Use careArticle link

Understanding Why People with Dementia Hide Soiled Underwear or Call 911 Repeatedly – and How to Respond

When your loved one hides soiled underwear or calls 911 over and over, it can feel baffling and exhausting. These behaviors aren't random – they are the person's way of communicating an unmet need or responding to a feeling of threat, confusion, or discomfort. The good news is that with a calm, detective-like approach, you can often uncover the root cause and reduce the frequency of these actions. This article dives deep into the 'why' behind these two specific behaviors and gives you concrete, step-by-step strategies to handle them with compassion and effectiveness.

Key points

  • Hiding soiled underwear and repeated 911 calls are forms of communication – they signal an unmet need (physical, emotional, or environmental).
  • Always rule out medical causes first: UTI, pain, constipation, medication side effects.
  • Never argue, shame, or punish. Validate their feelings and redirect to a calming activity.
  • Use environmental changes (covered laundry bins, phone locks) to reduce triggers.
  • Track patterns to identify what sets off the behavior and what helps.
  • Personalize your approach based on dementia type, stage, and the person's history.

The Hidden Message Behind Hiding Soiled Underwear

When a person with dementia hides soiled underwear, it's rarely about being 'naughty' or 'difficult.' Instead, it's often a sign of deep embarrassment or a loss of control. They may feel ashamed about the accident and want to 'get rid of the evidence' before anyone sees it. Alternatively, they might be trying to keep the item 'safe' – a common behavior where people with dementia hide things out of a misplaced sense of protection, only to forget where they put it. This can also be a reaction to physical discomfort: the wet or soiled clothing feels unpleasant, but they can't articulate that they need help changing. As one expert notes, 'if your person is in pain or experiencing an adverse side effect from a new medication... or their incontinence is causing them to feel frustrated that they're wet but they can't tell you that they're wet, so they start acting out in different ways' (Source 1). The behavior is a symptom, not the problem.

The Panic Behind Repeated 911 Calls

Repeatedly calling 911 is often driven by fear, confusion, or a false belief (delusion) that something is wrong. The person may genuinely believe there is an intruder, that they are being poisoned, or that a loved one has been replaced by an impostor (a common delusion called Capgras syndrome). They might also be trying to get help for a physical sensation they can't name – like pain from a urinary tract infection or constipation. Because dementia makes it hard to process information and memory, they draw false conclusions from bits of reality. As one source explains, 'a person with dementia may be unable to put bits of information and memory together correctly, which can lead them to draw false conclusions and believe something that isn't true' (Source 18). The call is a desperate attempt to regain safety or control. It's not a prank – it's a cry for help.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. 1. Stay calm and don't take it personally. Your first reaction might be frustration or embarrassment, but remember: the behavior is not about you. Take a deep breath and remind yourself, 'This is the disease, not the person.' Your calm energy will help de-escalate the situation.

  2. 2. Become a 'dementia detective' – look for the unmet need. Ask yourself: What changed? Is there a physical cause (pain, UTI, constipation, hunger, thirst, being too hot or cold)? Is there an environmental trigger (too much noise, a new caregiver, a cluttered room)? Is there an emotional trigger (fear, boredom, loneliness)? As one expert advises, 'start to try to become the dementia detective – see if you can figure out what the change was, because something changed' (Source 10).

  3. 3. For hiding soiled underwear: Approach gently and privately. Do not scold or shame. Say something like, 'I see you put your clothes away. Let me help you get a fresh, clean pair.' Offer to help them change in a private space. Use a calm, matter-of-fact tone. If they resist, don't force it – try again in 15 minutes.

  4. 4. For repeated 911 calls: Validate their fear first. Say, 'I can see you're really scared. You're safe now. I'm here with you.' Do not argue about whether the call was necessary. Instead, redirect to a calming activity: offer a warm drink, a favorite song, or a walk to a different room. If the calls happen frequently, consider a medical alert system or a locked phone that only dials you.

  5. 5. Rule out medical causes. Both behaviors can be triggered by pain, infection, or medication side effects. Check for signs of a UTI (confusion, agitation, fever, change in urine smell), constipation, or new medications. As one source emphasizes, 'always check with your doctor, your nurse practitioner, and make sure that there's not an organic cause to their newfound paranoia or false accusations' (Source 1).

  6. 6. Modify the environment to reduce triggers. For hiding: keep a discreet, easily accessible laundry hamper in their room. Use a covered bin so they can place soiled items there without embarrassment. For 911 calls: remove the phone from their reach at night or during high-anxiety times, and replace it with a simple emergency button that calls you. Reduce noise and clutter in their living space.

  7. 7. Use redirection and distraction. Once you've addressed the immediate need, gently guide them to a different activity. For hiding: involve them in folding clean towels or sorting socks – a purposeful task that reduces anxiety. For 911 calls: after calming them, say, 'Let's check on the garden together' or 'I need your help setting the table.'

  8. 8. Create a consistent routine. Predictability reduces confusion and anxiety. Schedule regular bathroom breaks, offer snacks and drinks at set times, and maintain a calm, familiar environment. When the person knows what to expect, they are less likely to feel the need to 'escape' or call for help.

  9. 9. Keep spare items handy. For hiding: have multiple pairs of clean underwear and pants ready so you can quickly replace soiled items without a fuss. For 911 calls: keep a list of calming phrases and activities posted near the phone as a quick reference for yourself or other caregivers.

  10. 10. Document the behavior pattern. Note the time of day, what happened before, and what seemed to help. This information is gold for your doctor and can help identify triggers you might miss. Share this log with your healthcare team.

What not to do

  • Do NOT scold or shame them for hiding soiled underwear. This will increase their embarrassment and may make them hide things more. Instead, respond with empathy: 'It's okay, accidents happen. Let's get you cleaned up.'

  • Do NOT argue about the 911 call. Arguing will only escalate their fear and confusion. They genuinely believe there is a threat. Instead, validate their feeling: 'I understand you're scared. I'm here now, and everything is okay.'

  • Do NOT try to 'catch them' or prove they are wrong. For example, don't say, 'You didn't see an intruder – it was just the TV.' This will make them feel more paranoid and distrustful. Instead, redirect to a safe, comforting activity.

  • Do NOT ignore the behavior hoping it will go away. Unaddressed, it can escalate. For example, hiding soiled underwear can lead to skin infections or falls if they try to dispose of it in unsafe places. Repeated 911 calls can lead to fines or emergency services becoming less responsive.

  • Do NOT use physical force or restraint to stop the behavior. This can cause trauma and increase agitation. If they are resisting care, step back, give them space, and try again later with a different approach.

  • Do NOT assume the behavior is 'just part of dementia' without checking for medical causes. A sudden increase in these behaviors often signals a UTI, pain, or a medication issue. Always consult a doctor.

Practical tools

  • The 'No-Shame' Laundry System

    Place a small, covered laundry basket in their room with a sign that says 'Dirty Clothes' (use a picture if they can't read). Keep extra clean underwear and pants in a drawer they can easily reach. When you find soiled items hidden, simply say, 'Oh, I see these need washing. Let me put them in the basket.' No fuss, no blame.

  • The 'I'm Safe' Script for 911 Calls

    When they are agitated and about to call 911, use this phrase: 'I can see you're really worried. You are safe with me. Let's sit down together and have a cup of tea.' If they have already called, say to the dispatcher, 'My loved one has dementia and is confused. We are safe. Thank you for your help.' Then redirect the person to a calming activity.

  • The 'Trigger Tracker' Log

    Keep a simple notebook or a note on your phone. For each incident, write: Date, Time, What happened just before, What the person said/did, What you did, How they responded. Over a week, patterns will emerge – like always happening after a bath or when they are hungry. Share this with their doctor.

  • The 'Comfort Kit' for Anxiety

    Prepare a small bag or box with items that soothe them: a favorite photo, a soft blanket, a familiar scent (like lavender), a stress ball, or a playlist of calming music. When they start to show signs of agitation (pacing, repeating questions), offer the kit and say, 'Here's something that might help you feel better.'

  • The 'Phone Lock' Strategy

    If 911 calls are frequent, consider a simple phone lock that only allows calls to you. Or, replace the landline with a medical alert pendant that connects to a monitoring service. Explain, 'This is a special phone that helps me know when you need me.' This gives them a sense of control while preventing emergency calls.

  • The 'Bathroom Schedule' Card

    Create a visual schedule with pictures: a toilet icon, a glass of water, a snack. Place it in the bathroom and in their room. Gently remind them every 2-3 hours, 'Let's check the schedule – it's time to use the bathroom.' This reduces accidents and the urge to hide soiled items.

Discuss with your clinician

Ask the doctor: 'Could a urinary tract infection or constipation be causing my loved one's sudden increase in hiding things or calling 911?'

Ask the pharmacist: 'Are any of my loved one's medications linked to increased confusion, paranoia, or agitation?'

Ask the neurologist: 'Is there a specific dementia type (like Lewy body) that makes these behaviors more common, and are there safer treatment options?'

Ask the primary care provider: 'Should we consider a medical alert system or a locked phone to prevent repeated 911 calls?'

Ask the geriatric psychiatrist: 'Could there be an underlying anxiety disorder or delusion that needs treatment?'

Related guides

Sources