The study examined 136 family caregivers of hospitalized older adults with dementia at four Thai university hospitals. Their knowledge of dementia was moderate overall, higher in caregivers with higher education and previous contact with dementia. Gaps in knowledge persisted, especially about the reversibility of dementia and patient behavior. More than 80% of carers reported adequate participation in day-to-day care and decision-making, but implementation of dementia-friendly hospital practices was patchy. Almost half of carers reported a lack of systematic identification of dementia, limited individual care planning and insufficient communication at discharge. Caregivers' experiences varied by location and were influenced by cultural factors such as filial duty and low expectations of formal support. No significant association was found between caregivers' knowledge and their experience with care. The study recommends standardized dementia screening, family involvement in care planning, and culturally sensitive education for caregivers and staff.