever they live; no room and board except short inpatient or respite stays the team arranges).
CMS: Medicare Benefit Policy Manual, chapter 9 (Rev. 13664, 2026-03-05: inpatient level for symptoms that cannot be managed elsewhere; respite day 6 and room and board; Medicaid pays room and board through the hospice in a nursing facility).
Arizona law: A.R.S. 36-401 (read 2026-10-14: assisted living homes of 10 or fewer and centers of 11 or more; the directed care definition).
Arizona Administrative Code, assisted living personal care and directed care rules, R9-10-814 and R9-10-815 (read on a Cornell Law School copy and, on October 20, 2026, on the Department of Health Services' copy of the rules: the bed or chair and stage 3 or 4 pressure sore limits, and the exception when a doctor examines the resident and signs that the home can meet the resident's needs).
Arizona Department of Health Services: memory care training bulletin (2025-07-01; read 2026-10-14: all staff in directed care facilities must complete state-approved training).
Arizona Department of Health Services: AZ Care Check (read 2026-10-14: license history, deficiencies and enforcement; licensing 602-542-1025).
AHCCCS: ALTCS (read 2026-10-14: "at little or no cost," members live at home or in assisted living, apply through Health-e-Arizona Plus).
AHCCCS: ALTCS services and benefits (2025-08-11; read 2026-10-14: "about 45 days," 888-621-6880, what to bring to the PAS interview).
AHCCCS: Eligibility requirements (February 2026; read 2026-10-14: income $2,982 a month, resources $2,000, share of cost, estate recovery after 55), with Eligibility Policy Manual section MA615.
AHCCCS Eligibility Policy Manual section MA707, with the CMS 2026 spousal standards bulletin (2026-04-27; read 2026-10-14: the spouse at home keeps half of countable resources, $32,532 to $162,660, and an income allowance of $2,705 to $4,066.50).
AHCCCS Eligibility Policy Manual sections 901 and 903 (read 2026-10-14: 60-month look-back, limited services during a penalty period, transfers of $1,500 or less a month do not count).
AHCCCS Eligibility Policy Manual sections 1001 and 1003 (rev. 2026-06-09; read 2026-10-14: the PAS by a nurse or social worker in person, by phone or video; 60 points for older adults; dementia weighted 20; behavior and orientation items).
AHCCCS fee-for-service provider billing manual, chapter 21 (rev. 2026-05-04; read 2026-10-14: ALTCS services at home, assisted living services except room and board, respite up to 600 hours a year, a spouse paid for up to 40 hours a week of attendant care).
AHCCCS: Trusts and ALTCS eligibility quick reference (rev. April 2026; read 2026-10-14: income-only trusts, recovery at death).
CMS: GUIDE Model and GUIDE FAQ (read 2026-10-14: up to $2,500 a year for respite; memory care unit residents not eligible since July 2026; assisted living residents get no GUIDE respite).
Banner Health: Dementia Care Partners and Hospice of the Valley: Supportive Care for Dementia (read 2026-10-14: Phoenix-area GUIDE programs, 623-832-6500 option 6 and 602-636-6363).
Hospice of the Valley: Locations (read 2026-10-14: nine inpatient care homes, 602-530-6900).
HonorHealth: Generations Behavioral Health Unit (read 2026-10-14: Mesa, 55 and older, dementia behaviors, typical stay 10 to 14 days, 480-358-6630).
Banner Health: Inpatient behavioral health admissions and Banner Del E. Webb behavioral health (read 2026-10-14: most stays 3 to 7 days; Banner's general Phoenix Valley Help Line, 480-448-7511, gives a free phone assessment; Del E. Webb confirms inpatient geriatric psychiatry; 911 or 988 in danger).
VA: Long-term care, respite care and Aid and Attendance (read 2026-10-14: home help, adult day, respite, nursing home care; the pension add-on).
Medical Care: Predictors of nursing home admission in dementia (Gaugler and others, 2009; read 2026-10-14: severity, daily-care dependence, behavior and depression; caregiver stress and feeling trapped; incontinence not consistent).
Journal of Geriatric Psychiatry and Neurology: Sleep problems and institutionalization of the elderly (Pollak and Perlick, 1991; read 2026-10-14: 70% named night problems).
JAMA: Caregiving as a risk factor for mortality (Schulz and Beach, 1999; read 2026-10-14: strained spouse caregivers, 63% higher mortality).
Neurology: Improving caregiver well-being delays nursing home placement (Mittelman and others, 2006; read 2026-10-14: a median of 557 days later, 28.3% lower placement rate).
Area Agency on Aging, Region One: aaaphx.org (read 2026-10-14: 24-hour Senior HELP LINE 602-264-4357; benefits and legal help; the ombudsman program).
Alliance for Care at Home (CaringInfo): The difference between palliative care and hospice care (read 2026-10-14: day-to-day care at home is still given by family or paid aides).
CMS: National Partnership antipsychotic data report (through 2025 Q2: 14.2% of long-stay residents), with CMS Provider Data Catalog MDS quality measure 481 (2025 Q2 to 2026 Q1, queried 2026-10-14: the middle half of homes run 7.8% to 20.4%; our computation); assisted living has no federal measure.
Sedation in nursing homes: CMS, National Partnership antipsychotic data report (14.2% of long-stay residents in 2025 Q2, from 23.9% in 2011 Q4; facility spread computed from CMS provider data, middle half 7.8% to 20.4%). Federal rule: 42 CFR 483.12 and 483.45 (no chemical restraint for discipline or convenience). All re-checked 2026-10-14.

Paying for care

Medicare: Medicare costs, 2026 (read 2026-10-14: Part B deductible $283, then usually 20%).
Medicare: Cognitive assessment and care plan services and CMS: Cognitive assessment (read 2026-10-14: code 99483 covered under Part B with the deductible and 20%; about 60 minutes with an independent historian present).
Medicare: Home health services (read 2026-10-14: skilled visits for homebound people at $0; not 24-hour or custodial-only care).
Medicare: Skilled nursing facility care (read 2026-10-14: after 3 inpatient days in a row, up to 100 days a benefit period).
Medicare: Hospice care (read 2026-10-14: $0 for hospice care, up to $5 a prescription, room and board not covered).
Medicare: Long-term care (read 2026-10-14: "Medicare doesn't pay for long-term care"; Medigap does not either).
CMS: GUIDE Model and GUIDE FAQ (read 2026-10-14: Original Medicare only, not Medicare Advantage; up to $2,500 a year of respite with no cost sharing; care navigator and 24/7 line; electing hospice ends eligibility; not for long-term nursing home residents or, since July 2026, memory care units; assisted living residents get no respite).
CMS: GUIDE participant list (last updated August 2026; read 2026-10-14: Banner Alzheimer's Institute, 623-832-6500, among the Arizona programs) and Hospice of the Valley: GUIDE (read 2026-10-14: Supportive Care for Dementia, 602-636-6363).
VA: Veterans Pension rates and Survivors Pension rates (effective 2025-12-01; read 2026-10-14: Aid and Attendance maximums $29,093 for a veteran alone, $34,488 with a spouse, $18,697 for a surviving spouse with no child; VA pays the difference between countable income and the limit; net worth limit $163,699 through 2026-11-30. The monthly figure is our arithmetic).
VA: Aid and Attendance and Housebound and Pension eligibility (read 2026-10-14: wartime service, age 65 or older or a disability; net worth leaves out the home, car and basic household goods; forms 21P-527EZ and 21-2680).
Code of Federal Regulations: 38 CFR 3.276 and 38 CFR 3.278 in the same subpart (read 2026-10-14 via the eCFR API: a 36-month look-back with a penalty of up to 5 years; paid in-home care counts as a medical expense when a physician, PA, NP or CNS states in writing that a cognitive disorder means they need it; facility meals and lodging can count).
VA: Get help from an accredited representative (read 2026-10-14: help from an accredited VSO representative is "always free").
VA Office of Inspector General: Pension poaching fraud alert (June 2025; read 2026-10-14: upfront fees or a percentage of the award, pressure to move assets into trusts or buy annuities to qualify).
VA: Veteran-Directed Care and Respite care (read 2026-10-14: a services budget whose workers "might include their own family member or neighbor"; services vary by location; respite for enrolled veterans who meet clinical criteria).
IRS: Publication 502, Medical and Dental Expenses (2025 edition; read 2026-10-14: qualified long-term care services for the chronically ill, including "substantial supervision" due to severe cognitive impairment, under a plan of care; nursing-type care by aides, not housework; a nursing home in full when medical care is the principal reason; a parent's medical costs when only their income stops you claiming them; the 7.5% floor; itemizing).
IRS: Revenue Procedure 2025-32 (read 2026-10-14: 2026 long-term care premium limits $4,960 at 61 to 70 and $6,200 over 70; per-day benefits tax-free up to $430; standard deduction $32,200 married filing jointly, $16,100 single).
IRS: Publication 503, Child and Dependent Care Expenses (2025 edition) and the draft 2026 Form 2441 instructions (read 2026-10-14: a spouse or dependent not able to care for themselves who lived with you more than half the year; the care lets you work or look for work; for 2026, up to 50% of up to $3,000 of costs for one person; payments to your spouse or a dependent do not count).
NAIC: A Shopper's Guide to Long-Term Care Insurance (read 2026-10-14: cognitive impairment as its own trigger; waiting periods of 20, 30, 60, 90 or 100 days; family care usually not paid; naming a third person for lapse notices; waiver of premium).
Arizona Administrative Code R20-6-1020 and R20-6-1005 (Cornell Law School copies; read 2026-10-14: for cognitive impairment an insurer may require no more than "supervision or verbal cueing by another person"; a policy lapsed through cognitive impairment is reinstated if asked within five months, with back premium).
AHCCCS: DE-800 (rev. 04/2026; read 2026-10-14: a qualified Arizona Partnership policy, bought on or after 2008-07-01, gives an asset disregard equal to what it paid, also shielded from estate recovery).
IRS: Publication 525, Taxable and Nontaxable Income (read 2026-10-14: long-term care benefits and accelerated death benefits excludable for the terminally or chronically ill, per-day amounts up to the limit).
NAIC: Consumer guide to life settlements and Arizona law A.R.S. 20-3211 (read 2026-10-14: settlements pay less than the death benefit, can affect Medicaid, and share medical details; Arizona owners may cancel within 15 days by paying the money back).
AHCCCS: DE-817, community spouse (rev. 06/2026; read 2026-10-14: the spouse's share is set from the couple's savings in the first month of long-term care; life insurance cash values count).
CFPB: Reverse mortgages, what one costs, moving to a nursing home or assisted living, who can live in the home and the discussion guide (2021 edition), with HUD Mortgagee Letter 2017-12 (read 2026-10-14: age 62 and over; counseling required, HUD counselor line 800-569-4287; origination "$6,000 or less," 2% upfront and 0.5% yearly mortgage insurance; due after more than 12 months in a facility with no co-borrower at home; an Eligible Non-Borrowing Spouse "can be difficult"; contractor warnings).
Lady Bird deeds: Vermont Enhanced Life Estate Deed Act, Michigan Bar Journal "Ladybird Deeds" (June 2016), Texas A&M AgriLife Texas Ag Law blog (2019) and Texas HHS I-3100 (read 2026-10-14: Vermont by statute; Michigan by title standards; Texas by case law; the method is common in Florida deeds; no Arizona statute names one).
Arizona law: A.R.S. 33-405, beneficiary deeds (read 2026-10-14: passes at death subject to liens; valid only if recorded before death; revocable; the beneficiary need not sign or be told).
AHCCCS: DE-810, estate recovery (rev. 07/2026) and the estate recovery overview (read 2026-10-14: members 55 and older; claims only against property subject to probate or a small estate affidavit; the monthly capitation "can exceed $8,900," owed even in months without services; families at home told to weigh private pay, and members may withdraw; a lien after 90 or more days in a facility with no return expected; a lien may also be recorded after death; no recovery while a spouse, a child under 21, or a blind or disabled child survives; waiver applications within 30 days; 602-345-1466).
Arizona law: A.R.S. 14-6102 (read 2026-10-14: nonprobate transferees, including beneficiary-deed recipients, can be pursued for allowed claims the probate estate cannot pay, within two years of death).
AHCCCS: DE-818, ALTCS policies on transfers (rev. 02/2024; read 2026-10-14: changing a deed is a transfer; a 60-month look-back; no penalty for transfers to a spouse or disabled child; the $150,000 home, $5,000 rate, 30-month example).
Tax basis: 26 U.S.C. 1014 and IRS Publication 551 (rev. December 2025; read 2026-10-14: inherited property takes its value at death; a gift keeps the giver's basis. The $90,000 and $400,000 example is our arithmetic).
AHCCCS Medical Policy Manual: 1240-A (effective 2025-10-01) and 1320-A (read 2026-10-14: paid family members include adult children, grandchildren, siblings and in-laws; a spouse up to 40 hours in seven days, through a contracted agency, for extraordinary care, paid no more than others; no spouse pay under self-directed attendant care).
Arizona DES: Family caregiver support (read 2026-10-14 in a browser: DES "does not offer any type of program or service by which a caregiver will be paid"; the route is ALTCS, then work for a contracted agency; Family Caregiver Support respite needs help with two daily activities, supervision included, and a caregiver risk assessment; Lifespan Respite pays back a worker who is not the spouse, child, parent, guardian or anyone in the home, for a caregiver living full time with someone who cannot be left alone, 888-737-7494).
Area Agency on Aging, Region One: Family caregiver support and Benefits assistance (read 2026-10-14: 24-Hour Senior HELP LINE 602-264-4357; Friends and Neighbors respite, where caregivers choose their own worker and are paid back; Certified Medicare Counselors).
National PACE Association: Find a PACE program and its "PACE in the States" (September 2026), with AHCCCS's FY2024 waiver report (read 2026-10-14: Arizona listed among states without PACE; AHCCCS funded an evaluation of adding it).
Arizona DES: Medicare assistance (SHIP) and shiphelp.org, Arizona (read 2026-10-14: 1-800-432-4040, free, not affiliated with the insurance industry).
Arizona Senior Citizens Law Project: asclp.org (read 2026-10-14: free legal help at 60 and over in Maricopa County, no income guidelines; new requests 602-252-6710, Tuesdays 10 a.m. to 1 p.m.).
Community Legal Services: clsaz.org (read 2026-10-14: free civil legal help for those who cannot afford it, AHCCCS issues included; 602-258-3434, intake 9 a.m. to 2 p.m. weekdays; 800-852-9075).

Toileting and hygiene

Alzheimer's Society (UK): Tips to prevent UTIs in people with dementia (read 2026-10-01; no review date shown. Wipe and wash front to back after the toilet, so bacteria do not reach the bladder. Corrected on the "A toilet accident" card the same day: it said back to front).

Sleep: the day after a bad night

National Institute on Aging: Sleep and older adults (reviewed 2025-02-06; read 2026-10-01. Poor sleep can make dementia symptoms worse; caffeine late in the day; big meals and drinks before bed; rugs and cords).
National Institute on Aging: Coping with agitation, aggression, and sundowning (reviewed 2024-07-17; read 2026-10-01. Too little sleep, being pushed to bathe, noise and crowds as causes of agitation; a snack or drink to calm. The same page as the older link in "Behavior, agitation & sundowning" above).
National Institute on Aging: Managing sleep problems in Alzheimer's disease (reviewed 2024-07-11; read 2026-10-01. Limit late naps; the same wake and bed times; a cool, low-lit bedroom; avoid caffeine and alcohol).
US Department of Veterans Affairs: Dementia caregiver support: sleep, illness and pain (updated 2026-08-03; read 2026-10-01. "Rest without sleep"; the signs of delirium, including the quiet, sleepy kind; dehydration; no sleep pills or tranquilizers during delirium; nightlight shadows; screens off during night waking).
NICE (UK): Delirium: prevention, diagnosis and management (CG103) (published 2010-07-28, updated 2023-01-18; read 2026-10-01. Sudden onset, swings through the day, much more alert or much sleepier than usual; poor sleep as a sign. Written for hospitals and care homes).
NHS (UK): Sudden confusion (delirium) (reviewed 2024-05-28; read 2026-10-01. Infection, a new medicine and a fall as causes; sudden confusion is urgent. Its emergency numbers are the UK's).
JMIR Aging: Sleep patterns and dementia symptoms, day by day (Cho and others, published 2026-03-23; read 2026-10-01. 154 people tracked for 14 days: more night waking came before more irritability the next day, and some daytime symptoms came before worse sleep. One observational study).
Archives of Internal Medicine: Measured sleep and the risk of falls in older women (Stone and others, 2008; read 2026-10-01. Five hours or less a night raised the odds of repeated falls in women aged 70 and up. Not a dementia sample).
American Journal of Alzheimer's Disease and Other Dementias: Sleep quality and the risk of falls in dementia (Eshkoor and others, published 2013-05-22; read 2026-10-01. Poor sleep linked to falls in 1,210 people with dementia; a link, not proof).
Journal of Applied Gerontology: Poor sleep and risk of falls in older adults: a systematic review (Min and Slattum, published 2016-12-20; read 2026-10-01. The overall picture is mixed; no study measured falls the day after one bad night).
CDC NIOSH: Napping and sleep inertia (reviewed 2020-03-31; read 2026-10-01. A 15 to 20 minute nap can improve alertness; grogginess usually lasts up to about 30 minutes; caffeine on waking. Written for shift workers, applied here to carers).
CDC NIOSH: Driving: preventing crashes (reviewed 2020-03-31; read 2026-10-01. Window-down and radio-up tricks are not supported; almost 60% of people who fell asleep driving were on trips under an hour).

Sleep options, medicines and supplements

Science: Sleep drives metabolite clearance from the adult brain (Xie et al., 2013, PMID 24136970. In mice, sleep widened the space between brain cells by 60% and sped the clearance of amyloid: the "brain cleans house" line on the sleep page and the ReCODE guide).
PNAS: β-Amyloid accumulation in the human brain after one night of sleep deprivation (Shokri-Kojori et al., 2018, PMID 29632177. 20 healthy adults; amyloid rose in the hippocampus and thalamus).
Nature Communications: Association of sleep duration in middle and old age with incidence of dementia (Sabia et al., 2021, PMID 33879784. 7,959 people over 25 years; persistent short sleep linked to a 30% higher dementia risk).
BMJ: Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits (Glass et al., 2005, PMID 16284208. 24 trials, 2,417 people over 60: about 25 more minutes of sleep, adverse cognitive events 4.78 times as common).
Cell: Norepinephrine-mediated slow vasomotion drives glymphatic clearance during sleep (Hauglund et al., 2025, PMID 39788123. In mice, the sleep aid zolpidem suppressed the brain's overnight clearance).
Cochrane Library: Non-drug treatments for sleep problems in dementia (Wilfling and others, published 2023-01-03; read 2026-10-01. Activity and carer programs may modestly help night sleep, low certainty; the one trial of cutting daytime sleep found little change. Mostly US nursing-home trials).
The Lancet Healthy Longevity: DREAMS START versus usual care (Rapaport and others, October 2024; read 2026-10-01. Six one-hour carer sessions lowered sleep disturbance at 8 months in 377 families in England. Publicly funded; the developers evaluated their own program).
Journal of the American Geriatrics Society: NITE-AD: a nighttime insomnia program for Alzheimer's (McCurry and others, 2005; read 2026-10-01. Sleep habits, a daily walk, light and carer skills cut night waking in 36 families. Small).
NICE (UK): Dementia: assessment, management and support (NG97) (published 2018-06-20; read 2026-10-01. A personal mix of sleep habits, daylight and exercise; do not offer melatonin for insomnia in Alzheimer's; antipsychotics only for severe distress or risk of harm).
Cochrane Library: Drug treatments for sleep problems in dementia (McCleery and Sharpley, published 2020-11-15; read 2026-10-01. Melatonin: little or no effect; trazodone: one small trial; orexin blockers: about 28 more minutes a night; no trials of benzodiazepines or Z-drugs in dementia).
American Academy of Sleep Medicine: Guideline for circadian rhythm sleep-wake disorders, 2015 update (published 2015-10-15; read 2026-10-01. Weakly against melatonin, weakly for light therapy, and strongly against sleep medicines, for older people with dementia and irregular sleep. Over ten years old; no update found).
American Academy of Sleep Medicine: Management of REM sleep behavior disorder (Howell and others, April 2023; read 2026-10-01. A conditional role for melatonin, and for clonazepam, when people act out their dreams).
Alzheimer's Society (UK): Sleep problems and treatments for people with dementia (no date shown; read 2026-10-01. Memory medicines that can cause insomnia; melatonin for acting out dreams; common physical causes of poor sleep).
Alzheimer's Society (UK): How to support someone with dementia to sleep better at night (no date shown; read 2026-10-01. Morning daylight; caffeine-free drinks from lunchtime; a bedroom of about 18°C).
Alzheimer's Association: "Sleep issues and sundowning", already listed above (no date shown; re-read 2026-10-01. Morning or early-afternoon appointments and bathing; avoid alcohol, caffeine and nicotine; lights on before dusk).
American Geriatrics Society: 2023 Beers Criteria, the list of medicines to avoid in older adults (published 2023; table read 2026-10-01 from the UConn copy. Avoid diphenhydramine and doxylamine, benzodiazepines and Z-drugs; caution with mirtazapine; antipsychotics only when other steps fail).
DailyMed (US National Library of Medicine): labels for Tylenol PM, Advil PM, ZzzQuil and Unisom (labels dated 2026; read 2026-10-01. Which "PM" products contain diphenhydramine and which contain doxylamine, including Unisom SleepTabs versus SleepGels).
DailyMed: Belsomra (suvorexant) label (Merck, revised March 2025; read 2026-10-01. The 285-person Alzheimer's trial; falls 2% versus 0%; next-day drowsiness and sleepwalking-type behavior. The trial was the maker's own).
DailyMed: Dayvigo (lemborexant) label (Eisai, revised February 2025; read 2026-10-01. Higher fall risk in older people; no dementia content).
Journal of Prevention of Alzheimer's Disease: Lemborexant in Alzheimer's with irregular sleep (Moline and others, 2021; read 2026-10-01. One exploratory trial in 62 people; preliminary only).
DailyMed: Seroquel (quetiapine) label, boxed warning (revised April 2025; read 2026-10-01. Higher risk of death in older people with dementia treated with antipsychotics; not approved for dementia-related psychosis).
DailyMed: Aricept (donepezil) label (Eisai, revised December 2021; read 2026-10-01. Insomnia and abnormal dreams as side effects; the label directs evening dosing).
Journal of the American Geriatrics Society: Low-dose trazodone, benzodiazepines and fall injuries in nursing homes (Bronskill and others, published 2018-09-24; read 2026-10-01. New trazodone users had fall injuries as often as new benzodiazepine users. Observational, Ontario).
Psychogeriatrics: Mirtazapine does not improve sleep in Alzheimer's disease (Scoralick and others, published 2016-01-27; read 2026-10-01. A 24-person pilot: no better night sleep, more daytime sleepiness).
BMC Medicine: Harms of Z-drugs for sleep in people with dementia (Richardson and others, published 2020-11-24; read 2026-10-01. Higher-strength use linked to more fractures, falls and stroke in 27,090 people in England. A link, not proof of cause).
Cochrane Library: Light therapy in dementia (Forbes and others, published 2014-02-26; read 2026-10-01. No clear effect on sleep, agitation or thinking).
American Journal of Alzheimer's Disease and Other Dementias: Light therapy for sleep, agitation and depression in dementia (Fong and others, 2023; read 2026-10-01. Slightly fewer night awakenings, pooled from 4 of its 11 trials; no change in time awake, agitation or depression).
Journal of Applied Gerontology: A weighted blanket for people living with dementia (Harris and Titler, published 2022-06-24; read 2026-10-01. A 21-family feasibility study with no comparison group).
Frontiers in Sleep: A weighted blanket after brain injury (Edwards, published 2024-01-24; read 2026-10-01. A 10-person pilot stopped early: patients found the blanket hot, heavy and uncomfortable. Not a dementia study).
National Council on Aging: Best weighted blankets 2026 (dated 2026-09-24; read 2026-10-01. The safety advice, and the $160 to $280 range for the models it tested. The review earns shop commissions).
Sleep Medicine Reviews: Noise as a sleep aid: a systematic review (Riedy and others, published 2020-09-09; read 2026-10-01. Very low evidence that steady noise helps sleep; it may disturb sleep and hearing. Not a dementia study).

Sleep: the two-week plan

Journal of the American Geriatrics Society: Training caregivers to change sleep habits in dementia (NITE-AD) (McCurry and others, 2003, PMID 14511168; read 2026-10-14. Carers given written tips alone kept a steady rising time on 59% of days and a daily walk on 7%; coached carers, 96% and 86%. Small; the developers tested their own program).
Journal of the American Geriatrics Society: Walking and bright light for sleep in Alzheimer's at home (McCurry and others, 2011; full text read 2026-10-14. 132 people: a 30-minute daily walk, a light box at about 2,500 lux for 1 hour in the 2 hours before bed, or both, gave 33, 39 and 40 fewer minutes awake a night at 2 months. Gains gone by 6 months; 4 or more days a week predicted benefit).
Journal of the American Geriatrics Society: Care2Sleep: a sleep program for people with dementia and their carers (Song and others, 2024; full text read 2026-10-14. Set bed and rise times, with 30 minutes either way counted as on time; naps of 30 minutes or less unless a set nap habit; gentle sleep compression. 30 pairs; 14 fewer minutes awake, not significant in a pilot).
Psychology and Aging: Evidence-based psychological treatments for insomnia in older adults (McCurry and others, 2007, PMID 17385979; read 2026-10-14. Sleep restriction and compression meet evidence-based criteria in older adults).
Sleep Health: National Sleep Foundation sleep duration recommendations (Hirshkowitz and others, 2015, PMID 29073412; read 2026-10-14. About 7 to 8 hours for adults over 65).
Journal of Clinical Sleep Medicine: Behavioral and psychological treatments for chronic insomnia, AASM guideline (Edinger and others, 2021; full text read 2026-10-14. Early daytime sleepiness with sleep restriction, usually fading; care with poorly controlled seizures, mania risk or heavy daytime sleepiness; conditional support for leaving the bed when sleep won't come. Adults, not dementia).
Annals of Neurology: Body-clock neurons and rest-activity rhythms in Alzheimer's (Wang and others, 2015, PMID 25921596; read 2026-10-14. Alzheimer's linked to a later body clock than healthy ageing).
Journal of the American Geriatrics Society: Timed bright light for early waking in older adults (Campbell and others, 1993, PMID 8340561; dose and results read 2026-10-14 in the AASM 2015 guideline. 16 early wakers averaging 70: 2 hours of bright light between 8 and 11pm for 12 days moved the clock about 2 hours 21 minutes later and added 51 minutes of sleep. Small).
PLOS Biology: Recommendations for daytime, evening and nighttime indoor light (Brown and others, 2022; full text read 2026-10-14. Indoor light is usually at least ten times dimmer than outdoors; older eyes pass less light; night light caps of about 1 lux in bed. Consensus for healthy adults 18 to 55).
British Journal of Ophthalmology: Circadian photoreception: ageing and the eye (Turner and Mainster, 2008, PMID 18757473; read 2026-10-14. The ageing lens and pupil cut the light signal that reaches the body clock).
Experimental Gerontology: Dawn and dusk simulation in older people with dementia (Fontana Gasio and others, 2003, PMID 12543279; read 2026-10-14. 13 people with advanced dementia: the main sleep moved earlier. Very small, very low certainty).
Journal of the American Geriatrics Society: Activity, daylight and routine for day and night sleep in nursing homes (Alessi and others, 2005, PMID 15877555; read 2026-10-14. 118 residents: daytime sleep fell from 32% to 21% of checks; night sleep barely changed).
Journal of the American Geriatrics Society: Individualized social activity and sleep in nursing homes (Richards and others, 2005, PMID 16137280; read 2026-10-14. 1 to 2 hours a day of activity matched to past interests: less daytime sleep, and the poorest sleepers slept better at night).
American Journal of Clinical Nutrition: Caffeine in elderly men (Trang and others, 1982, PMID 7064899; read 2026-10-14. Caffeine half-life about 4.6 hours in men aged 66 to 86. Small, men only).
US Food and Drug Administration: Spilling the beans: how much caffeine is too much? (content current as of 2024-08-28; read 2026-10-14. Caffeine in tea, cola and chocolate; decaf still has some; some over-the-counter medicines contain it).
DailyMed: Excedrin Extra Strength label (Haleon, dated 2024-04-23; read 2026-10-14. 65 mg caffeine per caplet; a dose has about as much caffeine as a cup of coffee).
Alcoholism: Clinical and Experimental Research: Alcohol and sleep: effects on normal sleep (Ebrahim and others, 2013, PMID 23347102; read 2026-10-14. At every dose, sleep comes sooner, then the second half of the night is disrupted).
National Institute on Alcohol Abuse and Alcoholism: Older adults (updated December 2025; read 2026-10-14 through a summary tool. Higher blood alcohol from the same drink, more falls and medicine interactions; drinking to sleep can make sleep worse).
Chronobiology International: The daily rhythm of agitation in nursing-home residents with Alzheimer's (Martin and others, 2000, PMID 10841213; read 2026-10-14. 85 residents: agitation peaked on average at 2:38pm; only 2 were evening-only sundowners).
Alzheimer Society of B.C.: Late-day confusion ("sundowning") handout (October 2020; read 2026-10-14. Naps of about 30 minutes; a simple job at the usual restless time; lamps on early and curtains closed at dusk; hunger can pass for sundowning; calm reassurance; log what came before. Charity consensus tips).
Journal of Clinical Endocrinology and Metabolism: Room light before bedtime suppresses melatonin (Gooley and others, 2011, PMID 21193540; read 2026-10-14. Ordinary room light before and during sleep hours held back melatonin. Young adults).
Cognitive and Behavioral Neurology: Feelings without memory in Alzheimer's disease (Guzmán-Vélez and others, 2014, PMID 25237742; read 2026-10-14. 17 patients stayed sad for over 30 minutes after a sad film they could no longer recall. Small).
Cochrane Library: Simulated presence therapy for dementia (Abraha and others, 2017, PMID 28418586; read 2026-10-14. Recorded family voices: three small nursing-home trials, mixed results, very low certainty. A 2020 update was not opened).
National Institute on Aging: Home safety and Alzheimer's disease (reviewed 2024-08-02; read 2026-10-14. Mirror images may confuse a person with Alzheimer's).

Sleep: why they are awake

Interior Health (Canada): Pain Assessment in Advanced Dementia (PAINAD) scale (the form, from Warden and others, 2003; read 2026-10-14. Five signs scored 0 to 2 over 5 minutes; 1 to 3 mild, 4 to 6 moderate, 7 to 10 moderate to severe).
BMJ: Treating pain to reduce agitation in nursing-home residents with dementia (Husebo and others, 2011, PMID 21765198; full text read 2026-10-14. 352 residents: stepped pain treatment, mostly regular acetaminophen, cut agitation by 17%; agitation rose again when it stopped).
International Journal of Geriatric Psychiatry and Frontiers in Psychology: pain treatment and sleep in nursing-home residents with dementia, at 1 week and at 13 weeks (Blytt and others, 2018; read 2026-10-14. Placebo-controlled, 106 residents: better sleep at 1 week, no difference at 13).
PubMed: Pain and measured sleep in nursing-home residents (Blytt and others, 2021, PMID 33959072; read 2026-10-14. 141 residents: those with pain slept more on wrist monitors. Observational).
DailyMed: Tylenol 8 HR Arthritis Pain label and Tylenol Regular Strength label (read 2026-10-14. The 8-hour form every 8 hours, swallowed whole, never crushed; regular strength every 4 to 6 hours).
MedlinePlus: Acetaminophen (read 2026-10-14. No more than 4,000 mg a day from all sources).
NHS (UK): Constipation (read 2026-10-14. Easily missed in dementia, where a change in behavior can be the sign; feet on a low stool).
PubMed: Bowel training and toilet posture for care-home residents with dementia (Naito and others, 2023, PMID 36066478; read 2026-10-14. 30 residents: complete bowel movements rose from 0.53 to 1.58 a week, and behavior and carer distress improved. Small).
American Family Physician: Nocturia (2025, PMID 40531150; full text read 2026-10-14. Night urination comes from too much urine at night, a small or poorly emptying bladder, or a sleep disorder).
PubMed: Compression stockings for night urination (Kaga and others, 2022, PMID 36185903; read 2026-10-14. 34 patients about 72: half a trip fewer a night, 0.8 hours more unbroken sleep; 2 stopped from pain. No comparison group).
NHS Devon formulary: Guidance on compression hosiery (read 2026-10-14. Not for suspected arterial disease, bypass grafts, or neuropathy and other sensory loss).
NHS (UK): How and when to take furosemide (read 2026-10-14. Once a day in the morning; twice a day, morning and late afternoon).
PubMed: CPAP and night urination in sleep apnea (Wang and others, 2015, PMID 26620900; read 2026-10-14. 5 studies, 307 patients: CPAP cut night trips and volume. Before-and-after studies).
MedlinePlus: Donepezil (read 2026-10-14. Frequent urination and trouble controlling urination among its side effects).
PubMed: Cholinesterase inhibitors and the bladder-pill cascade (Gill and others, 2005, PMID 15824303; read 2026-10-14. 44,884 people with dementia in Ontario: those started on a memory pill were more likely to then get an anticholinergic bladder drug, hazard ratio 1.55. Observational).
PubMed: Treating bladder problems in frail older adults (Wolff and others, 2021, PMID 33230803; read 2026-10-14. Anticholinergic bladder drugs risk confusion, delirium and falls in the frail; prostate alpha blockers can drop blood pressure on standing).
UK Health Security Agency: Diagnosing urinary tract infection in people over 65 (read 2026-10-14. No urine dipsticks over 65; germs without symptoms are not harmful; new confusion, new pain on peeing and fever are signs. UK guidance).
PubMed: night incontinence care and waking in nursing homes, Ouslander and others, 1998 and Schnelle and others, 1993 (read 2026-10-14. Only 4% of awakenings came with wetting; 87% of incontinence-care episodes were linked to waking. Observational).
Journal of the American Medical Directors Association: Gabapentin enacarbil for night agitation with restless legs in Alzheimer's (Richards and others, 2025, PMID 39909068; full text read 2026-10-14. 147 people: less night agitation, about 48 more minutes of sleep at 8 weeks, a trend to more falls; the leg signs watched before bed).
American Academy of Sleep Medicine: Treatment of restless legs syndrome, 2025 guideline (read 2026-10-14 with its plain-language summary. Morning iron tests; iron if ferritin is 75 or less or saturation under 20%; against standard use of dopamine drugs; strong for gabapentin-type drugs).
American Academy of Sleep Medicine: Restless legs syndrome (read 2026-10-14. Trigger medicines include many antidepressants, antihistamines and "PM" sleep aids, and dopamine-blocking anti-nausea drugs; do not start iron on your own).
NHS (UK): Restless legs syndrome (read 2026-10-14. Worse at rest and in the evening; a warm bath, walking, stretching or massage).
PubMed: Restless legs, iron and night agitation in Alzheimer's (Richards and others, 2021, PMID 33347845; read 2026-10-14. 76 people: 79% took at least one medicine that worsens restless legs).
PubMed: Restless legs with mirtazapine (Kim and others, 2008, PMID 18756499; read 2026-10-14. 8% of patients in a chart review, usually within days).
PubMed: Sleep apnea in Alzheimer's disease: a meta-analysis (Emamian and others, 2016, PMID 27148046; read 2026-10-14. 5 times the odds of apnea; about half had it after diagnosis).
PubMed: CPAP in Alzheimer's, Ayalon and others, 2006 and Sleep Medicine, Cooke and others, 2009 (read 2026-10-14. Used 4.8 hours a night on average, less with more depression; deeper sleep after one night in 52 patients averaging 78. Small trials).
PubMed: Donepezil and sleep apnea in Alzheimer's (Moraes and others, 2008, PMID 18198262; read 2026-10-14. 23 patients: apnea and oxygen improved versus placebo. Small).
PubMed: Medicines and night breathing (Cutrufello and others, 2020, PMID 32925368; read 2026-10-14. Opioids linked to central apnea, with added risk from benzodiazepines and gabapentinoids. Review).
American Academy of Sleep Medicine: Oral appliance therapy for snoring and apnea, 2015 guideline (read 2026-10-14. A custom, adjustable device from a qualified dentist when CPAP fails, with a follow-up sleep test).
American Academy of Sleep Medicine: REM sleep behavior disorder (read 2026-10-14. Acting out vivid dreams; easy to wake; rarely walking, eyes open or leaving the room).
PubMed: REM sleep behaviour disorder: a review (Dauvilliers and others, 2018, PMID 30166532; read 2026-10-14. Ties to Lewy body disease and Parkinson's; some cases caused by antidepressants).
PubMed: Medicines that trigger dream enactment (Kanj and others, 2026, PMID 42605551; read 2026-10-14. SSRIs most often named, then SNRIs and tricyclics. Scoping review).
National Institute on Aging: How Lewy body dementia is treated and managed (read 2026-10-14. Clonazepam can cause dizziness, unsteadiness and thinking problems).
National Institute of Neurological Disorders and Stroke: Brain basics: understanding sleep (read 2026-10-14. Muscles relax in REM sleep; REM periods grow longer through the night).
PubMed: skin warming and sleep in older adults, Raymann and others, 2008 and 2007 (read 2026-10-14. Warming older sleepers' skin by 0.4°C cut the chance of early-morning waking from 0.58 to 0.04; older people respond less to a poor bed temperature. Lab studies).
PubMed: Footbaths and sleep in older adults: a meta-analysis (Chang and others, 2025, PMID 40973991; read 2026-10-14. 18 studies, 950 older adults: better self-rated sleep; best at 40°C or below, 10 minutes or more, for at least a week).
Science of the Total Environment: Night-time room temperature and sleep in older adults (Baniassadi and others, 2023, PMID 37474050; read 2026-10-14. Sleep most efficient at 20 to 25°C, 5 to 10% worse from 25 to 30°C, with big differences between people. Observational).
Journal of Physiological Anthropology: Effects of the thermal environment on sleep (Okamoto-Mizuno and Mizuno, 2012, PMID 22738673; read 2026-10-14. With bedding on, heat disturbs sleep more than cold. Review).
PubMed: Unnoticed low blood sugar in older adults with diabetes (Tian and others, 2022, PMID 35414299; read 2026-10-14. 69 older adults on tight control with blinded sensors: 56% of lows at night, 9% noticed).
American Diabetes Association: Standards of Care 2026: older adults (PMID 41358888; read 2026-10-14. Bedtime glucose 100 to 180 mg/dL with mild to moderate cognitive impairment, 110 to 200 with moderate to severe; avoid lows; glucose sensors for older adults on insulin).
NHS (UK): Heartburn and acid reflux (read 2026-10-14. No food 3 to 4 hours before bed; raise the head of the bed).
NHS (UK): How and when to take donepezil (read 2026-10-14. With bad dreams or trouble sleeping, it can be taken in the morning instead. The US label says evening).
MedlinePlus: Galantamine (read 2026-10-14. The extended-release form is taken in the morning).
PubMed: Memory pills and insomnia: a meta-analysis (Bittner and others, 2023, PMID 37682445; read 2026-10-14. 48 trials, 22,845 patients: insomnia odds ratio 1.55, higher with donepezil than galantamine).
NHS (UK): How and when to take prednisolone (read 2026-10-14. With breakfast; in the morning it is less likely to affect sleep).
MedlinePlus: Bupropion (read 2026-10-14. Not too close to bedtime).
NHS (UK): How and when to take sertraline (read 2026-10-14. Morning or evening).
MedlinePlus: Pseudoephedrine (read 2026-10-14. Last dose several hours before bedtime; care with an enlarged prostate).
PubMed: beta blockers, melatonin and sleep, Stoschitzky and others, 1999 and Scheer and others, 2012 (read 2026-10-14. Propranolol and atenolol cut night melatonin by 80 to 86% in 15 volunteers; in 16 beta-blocker users aged 45 to 64, melatonin 2.5 mg added 36 minutes of sleep over 3 weeks. Small, not dementia).
NHS (UK): Side effects of propranolol (read 2026-10-14. Difficulty sleeping or nightmares).
DailyMed: Sinemet (carbidopa and levodopa) label (read 2026-10-14. Nightmares, insomnia and hallucinations; these may respond to a lower dose).
NHS (UK): Symptoms of depression (read 2026-10-14. Waking very early in the morning).
PubMed: What predicts night waking that wakes the carer in Alzheimer's (McCurry and others, 2004, PMID 14753054; read 2026-10-14. 153 people at home: anxiety, not depression, predicted it, odds ratio 2.1).
Cochrane Library: Psychological treatments for depression and anxiety in dementia (Orgeta and others, 2022, PMID 35466396; read 2026-10-14. 29 trials: approaches including planned pleasant activity probably slightly reduce depression, moderate certainty).
The Lancet: Sertraline or mirtazapine for depression in dementia (HTA-SADD) (Banerjee and others, 2011, PMID 21764118; read 2026-10-14. 326 people with Alzheimer's: no better than placebo, more side effects).
PubMed: Hearing aids and behavior symptoms in dementia (Shankar and others, 2025, PMID 40858488; read 2026-10-14. 10,054 people: hearing-aid users had fewer, milder behavior symptoms. Observational).
Alzheimer's Society (UK): Sundowning (no date shown; read 2026-10-14. Uneven light and reflective surfaces confuse; sight and hearing loss as causes; close curtains, cover mirrors and the TV).
PubMed: Amber light around the bathroom door and night falls in dementia (Zimmerman and others, 2024, PMID 39182511; read 2026-10-14. 38 people: 34% fewer night falls than standard nightlights, not statistically significant; a larger trial is under way).
PubMed: Vitamin D deficiency and sleep: a meta-analysis (Gao and others, 2018, PMID 30275418; read 2026-10-14. 9 studies, 9,397 people: deficiency linked to sleep disorders, odds ratio 1.50, and to short sleep. Observational).
PubMed: Vitamin D and measured sleep in older men (MrOS) (PMID 25581929; read 2026-10-14. 3,048 men 68 and older: the lowest quarter had about twice the odds of sleeping under 5 hours, odds ratio 2.15. Observational).
PubMed: Vitamin D supplements and sleep: a meta-analysis (Abboud, 2022, PMID 35268051; full text read 2026-10-14. 3 small trials: better self-rated sleep, moderate certainty; none in older people with dementia. Reports the VITAL and other null trials).
JAMA: VITAL: vitamin D and late-life depression (Okereke and others, 2020, PMID 32749491; title read, sleep results taken from Abboud 2022. 2,000 IU a day for a median 5.3 years in adults 50 and over: no difference in sleep problems).
PubMed: Vitamin D and obstructive sleep apnea: a meta-analysis (Loh and others, 2023, PMID 37704922; read 2026-10-14. Lower vitamin D in moderate and severe apnea).
Endocrine Society: Vitamin D for the prevention of disease, 2024 guideline (PMID 38828931; read 2026-10-14. Suggests vitamin D for everyone 75 and older; daily rather than big intermittent doses over 50; against routine testing in healthy people).
NIH Office of Dietary Supplements: Vitamin D fact sheet (updated 2025-06-27; read 2026-10-14. Upper limit 4,000 IU a day; levels above 50 ng/mL linked to possible harm, especially above 60; thiazide water pills plus vitamin D can raise calcium in older adults).
NIH Office of Dietary Supplements: Vitamin B12 fact sheet (updated 2025-07-02; read 2026-10-14. 3% to 43% of older adults at home deficient; metformin and acid reducers as causes; MMA when B12 is 150 to 399 pg/mL; no upper limit; trials found no memory gain from B12 alone or with other B vitamins).
NIH Office of Dietary Supplements: Vitamin B6 fact sheet (updated 2023-06-16; read 2026-10-14. Upper limit 100 mg a day; nerve damage reported below 500 mg).
Therapeutic Goods Administration (Australia): Stronger safety controls for products containing vitamin B6 (2025-11-25; read 2026-10-14. Stop at once with tingling, burning or numb hands or feet; tighter sales of higher doses from June 2027).
PubMed: B vitamins and brain shrinkage in memory problems (VITACOG), Smith and others, 2010 and Douaud and others, 2013 (read 2026-10-14. 271 people over 70: folic acid 0.8 mg, B12 0.5 mg and B6 20 mg daily for 2 years slowed shrinkage, 0.76% against 1.08% a year; the benefit was in those with homocysteine above about 11. Two authors hold B-vitamin patents).
PubMed: Methyl-B12 and sleep (Mayer and others, 1996, PMID 8914118; read 2026-10-14. 20 healthy adults: sleep time fell. Small, not older adults).
PubMed: Vitamin B6, B complex and sleep (Aspy and others, 2018, PMID 29665762; read 2026-10-14. 100 adults: a B complex at bedtime lowered self-rated sleep quality and raised tiredness on waking).
Medical Hypotheses: Gominak's vitamin D and sleep papers, 2012 and 2016 (read 2026-10-14. 1,500 neurology patients over 2 years with vitamin D held at 60 to 80 ng/mL; then B100 with vitamin D in over 1,000, with better sleep and less pain at 3 months. Hypothesis papers built on her own uncontrolled clinic records).
The Diary Of A CEO: interview with Dr Stasha Gominak (2026-07-27; read 2026-10-14 through a third-party transcript, not the video. Vitamin D above 60 with monthly tests; B12 for 3 months if low; then B50 for about 3 months; too much B can act like caffeine. Her own site blocked automated reading and was not checked).
PubMed: Vitamin D and gut bacteria: a review of trials (Zeb and others, 2026, PMID 40673989; read 2026-10-14. 14 trials: vitamin D shifted gut bacteria; results varied).
PubMed: B-vitamin making by gut bacteria (Magnusdottir and others, 2015, PMID 25941533; read 2026-10-14. 40 to 65% of 256 common gut bacteria make each B vitamin. Genome analysis, not how much reaches the person).
Aging: The first ReCODE protocol paper (Bredesen, 2014; full text read 2026-10-14. ReCODE's table: 8 hours of sleep, exclude apnea, vitamin D 50 to 100 ng/mL, homocysteine under 7, B12 over 500, melatonin 0.5 mg, gut repair, no food 3 hours before bed).
PubMed: ReCODE-style precision medicine pilot (Toups and others, 2022, PMID 35811518; full text read 2026-10-14. Home sleep studies for everyone without known apnea; 7 to 8 hours of sleep).
Preprints.org: Precision medicine treatment of Alzheimer's disease: randomized controlled trial (Toups and others, version 3 posted 2026-04-20, a preprint; read 2026-10-14. 73 people over 9 months: large gains in thinking and memory against standard care; sleep was not reported as an outcome. Authors include ReCODE's developer, who consults for Apollo Health).
Big single doses of vitamin D and falls: Sanders and others, 2010 (JAMA), and Bischoff-Ferrari and others, 2016 (read 2026-10-14. 500,000 IU once a year raised falls 15% in 2,256 women over 70; 60,000 IU a month raised falls in people over 70 who had fallen, 66.9% against 47.9%).
Centers for Medicare & Medicaid Services: Billing and coding: assays for vitamins and metabolic function (A56416) (Novitas region; read 2026-10-14. Dementia and Alzheimer's codes support B12, folate and homocysteine tests. One region's rules).
Centers for Medicare & Medicaid Services: Vitamin D assay testing (L36692) (Noridian region; revision effective 2025-08-14; read 2026-10-14. Covered for listed conditions, not routine screening; insomnia and dementia not listed. Other regions set their own).
Medicare.gov: Clinical diagnostic laboratory tests (read 2026-10-14. You usually pay nothing for Medicare-covered diagnostic lab tests).
Quest Diagnostics: Vitamin D test, direct to consumer (price checked 2026-10-14: $75 plus a $6 physician fee. Prices change).

Keeping them on their side

American Journal of Gastroenterology: ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease (Katz and others, 2022; read 2026-10-14 in full via PubMed Central. Raise the head of the bed for night symptoms; no meals 2 to 3 hours before bed; lying right side down raises night reflux; "Sleep on the left side". It gives no height).
American Journal of Gastroenterology: Sleep position and nocturnal reflux, measured with position sensors and pH probes (Schuitenmaker and others, 2022; read 2026-10-14. 57 patients: acid 0.0% of the time on the left, 1.2% on the right, 0.6% on the back).
Cochrane: Positional therapy for obstructive sleep apnoea (Srijithesh and others, 2019; read 2026-10-14. 8 trials, 323 people: keeping off the back beat no treatment; CPAP lowered breathing events more; people used positional therapy about 2.5 hours a night longer than CPAP. All trials short).
The Royal Wolverhampton NHS Trust: 24-hour postural care (read 2026-10-14. A person not properly supported on their side works hard to stay there; do not twist the body and rib cage).
Centers for Medicare & Medicaid Services: State Operations Manual, Appendix PP (F604 restraints, F700 bed rails) (Rev. 225, issued 2024-08-08; read 2026-10-14. A restraint is attached or next to the body, cannot be removed easily, and restricts movement; "removes easily" means the way staff put it on; cognition counts. Listed as restraints: a bed close enough to a wall to stop the person getting out, a concave mattress they cannot get out of, sheets tucked in tightly, an alarm that makes them afraid to move. Half rails used as a handhold by an independent person are not. A practitioner's order and alternatives first. Serious fall injury is more likely from a bed with raised rails. A nursing-home rule).
NHS: Heartburn and acid reflux (reviewed 2023-11-20; read 2026-10-14. Raise the head of the bed around 10 to 20cm with wood, bricks or books under it; extra pillows can increase pressure on the belly; no food 3 or 4 hours before bed).
National Institute of Diabetes and Digestive and Kidney Diseases: Treatment for GER and GERD (last reviewed July 2020; read 2026-10-14. Raise the head 6 to 8 inches with a foam wedge or pillows under the head and upper back. It allows pillows; the NHS does not).
National Pressure Injury Advisory Panel: Side-lying positioning tip sheet (2020, citing the 2019 international guideline; read 2026-10-14 from the Vanderbilt copy. The 30-degree side-lying position in preference to 90; pillows between knees and ankles; heels offloaded; head of bed 30 degrees or lower; raise the knees first, 20 and no more than 30 degrees, to stop sliding; small shifts by lifting the sheet).
Wrightington, Wigan and Leigh NHS Trust: 30-degree tilt positioning leaflet (produced November 2024, review date November 2026; read 2026-10-14. Pillows for head and neck, and behind the shoulder and lower back with no pressure on hip and buttock; a pillow between the knees; heels offloaded; alternate sides on the nurse's plan; check with your palm for a gap under the lower back).
Journal of the American Geriatrics Society: Deaths between bedrails and air pressure mattresses (Miles, 2002; read 2026-10-14. 35 deaths in FDA reports, 1994 to 2001; in one pattern the mattress bunched up behind a person lying on their side and pushed the neck against the rail).
TIDI Products: Posey Self-Releasing Roll Belt instructions (Rev B, 2024-06-28; read 2026-10-14. Rx only; a restraint if the patient cannot easily self-release; for licensed healthcare facilities only; "DO NOT use at home"; if straps slip the patient may slide off the bed, risking serious injury or suffocation; never secure the strap to a side rail; constant monitoring for agitated patients; strap to the bed frame part that moves with the patient; scissors at hand).
Sleep Medicine: Prevalence of sleep-related breathing disorders among people with dementia: a meta-analysis (Aini and others, 2023; read 2026-10-14. 20 studies, 1,461 people: obstructive sleep apnea in 55%).
Journal of Clinical Sleep Medicine: Community prevalence of positional obstructive sleep apnea (Duce and others, 2025; read 2026-10-14. Sleep Heart Health Study, 1,870 people: 62% of those with apnea were twice as bad on their back).
NHS Ayrshire and Arran: Advice to help control saliva (speech and language therapy, written for Parkinson's; last reviewed March 2017; read 2026-10-14. If saliva chokes you lying down, raise the head or lie on your side so it drains out of the mouth).
National Institute on Aging: Providing care and comfort at the end of life (reviewed 2022-11-17; read 2026-10-14. For noisy breathing near death, try turning the person onto one side or raising the head).
Sleep Medicine: Positional therapy in ischemic stroke patients with obstructive sleep apnea (Svatikova and others, 2011; read 2026-10-14. Randomized crossover: a positioning pillow, nothing worn, cut time on the back by 36% and the apnea index by about 20%).
US Food and Drug Administration: Adult portable bed rails: recommendations for consumers and caregivers (current as of 2023-02-27; read 2026-10-14. Dementia raises the risk of entrapment; alternatives are roll guards, foam bumpers, a bed lowered near the floor, a concave mattress or a bed trapeze; no gap wide enough to trap a head or body; soft or air mattresses and mattress pads create gaps).
Skil-Care: 30-Degree Positioning Wedge (read 2026-10-14. 16 inch $51.30; 24 inch $86.60; 34 inch $111.90; 7 inches high).
Journal of Clinical Gastroenterology: A novel sleep positioning device reduces gastroesophageal reflux: a randomized controlled trial (Person and others, 2015; read 2026-10-14. 20 healthy volunteers: left side down on the incline cut acid; right side down had the most. Run with the device's maker).
Journal of Clinical Sleep Medicine: Usage of positional therapy in adults with obstructive sleep apnea (de Vries and others, 2015; read 2026-10-14. Tennis-ball technique: 68% success; 65% had stopped by about 13 months).
Journal of Clinical Sleep Medicine: Poor long-term patient compliance with the tennis ball technique (Bignold and others, 2009; read 2026-10-14. About 2.5 years on, 6% still used it; discomfort the main reason to stop).
Laryngoscope: Positional therapy for obstructive sleep apnea patients: a 6-month follow-up study (Oksenberg and others, 2006; read 2026-10-14. 38% still used it at 6 months; those who kept it up were older; discomfort the main reason to stop).
Rematee: The Belt, anti-snore bumper belt (read 2026-10-14. $108.78; Sleep Bundle $128.78).
Zzoma: Zzoma positional device (read 2026-10-14. $350.00; FDA-cleared; needs a doctor's prescription in the US).
Journal of Clinical Sleep Medicine: Sleep position trainer versus tennis ball technique in positional obstructive sleep apnea (Eijsvogel and others, 2015; read 2026-10-14. Same effect on breathing at one month; 76% kept using the vibrating trainer, 42% the ball).
Philips: Sleep and respiratory care portfolio update (read 2026-10-14. NightBalance US sales discontinued September 2023; service ended 2026-10-01).
BMC Family Practice: Head of bed elevation to relieve gastroesophageal reflux symptoms: a systematic review (Albarqouni and others, 2021; read 2026-10-14. 5 trials, 228 patients: symptoms improved; "cheap and safe").
Sleep and Breathing: The influence of head-of-bed elevation in patients with obstructive sleep apnea (Souza and others, 2017; read 2026-10-14. 52 patients, a 7.5-degree tilt: apnea index 15.7 down to 10.7, back to baseline without it. The block height on our page is our arithmetic, not the study's).
Cochrane: Raising the head of the bed for adults on ventilators in intensive care (read 2026-10-14. 30 to 45 degrees reduces lung infections; higher probably reduces them further but raises bedsore risk. Intensive care only, so it applies at home by analogy).
Cochrane: Repositioning for pressure injury prevention in adults (Gillespie and others, 2020; read 2026-10-14. 8 trials, 3,941 people: 30 versus 90 degrees uncertain, at the lowest certainty grade).
Journal of the American Geriatrics Society: the TURN trial (Bergstrom and others, 2013; read 2026-10-14. 942 nursing-home residents, 72.5% with dementia, on high-density foam mattresses: new sores in 2.5% turned every 2 hours, 0.6% every 3 and 3.1% every 4, no real difference. Already listed under bedbound care).
US Food and Drug Administration: A guide to bed safety: bed rails in hospitals, nursing homes and home health care (current as of 2017-12-11; read 2026-10-14. 803 rail entrapment reports and 480 deaths, 1985 to 2009, mostly frail, elderly or confused people; most patients can be in bed safely without rails; lowest bed, mats beside it; plan for hunger, thirst, the toilet, restlessness and pain).
US Consumer Product Safety Commission: Safety standard for adult portable bed rails, final rule (Federal Register, 2023-07-21; read 2026-10-14. 284 entrapment deaths with adult portable bed rails, 2003 to 2021; by place, 158 in homes (from the proposed-rule data); rails made after 2023-08-21 must meet the standard).
Clinical Neurology and Neurosurgery: Impaired ability to turn in bed in Parkinson's disease as a potential rare cause of positional asphyxia (Sringean and others, 2020; read 2026-10-14. 2 of 16 people could not start a turn from face-down to back).
Journal of the American Geriatrics Society: Caregiver-reported use of physical restraints among community-dwelling older adults with severe dementia in Singapore (Andres and others, 2024; read 2026-10-14. 47% of 215 family caregivers reported restraint use, mostly for falls).
California Welfare and Institutions Code: Section 15610.63, physical abuse (read 2026-10-14 on california.public.law; the official legislature site refused the request. Includes unreasonable physical constraint, and restraint used for any purpose not authorized by the physician and surgeon. Other states not checked).
National Institute on Aging: Elder abuse (reviewed 2023-07-21; read 2026-10-14. Physical abuse may include restraining an older adult against their will).
Alzheimer's Association: Sleep issues and sundowning (read 2026-10-14. "Don't use physical restraint").
US Food and Drug Administration: Safety concerns about adult portable bed rails (read 2026-10-14. Adult portable bed rails should not be used as a restraint).
Deutsches Ärzteblatt International: Deaths due to physical restraint (Berzlanovich and others, 2012; read 2026-10-14. Munich autopsies 1997 to 2010: 22 deaths caused by restraint alone, all in people not continuously observed; one correctly applied waist belt killed a woman mobile enough to slip through it).
Forensic Science International: Fatalities related to medical restraint devices (Karger and others, 2008; read 2026-10-14. 7 deaths, mostly people with dementia; most involved a single device that did not restrict movement enough).
Archives of Family Medicine: Asphyxial deaths due to physical restraint: a case series (Rubin and others, 1993; read 2026-10-14. 63 deaths; vest restraints most common; 57 occurred with the restraint properly applied).
Cochrane: Interventions for preventing and reducing the use of physical restraints for older people in all long-term care settings (Möhler and others, 2023; read 2026-10-14. 11 studies, 19,003 nursing-home residents: restraint use fell, belts by almost half, with little or no effect on falls or fall-related injuries. No studies in homes).
Medical Care: The health consequences of using physical restraints in nursing homes (Castle and others, 2009; read 2026-10-14. 264,068 matched US residents: restrained residents did worse on falls, walking, daily activities, cognition, behavior, pressure ulcers and contractures).
Journal of the American Geriatrics Society: Restraint reduction reduces serious injuries among nursing home residents (Neufeld and others, 1999; read 2026-10-14. 16 nursing homes cut restraints from 41% to 4%: serious injuries did not rise; minor injuries and falls did).
Centers for Medicare & Medicaid Services: Hospital beds and accessories, LCD L33820 (read 2026-10-14 via the CMS Coverage API. Covered when positioning is not feasible in an ordinary bed, to relieve pain, or with the head above 30 degrees most of the time for heart failure, chronic lung disease or "problems with aspiration"; semi-electric for frequent position changes; total-electric not covered, height being "a convenience feature"; side rails and safety enclosures when required with a covered bed; trapeze to change position or get in and out of bed).
US Food and Drug Administration: Class 1 recall: Vail 500 Enclosed Bed System (2005; read 2026-10-14. "Risk of patient entrapment, may result in serious injury or death").
Drive Medical: PreserveTech LS9500N lateral rotation mattress (read 2026-10-14. Turns up to 40 degrees left, right or both, on cycles of 10 to 60 minutes; HCPCS E0277; no price shown).
Centers for Medicare & Medicaid Services: Group 2 support surfaces, LCD L33642 (read 2026-10-14. Covered mainly for existing stage 2 or worse ulcers on the trunk or pelvis that have not improved over a month of care).
Medicare: Hospital beds (read 2026-10-14. Part B durable medical equipment; 20% of the approved amount after the deductible; ask whether the supplier accepts assignment).
Centers for Medicare & Medicaid Services: Group 1 support surfaces, LCD L33830 (read 2026-10-14. Covered if completely immobile, or limited mobility plus poor nutrition, incontinence, altered sensation or poor circulation).
Skil-Care: 30-Degree Bed System with slider sheet and two wedges (read 2026-10-14. $91.90 to $99.10; a spare wedge $44.25).

A calmer room, and bed rails

Dementia Services Development Centre, University of Stirling: Improving the design of housing to assist people with dementia (2013; read 2026-10-01 from the Housing LIN copy. Double the usual light; mirrors; nightlight and sun shadows; noise; contrast; floors one even tone. Mostly expert opinion, as it says itself).
Alzheimer's Society (UK): Factsheet 819: Making your home dementia friendly (reviewed March 2026; read 2026-10-01. Closing curtains at dusk; covering mirrors; the toilet light; clutter; contrast for toilet seats and switches. The charity sells some of the products it mentions).
National Institute on Aging: Home safety and Alzheimer's disease (reviewed 2024-08-02; read 2026-10-01. Fewer and smaller mirrors; nightlights; floors and walls. Its advice to install bed rails conflicts with the FDA's warning below).
US Food and Drug Administration: Adult portable bed rails: advice for consumers and caregivers (current as of 2023-02-27; read 2026-10-01. People with dementia are at higher risk of getting trapped; the alternatives: a low bed, roll guards, foam bumpers, a concave mattress).
Clinical Nutrition: Visual contrast and food and drink intake in advanced Alzheimer's (Dunne and others, 2004; read 2026-10-01. Nine men ate and drank more from red plates and cups than from white. Very small).

When they hit, and if police come

For when they hit, grab or threaten you and if police come. All read on October 1, 2026, except where a row says October 3.

For if you've been hurt, Texas and Arizona, read October 20, 2026. The story lines on that page are a pattern only. They are not rates, and they name no one. The first lines below are the statutes and rules behind that page.

Texas Penal Code 22.04, injury to an elderly individual: statutes.capitol.texas.gov. It reaches criminal negligence as well as intent, knowledge, and recklessness, and it can be a felony. It also covers failing to act by someone who has assumed care, custody, or control. Read October 20, 2026.
Texas Estates Code 1104.102: statutes.capitol.texas.gov. If two or more eligible people are equally entitled, the spouse is preferred. The court still checks eligibility. Read October 20, 2026.
Texas Human Resources Code 48.204 and 48.208: statutes.capitol.texas.gov. If he lacks capacity to consent, services without his consent are only as chapter 48 provides, through a court order under 48.208. The court appoints a lawyer for him (48.208(g)). If the court is closed, 48.208(h) lets APS act first, and it must get the order by 4 p.m. the next business day or stop and bring him back. Read October 20, 2026.
45 CFR 164.510(b): eCFR 164.510. His doctor may share what is directly relevant to your role in his care, if he agrees or does not object, or, if he cannot decide, when the doctor judges it is in his best interest. Read October 20, 2026.
45 CFR 146.121(b)(2)(iii): eCFR 146.121. A group health plan cannot deny benefits for an injury just because it came from domestic violence or a medical condition. Read October 20, 2026.
Arizona Revised Statutes 13-3601: azleg.gov. Under the must-arrest rule in subsection B, when a domestic-violence offense involves physical injury the officer shall arrest unless the officer has reasonable grounds to believe the victim will be protected from further injury. Subsection N: if a minor is present, the officer shall conduct a child welfare check. Texas arrest for family violence is up to the officer: Code of Criminal Procedure 14.03. Read October 20, 2026.
42 CFR 418.302(e)(5): eCFR 418.302. Medicare pays for inpatient respite for no more than 5 days at a time. Later days in that stay are paid at the routine home care rate. Read October 20, 2026.
Arizona Revised Statutes 13-3806 (hospital report to police of an injury that may come from an unlawful act) and Texas Health and Safety Code 161.041 (gunshot wounds only). Read October 20, 2026.
Texas Human Resources Code 48.002 and 48.051 (who APS serves; anyone who believes an older or disabled adult is abused or neglected must report) and the DFPS APS Handbook, section 8000 (valid but no-fault findings). Read October 20, 2026.
Arizona Department of Economic Security, Adult Protective Services, and Arizona Revised Statutes 46-451 to 46-458 (what APS may do, which does not include taking custody of adults or their money), and Arizona Administrative Code R6-8-208 (an adult may refuse services). Read October 20, 2026.
Texas Estates Code 1101.101 and Arizona Revised Statutes 14-5303 and 14-5304 (guardianship only on clear and convincing evidence, less restrictive help first). Read October 20, 2026.
Texas Code of Criminal Procedure chapter 46B and Arizona Revised Statutes 13-4501 and 13-4517, 13-4521 and 13-706 (competency to stand trial; dismissal without prejudice, civil commitment or guardianship; for a serious offense, a trial on dangerousness and commitment to a secure facility). Read October 20, 2026.
Arizona Revised Statutes 13-4419 and Arizona Constitution article 2, section 2.1 (the prosecutor decides; a victim may refuse a defense interview and may confer with the prosecutor after charging). Read October 20, 2026.
Texas Family Code 71.004(1) and Arizona Revised Statutes 13-3601(B) (defending yourself is not family or domestic violence). Read October 20, 2026.
Arizona Revised Statutes 36-3283 and 36-3208 (psychiatric admission must be allowed in the power of attorney; an out-of-state power of attorney valid where and when it was signed). Read October 20, 2026.
42 CFR 405.1206 (Medicare inpatient discharge appeal, no later than the day of discharge). Read October 20, 2026.
Also behind that page: Texas Health and Safety Code 161.041 (gunshot wounds), Human Resources Code 48.051 and 48.203, Estates Code 1101.101, and the DFPS APS handbook (valid, no-fault); Arizona 13-3806, 46-452, 13-4501, 13-4517, 14-5304, 13-4419, 13-4433, 36-3283 and 36-3208; and 42 CFR 405.1206 (discharge appeal) and 42 CFR 418.22 (hospice). Read October 20, 2026.
Medical care in jail: Estelle v. Gamble, 429 U.S. 97 (1976), and, for people held before trial, City of Revere v. Massachusetts General Hospital, 463 U.S. 239 (1983). Read October 20, 2026.
Arizona Revised Statutes 46-452 (APS can ask a court; no custody power), 14-5310 (emergency temporary guardian), 36-524 and 36-526 (emergency admission for evaluation), and 36-3231 (spouse first as surrogate). Read October 20, 2026.
Arizona Revised Statutes 46-458 and 46-459 (APS outcomes, hearing, public registry). Read October 20, 2026.
Arizona Revised Statutes 13-3601(I) (every domestic-violence release order includes conditions to protect the victim), 13-3967(E) (no contact and electronic monitoring for a domestic-violence felony that causes physical harm), 13-1204(A)(3) (a fracture makes it aggravated assault) and 13-4422 (the victim's right to be heard on release); Texas Code of Criminal Procedure 17.291 and 17.292 (a hold of four hours after bond; the emergency protection order, 61 to 91 days or 91 to 121 with a weapon, and "no person, including a person who is protected by this order, may give permission to anyone to ignore or violate any provision of this order") and 14.03(b) (arrest when an order is broken in front of an officer); Texas Human Resources Code 48.1522 (APS tells police when it believes a crime happened); Texas Health and Safety Code 571.003(14) (dementia alone is not "mental illness" for an emergency hold); Texas Health and Human Services, Mobile Crisis Outreach Teams (available to anyone, through the local mental health authority or 2-1-1); and AHCCCS AMPM 590 (crisis services for all individuals; mobile teams). These back the October 21, 2026 update of If you've been hurt. Read October 21, 2026.
Also: Texas Health and Safety Code 573.001 to 573.022 (emergency detention) and Code of Criminal Procedure 1.051 (appointed counsel); for Arizona, Arizona Rules of Criminal Procedure, rule 6.1 (right to counsel; appointed if he cannot pay); Arizona Constitution article 2, section 2.1 (victims' rights). Read October 20, 2026.
National Institute on Aging: Coping with agitation, aggression, and sundowning (distance, reassurance, triggers, telling 911 about the dementia). Reviewed July 2024.
Alzheimer's Association: Aggression and anger (what happened just before, best time of day, telling responders the dementia causes the aggression).
Dementia UK: Keeping safe when you care for someone with dementia (arm's length, sideways stance, a barrier, a room that locks, letting them leave, settling time, the safety plan). Updated October 2023.
Alzheimer's Society: Preventing and managing aggressive behaviour (no restraint, no blame afterward).
Alzheimer's Society: Behaviour that challenges: looking after yourself (shock, guilt and anger are normal).
County of Sonoma Behavioral Health: Guidelines for effective communication with 911 dispatch (call away from them, speak calmly, weapons, no sirens, stay on the line).
NAMI: Calling 911 and talking with police (asking for CIT, what to expect, handcuffs). Modified October 2025.
NAMI: Crisis Intervention Team programs.
Trillium Health Resources: Crisis Intervention Team, and NAMI Pinellas: C.I.T. (callers can ask for a CIT officer).
Positive Approach to Care: 10 steps to de-escalating a dementia care crisis (remove the threat; back off if you are seen as it). A training company; archive copy.
UCLA Alzheimer's and Dementia Care Program: Aggressive language and behavior (stop, offer to come back, give choices).
NHS: Animal and human bites (washing a bite, when to get urgent or emergency care). Reviewed October 2025.
VA Caregiver Support Program: Caregiving tips: dementia (medical check for sudden change, pain, bathing tips, the support line). Updated July 2025.
Alzheimer's Association: Treatments for behavior (causes to rule out; drugs never to sedate or restrain).
Infectious Diseases Society of America: Asymptomatic bacteriuria guideline, 2019 (a positive urine test without symptoms).
SAMHSA: 988 frequently asked questions (calling about someone else, mobile crisis availability). Updated December 2025.
Wharton and Ford, dementia care recipient violence against caregivers, J Gerontol Soc Work 2014 (more than 1 in 5; a thin evidence base).
Isham, Bradbury-Jones and Hewison, female family carers' experiences of violent behaviour, Sociol Health Illn 2020 (12 UK carers).
Alzheimer's Association: Communication and Alzheimer's (approach from the front, one question at a time).
Sloane and others, person-centered showering and the towel bath, J Am Geriatr Soc 2004 (53% and 60% fewer aggressive incidents in nursing homes).
Husebo and others, treating pain to reduce behavioural disturbances, BMJ 2011 (352 residents; agitation down 17%).
NICE: Dementia guideline NG97, recommendations 1.7.1 to 1.7.10 (causes first; when calming drugs are allowed; Lewy body danger). 2018.
American Psychiatric Association: Patient and caregiver guide: antipsychotics for agitation in dementia (small benefit, the 4-week check, stopping within 4 months).
Rexulti (brexpiprazole) US prescribing information (the boxed warning and death rates) and the FDA's May 2023 approval.
Auvelity (dextromethorphan-bupropion) US prescribing information, August 2026, and the Alzheimer's Association's April 2026 approval release.
Alzheimer's Association: Firearm safety tip sheet (removal over locking; every gun; moving them while the person is out). July 2024.
Family Caregiver Alliance: Guns and dementia (stop and retry, neutral messengers, a doctor's note, Extreme Risk Protection Orders).
Safety in Dementia, University of Colorado: Firearms FAQ (who can move guns; free locks from police, sheriffs or VA hospitals).
VA: Keep It Secure (free cable locks).
ABA Commission on Law and Aging and partners: Persons living with dementia in the criminal legal system, May 2022 (fitness for trial, prosecutors' discretion, lawyers, care providers refusing admission).
Battered Women's Justice Project: Domestic violence arrest policies, August 2023.
State arrest laws read as examples: Alaska 18.65.530, Washington 10.31.100, Florida 741.29, New York CPL 140.10.
Emergency hold laws read as examples: Florida 394.455 and 394.463, California 5150; Treatment Advocacy Center, Grading the States, 2026, for every state.
Schulte and others, emergency department boarding for psychiatric hospitalization in older adults, West J Emerg Med 2026 (waits, video psychiatry).
CMS: EMTALA (the ER screening exam).
Medicare: Inpatient mental health care (190-day limit, 2026 deductible), emergency department services, outpatient mental health care, and fast appeals.
Wolverson and others, family experiences of inpatient mental health care for people with dementia, Front Psychiatry 2023 (7 UK carers).
Federal rules: 42 CFR 482.43 (hospital discharge planning), 42 CFR 483.15 (nursing home discharge), 45 CFR 1324 Subpart D (APS), and HIPAA 164.510, 164.502(g) and 164.512(c), (f) and (j) (164.512 re-read October 3: abuse reports, wound laws, telling the patient).
National Center on Elder Abuse: Adult Protective Services: what you must know, and the NAPSA state directory.
Alzheimer's Association: Abuse, the 24/7 Helpline, and First responders.
California Penal Code 11160 (clinicians reporting assault injuries, and naming who the patient says caused them; re-read October 3).
Injury-report laws read as examples on October 3: Washington 70.41.440 (gunshot and stab wounds), Oklahoma 22 O.S. 58 and 60.1 (an adult hurt by family decides), Pennsylvania 18 Pa.C.S. 5106 (the spouse or partner exception), and the California Senate's AB 3127 analysis, June 2024 (California reports go in regardless of consent).
Futures Without Violence: Compendium of state and U.S. territory statutes and policies on domestic violence and health care, 4th edition, 2019 (which injuries states make clinics report; asking about the limits first; telling the patient where a report goes). Read October 3 from an archive copy. Laws change, so check the law it names.
U.S. Department of Health and Human Services, HIPAA questions: what clinics may tell police (state wound-report laws; reviewed December 2022) and your medical information and police (a victim's OK is usually needed; reviewed January 2023). Read October 3.
Seattle City Attorney: Domestic violence court process (the prosecutor decides on charges; the victim's view counts). One city's office. Read October 3.
National Network to End Domestic Violence: State and U.S. territory coalitions (56 coalitions, with state law and services). Read October 3.
ACL: Long-Term Care Ombudsman Program and National Family Caregiver Support Program; Eldercare Locator; 211.
Hua and others, assisted living admission and discharge practices, The Gerontologist 2024 (state rules vary).
Legal help: Legal Services Corporation and LawHelp.org.
What families report: caregiver forum threads on ALZConnected, AgingCare and the Alzheimer's Society forum (posters not named); news reports from The Marshall Project (2022), The Baltimore Sun (2023), Police1 (2026), CTV News (2026) and NPR with KFF Health News (2026); and Polzer and others, firearm access and dementia, J Am Geriatr Soc 2022. Stories show what can happen, not how often.
Elder and vulnerable-adult reporting laws, read October 3: Arizona 46-454 with 46-451, Washington 74.34.035, Oklahoma 43A 10-104 and Kentucky 209.030 (health workers must report abuse of an older or impaired adult to APS, with no exception for the victim saying no; California's WIC 15630 counts anyone 65 or over as an elder).

A band they can keep on: the sources

Prices re-opened 21 October 2026 for A band they can keep on. A company slogan is not a result. The GENEActiv page had no price, so none is printed. The pad and the ring prices were open that day.

Guu and others, wrist-worn actigraphy in agitated late-stage dementia, Alzheimer's & Dementia, 18 March 2024. GENEActiv Original, blank face, 29 care-home residents, four weeks. Acceptance 96.6 percent. Mean wear time 88 percent. One refusal. One band broken for discomfort. Two women removed it at night. Staff and researchers managed it.
Rahimi and others, GeneActiv against a sleep-lab night in older adults, Sleep and Breathing, 2025. Twelve adults, mean age 67.7, not a dementia group. Total sleep time ICC 0.79, and the band ran long (about 423 minutes versus about 376). Wake after sleep onset did not agree.
Activinsights, GENEActiv product page, read 21 October 2026. No price. It asks you to get in touch. A USB cradle is a separate purchase. Up to two months of battery, waterproof, records movement, light, and temperature. The maker says it is exempt from FDA premarket clearance. That is not a sleep diagnosis.
Rapaport and others, DREAMS START, The Lancet Healthy Longevity, 2024. 377 dyads at home. At 8 months the sleep score was about 4.7 points lower than usual care. The wrist recorder was an Axivity AX3. Usable weeks fell from about 70 percent at the start to about 22 percent at 8 months. An earlier feasibility test found this kind of recording was not valid enough, and not acceptable to some, so it was not the main result.
Rapaport and others, DREAMS START at 2 years, Alzheimer's & Dementia, DOI 10.1002/alz.71274. Adjusted sleep score about 5.4 points lower than usual care. The program, not a gadget, is what the trial tested.
Ford and others, Apple Watches in cognitive impairment, The Journals of Gerontology Series A, 30 October 2024. Seven people with subjective decline, mild impairment, or mild dementia. About 11.5 hours a day. They had to charge it. Not a severe-dementia study.
Peterson, St Louis, and Flannagan, wearable adherence in dementia research, JMIR Aging, 31 July 2025. 58 studies. Removal for bathing or sleep, charging left to the caregiver, and skin irritation, including abrasions in one report. Wristwatches were the familiar shape.
No magazine review of the GENEActiv Original was found that day. No priced listing was open on the maker's page or a major retailer. A specialist supplier page was not used as a price.
Ravindran and others, three contactless sleep devices in older adults, JMIR mHealth and uHealth, 25 October 2023. 35 adults, mean age 70.8. Withings Sleep Analyzer, Emfit, and a Somnofy bedside radar against a sleep lab and a wrist recorder. All three contactless devices made total sleep look more than 90 minutes longer than the lab. The radar was closer on sleep versus wake. No Somnofy price was open on a maker page or a major retailer, so it is not on the buy list.
Eve Davies, Withings Sleep Analyzer review, Tom's Guide, 17 September 2025. Two weeks at home against an Oura Ring 4 and her diary. Wake periods mostly matched. A couple of nights counted about 10 extra minutes in bed as sleep. Daytime lounging can land in the score. A solid base suited it better than slats. Her prices are not the prices printed on the guide. She is not a dementia study.
Withings, Sleep product page, read 21 October 2026. $199.95, in stock. Sleep history free. Withings+ optional. Plugs in. Not for a waterbed or an air mattress. The metrics list snoring duration. That page does not offer a sleep-disorder diagnosis.
Amazon.com, Withings Sleep listing, read 21 October 2026. New price $199.95, sold by Amazon.com, in stock. Used price $154.41, sold by Amazon Resale, fulfilled by Amazon, original packaging, no damage noted, 6 left. The used price is the cheapest opened that day.
Victoria Song, Oura Ring 5 review, The Verge, 12 July 2026. She wrote that the sensors match the Ring 4, and she would not tell a Ring 4 owner to upgrade. She likes a ring because it does not buzz. She found the app crowded. Not a sleep-lab study and not a dementia study.
Oura, store, read 21 October 2026. Ring 5 Silver $399 and Black $399. Ring 4 still listed from $349. The page names the Ring 5 because it is the current ring. General FAQs, updated 18 September 2026, re-read 21 October 2026: Ring 5 usually lasts 6 to 9 days. No sound, light, or vibration. Phone notices can be turned off. Not for anyone under 18. A sizing kit is recommended. Membership, updated 16 October 2026, re-read 21 October 2026: $5.99 a month or $69.99 a year in the US. First month included. Without it, only the three daily scores, including sleep.
Amazon, Oura Ring 5 Silver, size 8, read 21 October 2026. $399, in stock. Same new price as the maker. No lower new price was open.
Garmin, Index Sleep Monitor manual: snooze or stop an alarm. Stop the buzz by tapping the module four times. That alarm is why the upper-arm band stays off the buy list. No price for it is printed, because it is not offered.

Techniques & training videos: the teachers behind them

UCLA Alzheimer's & Dementia Care Program, free caregiver-training video series: agitation & anxiety, repetitive questions, home safety, depression & apathy. Also on the UCLA Health site.
Teepa Snow / Positive Approach to Care, Hand-under-Hand®: connect and assist, dressing, eating and drinking.

A note on honesty

Phone numbers and links on this page were verified in July 2026. If a link breaks, the helpline numbers last, and 1-800-272-3900 can route you to nearly everything else. Nothing on this site is medical advice.

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