My dad's dementia has suddenly gotten mu

Call your local emergency number now, or take Dad straight to the nearest emergency department today if getting there is safe and quicker — do not wait for Friday's nurse line. A few weeks of new hallucinations, dizziness and aggression in a person with dementia is not automatically "the disease getting worse": the commonest causes are medicines, dehydration and infection, and those are the treatable ones. (I can't name your local number from here — which country and city are you in? — and anything on the red-flag list in part 3 means call, don't drive.)

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1. What you've tried vs. what to do instead

What you've tried: assuming it's progression, and carrying it alone between visits.

The better move: treat this as a *change to investigate*, and take a written baseline in with you. The single most useful thing you can say to a clinician is: "here is what he was like, and here is exactly when he stopped being like that." In an older adult, the abnormality is the deviation, not the severity.

Today (under 25 minutes, one pass):

1. Write the baseline, 5 minutes. One page: normal walking, normal memory, normal sleep, normal toileting, how much help he needs — then the dates: when the hallucinations started, when the dizziness started, when the aggression started, and whether it's steady or getting worse this week.
2. Bag the medicines, 10 minutes. Every container, in one bag, exactly as they come. Include anything bought without a prescription, anything from another doctor, anything started, stopped or changed in the last few months, plus the dates you can remember. This is the single highest-value thing you carry — ask for a full medication review. Confusion, hallucinations, unsteadiness, drowsiness, constipation and falls are all recognised medicine side effects, and older people are more susceptible to them. Whether any drug should be changed is the prescriber's decision, not the family's.
3. Note the basics, 3 minutes: when he last drank, when he last passed urine, what he ate, and whether he's had a fall or a knock to the head in the last few weeks or months — even one nobody thinks twice about. Also whether he takes a blood thinner, and say that first if there was any fall or head knock.

What to ask the doctors to check — this is exactly the list to hand over or read out:

• Medicines. Anything that causes confusion, drowsiness or unsteadiness; the combination of several; anything recently started or stopped; over-the-counter sleep or "calming" products; whether his kidneys or liver are clearing what he has always tolerated. Dose and stopping decisions belong to the prescriber — never adjust them yourselves.
• Fluid intake and dehydration. In an older person this shows up as confusion before it shows up as thirst.
• Infection — urine, chest, skin, teeth, feet. He may have no fever at all; confusion can be the sign. Ask specifically about a urine test, not just a general examination.
• Blood pressure and dizziness. Have them look at the reading sitting and standing, and at the pulse, and ask about medicines that affect both. Log your home readings with the time and how he was — as evidence for the visit, not as a reason to change a tablet.
• Blood sugar, if he has diabetes — this can cause confusion and agitation, or mimic a stroke, and the early warning signs may be gone.
• A head injury. A slow bleed after a knock can show up weeks later as confusion and unsteadiness in someone whose memory is already poor. Mention any knock at all, even a forgotten one.
• Stroke signs — one-sided weakness, face dropping, slurred or muddled speech, vision change. If you ever see these, note the time it started and the time he was last known well.
• Pain, constipation, trouble passing urine, poor sleep, and a sudden change in his usual self — all of these are on the known list of things that tip a person with dementia into acute confusion.
• His hearing aids and glasses in the room. Not being able to hear the questions is itself a reason people are assessed badly.

Tonight, at home — no diagnosis, no new medicine, no change to anything:

• Keep the room familiar and quiet; one calm voice at a time; don't argue with what he sees or hears, and don't try to prove it isn't real. Redirect, reassure, move on.
• Offer sips of fluid and a light familiar food only if he is fully awake and swallowing normally. Nothing by mouth if he is drowsy or foggy.
• Glasses on, hearing aids in, lights on, a night-light on the way to the bathroom, and a clear path to it — he is unsteady and it's dark.
• Don't leave him alone tonight if he is drowsy, badly confused, or his aggression is putting anyone at risk. If you need a second person, ask your sibling or a neighbour tonight rather than improvising alone.
• Eat and sit down yourself. Caregiver collapse helps nobody, and asking a specific person for a specific block of help is a normal, respectable request.

Make the Friday nurse line work for you. Call 08:00–16:00 and say, in the first sentence: "My father has dementia and has been newly and clearly worse over the last few weeks — new hallucinations, dizziness, aggression. I'd like him assessed this week, not at the next routine appointment, and I'd like a medication review." If they offer a routine slot, repeat the request and ask what would have to change for it to be seen sooner. If Friday is too late for how he's behaving tonight, the emergency department is the door — and going there, you hand over the bag, the one-page baseline, and the words "acute confusion."

2. The avoid list — hard rules for this week

• Do not stop, halve, skip, double, or re-time any medicine — not even one that seems obviously related. Starting and stopping a drug are both doctor decisions, and stopping one suddenly can be dangerous in its own right. The right action is to *ask for a review*, not to act on it.
• No "calming" medicine from anyone else — not a neighbour's, not a leftover, not something bought online, no powders or mixes of unknown content. This is exactly the route to a second emergency.
• Do not accept "it's just his dementia" or "it's just his age" for a *new* change, and do not wait for a fever. The common causes of acute confusion in older adults are the treatable ones.
• Do not use a normal temperature or a normal blood-pressure reading as reassurance, and do not skip or add a dose based on a home reading.
• Nothing by mouth — no food, no drink, no pill, no glucose gel — if he is drowsy, foggy, or hard to wake.
• No home test kit, online questionnaire or AI guess replacing an examination. This is one to ask a doctor in person.
• Don't argue with hallucinations, don't restrain him, and don't lock a door behind him. Stay close, keep it calm, get a second adult in the room if he's escalating.
• No single caregiver carrying it alone. Split the week: your sibling or another relative takes one fixed block, and one of you does the medicine-and-baseline pass — not both, separately.

3. Red flags — stop the home plan and get help now

Call your local emergency number now, or go to the emergency department today, if any of these are happening:

• The change came on over hours or days rather than weeks, or it is noticeably worse over the last day.
• He is hard to wake, unusually drowsy, or drifting in and out.
• Not drinking, hardly any urine, or far less food than usual.
• Signs of infection without a fever: burning or cloudy-smelling urine, a new cough or fast breathing, a sore or weeping area anywhere, suddenly worse walking.
• One side weak or drooping, slurred or muddled speech, sudden loss of vision, a sudden severe headache, or a new unsteady lurch — note when it started and when he was last known well, and say both.
• A fall, or any head knock, in the last weeks or months — especially if he takes a blood thinner. Say so in the first sentence.
• Fainting, a fit, chest pain, or new breathlessness.
• He cannot swallow safely, or coughs on his own drinks.
• Aggression that puts you, him, or anyone nearby at risk of being hurt, or you feel you cannot keep him safe.
• Anything you are frightened of, cannot explain, or would not want to be asked about twice.

What to say when you call or arrive, in this order: "He's [age / age band] with dementia, normally [one line of baseline], and over the last [time] he's become [hallucinations, dizzy, aggressive]." Then: the medicine list, whether he's on a blood thinner, any fall or head knock, and when he last drank and passed urine. Put the bag of medicines in their hands.

What success looks like in the next 24 hours — not a cure, and nobody can promise one:

• Someone clinical has seen him or spoken to you with the change taken seriously, with a date for review earlier than a routine slot.
• The medication review is on the record, with the bag of containers in front of them.
• You have a one-page written baseline and timeline you can hand to anyone, and a red-flag list you're not afraid to act on.
• Tonight was calmer, he drank something, and nothing was changed at home that you'd have to explain backwards.
• And a real possibility worth saying out loud: when the cause is one of the treatable ones, people often improve once it's found and treated — which is exactly why this is worth pushing today rather than folding into "just the disease."

The one thing I'd ask you first: has he had any fall or a knock to the head in the last few weeks or months, and does he take a blood thinner? That single answer can move this from "seen this week" to "seen today."