She's Trying to Leave the House

Before anything else: could this be physical? Restlessness that ends at the front door often starts as pain, a full bladder, hunger, or a room that is simply too warm. Check the body before you interpret the behavior.

Exit-seeking almost always has a destination attached, and the destination is usually real, though not real now. Going to work, picking up the children, getting home to a mother who has been gone for forty years. The internal clock has rolled back to a period when leaving the house at this hour was part of the job, which is why being stopped at the door does not register as safety. It registers as being kept from something she is responsible for.

The timing is a clue. Exit-seeking clusters in the late afternoon and early evening, and nobody is certain why, since fatigue, changing light and the body clock are all likely involved. It overlaps with sundowning, the late-day restlessness that builds as the light goes, and treating the two as one pattern usually works better than treating them as two problems.

A person with dementia who leaves alone is genuinely vulnerable, particularly in cold or heat, near traffic, or after dark. Most people are found within a mile or so of where they went missing, and calling early is the biggest reason they are found safe. Closeness is not the same as safety, since people who are found too late are usually found close by too, in water, ditches, hedges or sheds rather than out on the road. If you have already had a scare and drove around for twenty minutes before calling, that is what most people do the first time, and it is what the preparation below is for.

Two things run at once here: what you do at the door, and the preparation that is best done on an ordinary afternoon.

1. Walk with her. Ten minutes outside in your company satisfies the urge more reliably than any redirection, and it is far safer than an exit you didn't see. If you don't drive at night or can't leave the house, the end of the driveway and back does the same work.
2. Make the entryway less interesting rather than harder to use: a curtain over the door glass, a different mat, and coats, purse and shoes out of the sightline, since the cues at the door trigger this more often than families expect. Car keys go out of the house rather than out of sight, and if she is still driving at all, raise it with the clinician, since driving fitness in dementia is a medical question.
3. Add warning rather than confinement. A chime or a bell on the handle tells you the door opened, which a lock cannot do. If you do add a lock, use one that opens from the inside without a key, since a deadbolt needing a key on the inside is a fire trap and breaks code in many places. Never use one when she is in the house without you.
4. Pre-empt the hour. If the exits cluster at five, put the walk or the visitor at four, and give the late afternoon a job with a visible beginning and end, since folding or sweeping competes with the sense that there is somewhere she is supposed to be.

1. Tonight, and free: put a card with your name and phone number in every coat pocket and in her purse, and take a photo of her in what she wears now.
2. This week: a real GPS locator, a shoe insole, a keyring tag or a wearable. Not an AirTag or a Tile, since Bluetooth tags only report a position when a stranger's phone happens to walk past. Attach the charging to something you already do at night, because charging is the part that fails.
3. Tell two or three neighbors in person, and give them the words: "My mother has dementia. If you see her outside on her own, please call me on this number and stay with her until I get there." If you don't know your neighbors, the mail carrier and the nearest corner store are next best.

Note the time, what happened in the twenty minutes before, and where she said she was going. Exit-seeking is one of the most patterned behaviors in dementia, and the destination is usually consistent, which tells you which need to meet earlier in the day.

Staying steady here means the goal is not a person who never goes to the door. It is a walk to the door that stays calm and stays accompanied. This is also one of the most common points at which families start thinking about more help in the house, and thinking about it is not giving up, since nobody supervises another adult around the clock. If she gets out while you are asleep, that is not neglect. It is the reason chimes, locks and help exist.