It's 7 p.m. and something is different. She's more confused than yesterday. He's suddenly not making sense. And you're standing in the kitchen doing the math every dementia caregiver knows: Is this an emergency? Do I call someone? Do we go in?
Emergency departments are very good at fixing specific, fixable problems — and very hard on people with dementia. They're loud, bright, disorienting, and a common trigger for delirium. So the goal is not "never go." The goal is to go when it counts, and to have a calmer plan for everything else. On house calls we teach families a traffic-light way of thinking.
Green — note it down, mention it at the next visit
Slow changes over weeks to months. Gradually needing more help with dressing or finding words. Sleep or appetite drifting. More repeated questions than before. These matter — they're information, not alarms. Write them down with a date so the next appointment is useful, and keep them in one place the whole family can find.
Amber — call the doctor's office this week
Changes over days. New or worse confusion that comes and goes. A new medication followed by a new problem. Eating or drinking noticeably less. Behaviour that's new for them — more agitated, more withdrawn, more suspicious. Amber changes deserve a phone call, not a waiting room: many have causes a doctor can sort out without a hospital — an infection brewing, a medication interacting, pain the person can't name.
Red — call emergency services now
Sudden changes, over minutes to hours. Signs of stroke — face drooping, arm weakness, speech trouble. A fall with a hard knock to the head, especially on blood thinners. Chest pain, real trouble breathing, a burn or injury that frightens you, confusion so sudden and severe it's nothing like their normal. You are not overreacting by calling. Sudden is the word that matters.
The whole point
You can't make these calls well at 7 p.m., frightened, from memory. That's why we put the full traffic-light guide — with the specific signs in each zone — on paper, in the binder, where anyone in the family can find it and act on it. The middle of a worrying moment is the wrong time to invent a system. It's the right time to open one.