What the Dispatcher Hears

The words you use in the first fifteen seconds of a 911 call decide what pulls up outside your house.

Should I call 911 at all?

Call for a genuine emergency. For a person who is agitated but not in danger, there are usually better numbers — because once officers are on their way, you no longer control what arrives at the door.

The advice families are given is short: if you cannot manage him, call 911. The part that is left out is that a 911 call for behavior brings a response designed for a different problem. Officers arrive trained to establish control, issue commands, and evaluate compliance. A person with dementia cannot reliably follow a command, may not understand who is in his house, and may become more frightened as the response escalates. Confusion reads, from the outside, as noncompliance.

Call 911 without hesitating when:

• Someone is injured or bleeding, or has fallen and cannot get up.
• The person is missing.
• There is an immediate physical danger to someone in the house.
• There is a fire, a gas leak, or a medical emergency.

Consider a different number first when the problem is agitation, refusal, or fear, and nobody is in danger:

• The prescribing doctor's after-hours line. Sudden behavior change is a medical event more often than families expect — a urinary tract infection, pain, constipation, or a new medication.
• The hospice or home health on-call nurse, if the person is enrolled. This is one of the largest practical benefits of hospice, and it is underused.
• 988, the Suicide and Crisis Lifeline, which in a growing number of counties can dispatch a mobile crisis team. These teams arrive in plain clothes and unmarked cars, without lights, which means they are usually slower than a police response — often within the hour rather than within minutes. That trade is sometimes worth making and sometimes not.
• The non-emergency police line, if you want a record made or need help finding someone, without a lights-and-sirens response.

What do I actually say when I call?

Lead with dementia, then location, then what you need. Describe behavior instead of labeling it, and say plainly whether there are weapons in the house.

Dispatchers assign a response based on what they are told in the first fifteen seconds. A useful opening, in this order:

• "My husband has Alzheimer's disease. He is 78. He is confused, not dangerous." Say the diagnosis before anything else. It is the single fact that changes how the call is coded.
• "I need help getting him to the hospital" or "I need help finding him." Name what you want the outcome to be. Absent that, the outcome defaults.
• "There are no weapons in the house." Or, if there are, say so. Do not leave this to be discovered.
• "He does not follow instructions and he does not understand commands." Say it in those words — it is the line most often left out.
• "Please send a CIT officer if one is available." Many departments have officers with crisis intervention training. Asking costs nothing.

Words that make things worse:

• "Violent." It is a category, and a dispatcher must treat it as one. "He pushed me when I tried to take his keys" tells the responding officer far more and codes far lower.
• "Out of control." Same problem.
• Understating. If he has a knife in his hand, say so. An officer surprised by a weapon responds very differently from one who expected it.

He calls 911 himself. What do I do?

Tell the department in advance, through the non-emergency line, and ask whether they can attach a note to the address. Then treat the call as a symptom rather than a discipline problem.

One caregiver described it this way: "He rang 999 asking for help to find my mom as she's been missing for hours. But she passed away 15 years ago." The number differs by country. The event does not. People with dementia call emergency services because they are frightened, because they believe someone is missing, because they think there is an intruder, or because they are living in a year in which someone who has died is still alive.

What helps:

• Call the non-emergency line and explain. Many dispatch systems can attach a premise note or a caller flag to an address, so that responding officers know before they arrive that a person with dementia lives there. Ask specifically whether your department does this and what it needs from you.
• Do not try to have the number blocked. Emergency lines cannot and should not refuse a call from an address, and a person with dementia who genuinely needs help will one day be on the line.
• Look at the phone. Some families move to a phone with no keypad, or a phone that dials a fixed list of numbers. That is a real intervention and worth considering before it becomes a police matter.
• Treat the content seriously even when it is not true. A man calling to report his wife missing fifteen years after her death is describing grief and fear that are entirely real to him. Arguing with the facts does not work. Answering the feeling sometimes does.

What if he accuses me of something?

Assume it will be investigated, and prepare accordingly. Accusations of theft, poisoning, and imprisonment are common symptoms, and an agency receiving one is required to look.

Delusions of theft are among the most frequent psychotic symptoms in dementia, and the accused is almost always the person doing the most care. A report to police or adult protective services triggers an investigation regardless of its plausibility, because the alternative — agencies deciding which elder abuse reports to believe before investigating — is worse.

The practical protections:

• Keep the money separate and documented. Do not commingle accounts. Keep receipts for anything bought with her funds. If you are the agent under a power of attorney, act like a fiduciary who expects to be audited, because you may be.
• Get the diagnosis and the symptom into the medical record. A neurologist's note documenting paranoid delusions is the most useful single piece of paper you can have.
• Have someone else in the room for personal care where it is possible, particularly if accusations have already started.
• Do not argue with the investigator, and do not refuse to cooperate. Give them the medical records and the documentation and let the file close on its own.
• If the same accusation keeps coming, treat it clinically. Recurring delusions of theft or infidelity are a symptom to bring to the physician, not a character problem to endure.

Can a person with dementia be arrested?

Yes, and it happens more often than families expect — sometimes before anyone knows there is a diagnosis at all.

In a review of 2,397 patients seen at the University of California, San Francisco Memory and Aging Center between 1999 and 2012, criminal behavior was the presenting symptom — the first thing anyone noticed — in 14.0% of patients with behavioral-variant frontotemporal dementia, 7.8% of those with semantic variant primary progressive aphasia, and 2.0% of those with Alzheimer's disease. Shoplifting, traffic violations, trespassing and public indecency are the common categories.

That statistic is easy to misread. It does not mean people with dementia are dangerous. It means that in the frontal and temporal dementias, the loss of social judgment can arrive before the memory loss that would have made a family think of a doctor — and the first professional to encounter the illness is a police officer, not a neurologist.

If it happens:

• Say the diagnosis immediately, to whoever is present.
• Ask that the person not be left alone in a holding cell — disorientation, dehydration and delirium escalate fast.
• Get a lawyer with elder or disability experience, and get the medical records to them.
• Bring medications and the list, because a missed dose of some medications in custody is its own emergency.

He is missing. What actually happens, and what should I do first?

Report immediately. There is no waiting period. And check whether the car is gone before you check the yard.

The single most useful finding in the recent research is one that contradicts almost all caregiver wandering advice. When researchers analyzed 548 Silver Alert activations in Texas between August 2017 and March 2022, covering 524 missing adults with dementia, they found that 61.7% of activations involved a missing vehicle. Median age was 77. Most were men. Nearly all of the standard guidance — door alarms, deadbolts high on the frame, GPS insoles, chimes — addresses a person leaving on foot. Most of these people drove away.

The other findings are equally practical:

• Nights and evenings dominate. 43.4% of activations occurred between 11 p.m. and 7 a.m., and another 42.7% between 3 p.m. and 11 p.m.
• Holidays are the outlier. Fourteen holidays make up 3.8% of the calendar and accounted for 25.4% of all activations. Disrupted routine, unfamiliar houses, more people, more doors.
• Most were found. 94.7% of activations ended in the person being located. That number is genuinely reassuring, and it is a Texas-specific figure from one alert system rather than a national survival rate.

What to do in the first hour:

• Call 911 right away. The idea that you must wait 24 hours to report a missing adult is a myth with no basis in law.
• Say "vulnerable adult with dementia." That phrase, or your state's equivalent, is what activates a different search protocol and, in most states, the Silver Alert criteria.
• Check for the car and give the plate number. Given the Texas data, this is the first question, not the last.
• Have a recent photograph ready — recent, not the one you like.
• Tell them where he used to live and where he used to work. People with dementia frequently travel toward a former home or a former workplace.
• Say whether he can ask for help, whether he can say his own name, and whether he will respond to it.

Does police dementia training actually help?

Officer knowledge and attitudes improve. Whether that changes what happens on a call is not established, so do not rely on it.

Crisis Intervention Team training is the main model, developed for mental health crises and increasingly extended to dementia. A 2019 review in the Journal of the American Academy of Psychiatry and the Law summarized the evidence: CIT training produces measurable improvement in officers' knowledge and attitudes, reduces stigma, improves officer satisfaction and officers' own perception that they use less force, and appears to increase pre-booking diversion to psychiatric care rather than jail. On objective outcomes — arrests, officer injuries, citizen injuries, use of force — there is little evidence of benefit in the peer-reviewed literature.

That is not an argument against asking for a CIT officer. It is an argument against treating the request as protection. The things that reliably change a police encounter are the things you control: what the dispatcher is told, whether you meet them outside, and whether the officer knows before he walks in that the man in the kitchen has a disease.

Two enrollment programs, both operating locally rather than nationally:

• Project Lifesaver and similar sheriff-run programs, which fit a radio-frequency bracelet trackable by trained responders. Availability is county by county.
• Local first-responder registries, run by some police and fire departments, which record that a person with a disability lives at an address. Ask your non-emergency line whether one exists.