Aunt Nelly was a sweet old woman with dementia. She was the kind of woman that could make babies coo and laugh. She was the type of person that would kiss you on the cheek and give you a big hug before you said goodbye, and made you happy that she did.
As Aunt Nelly’s dementia progressed, she remained sweet. Well, sweet until late afternoon or early evening. It was almost as if she had a switch that was flipped, right around dusk. A switch that turned Aunt Nelly’s sweet disposition to agitated, fretful, and very confused behavior. She would begin pacing and worriedly ask about the children, or fretfully say that she needed to go home. Aunt Nelly’s children were long grown and she had lived in the same place for over a decade. Her niece, Amy, who cared for her, tried to explain, cajole and redirect, but nothing seemed to work. Aunt Nelly would argue with Amy and accuse her of untrue and nasty things. Amy was perplexed by her sweet aunt’s behavior and spoke to a healthcare professional. Here’s what she learned:
Aunt Nelly was experiencing Sundowners, or Sundown Syndrome.
The term “sundowning” is used to describe the baffling changes in behavior and increased confusion that occur in the late afternoon, and sometimes well into the evening, with dementia. Sundowners isn’t a disease, but according to Mayo Clinic, it’s “a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer’s disease.”
Some of the symptoms might include agitation, easily becoming upset or anxious, restlessness, irritability, confusion, disorientation, or suspiciousness. The person might yell, pace, or hear or see things that aren’t there. Fear, anger, or stubbornness might be displayed. Sometimes the person hides things, cries, wanders, becomes paranoid, or may even become violent. The symptoms typically occur at twilight – the time of day when daylight is almost gone, but it’s not yet completely dark – but this can vary greatly from person to person.
What causes Sundowners?
While the exact cause of Sundowners isn’t known, fading light seems to be the trigger. Causes, or factors that may result in sundowning behaviors include:
• Fatigue, or being overly tired
• Low lighting, which may increase shadows
• Disruption of the person’s internal or biological clock, which may lead to confused sleep-wake cycles
• Pain
• Depression
• Boredom
• Hunger or thirst
• Presence of an infection, such as a urinary tract infection
How to prevent or cope with sundowning?
Watch for signs of increased confusion and changes in behavior in the late afternoon or around dusk. Try to find the cause of the person’s behavior: Are they hungry, thirsty, or bored? Be sure to rule out physical pain, presence of an infection or other medical problem by seeking advice from the person’s healthcare professional.
Other tips include the following:
• Keep a routine during the day that includes activities that your person enjoys.
• Make part of the routine include exposure to light (go outside or sit by a window) to encourage nighttime sleepiness.
• Limit daytime napping.
• Limit caffeine and sugar to morning hours. Alcohol may add to confusion and anxiety.
• Reduce clutter.
• Reduce noise and stimulating activities. The number of people in the room, noisy family activities, or other distractions might be overwhelming. Some television shows can be upsetting, especially if the person is unable to distinguish what they see on the screen from reality. Silence or soothing music might help calm.
• Close the curtains and turn on lights to improve visibility and decrease shadows, which may be confusing or frightening. Reflections from mirrors or glass doors can also be confusing.
• Avoid arguing or rationalizing.
• Keep your person safe with nightlights and other safety devices if necessary. Remove or secure potentially dangerous items as needed.
Be sure to listen and respond to your person calmly. Reassure them that everything is okay and you are there to help them. Try to distract your person with a snack, a simple task or favorite activity.
If you have questions, comments, or have caregiving topics you would like to see on this blog site, please send an e-mail to caregivers@upcap.org.
Until next time, pidä huolta itsestäsi!
Disclaimer: This blog exists to provide general information, not specific professional advice. No content on this site should be used as a substitute for direct medical advice from your physician or other qualified clinician. No products are endorsed on this blog.
For more Tips for Managing Agitation, Aggression, and Sundowning:
https://order.nia.nih.gov/sites/default/files/2022-08/tips-agitation-aggression-sundowning.pdf
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