Sundowning & Seniors with Dementia – Helping Them & Family Caregivers

Caregivers who look forward to having a nice dinner and relaxing at the end of the day may find that their senior loved one with cognitive impairment makes that dream a nightmare.

Many older adults who have dementia find that time of the day, referred to by some as the gloaming, a very difficult time.

The gloaming refers to twilight or the time between sunset and dark.

Late afternoon and early evening marks a time for those people with dementia to exhibit aggression, restlessness, confusion, and irritability. This change in behavior is called sundowning,  symptoms that occur as the sun is setting.

Unfortunately, behavior changes right at the time when caregivers are tired from a long day and hoping to begin to unwind can be among the hardest to handle. Even worse, this behavior change and agitation can last until bedtime, making it harder for the person with dementia to fall to sleep further worsening symptoms and escalating behaviors.

What is Sundowning and What Causes It?

Sundowning is basically a group of symptoms, not a disease itself, affecting people with dementia, including those with Alzheimer’s disease. It occurs at a specific time of day — at the end of the day up until bedtime.

The symptoms experienced include as described above confusion, agitation, anxiety, ignoring directions, yelling, restlessness, combativeness and irritability that could result in pacing and wandering. Research indicates that 20–45% of Alzheimer’s patients will experience some sort of sundowning symptoms.

Little is known about what actually causes sundowning, although a change in the biologic clock caused by dementia is a likely reason.

There are things that can influence its occurrence and make it worse including:

• Being tired or overstimulated
• Being hungry or thirsty
• Low light levels
• Shadows
• Depression
• Pain
• Boredom
• Unmet needs
• Activity in the home, visitors or loud talking

How to Reduce the Incidence or Treat Sundowning

It is very helpful for caregivers to try to determine what seems to trigger symptoms in your senior loved one. Since everyone is different, there may be specific things that seem to bring on this behavior that you can alter to help prevent sundowning from occurring or at least lessening its severity.

1. Listen to their concerns, talk to them reassuringly to try to reduce their agitation
2. Redirect their behavior
3. Ensure the environment is calm and quiet, reduce noise, move to a quiet room
4. Keep an afternoon, evening and bedtime routine
5. Offer food and beverages before behaviors occur perhaps prior to sunset
6. Encourage toileting
7. Give them a task to refocus them and relieve boredom
8. Keep the lighting levels up to reduce shadows and dimness
9. Play some soothing music
10. Keep nightlights on in areas that can be dark
11. During the day, go outside into the sunshine
12. Stay physically active during the day
13. Don’t allow long naps that keep them from being ready to sleep at night
14. Keep daily activities from being overtiring or over stimulating
15. Reduce caffeine
16. Check medications for possible side effects
17. Check with your senior’s physician to rule out pain or other process that might be causing increased behaviors
18. Ask the doctor if melatonin would help with sleep routine

Sundowning seems to be the worst during middle stages of Alzheimer’s but as the disease progresses the sundowning diminishes.

Sundowning Impacts Caregivers Too

Unfortunately, the most difficult part of sundowning can be the effect it has on caregivers. It can be very hard for caregivers to handle the behaviors of their senior loved ones, especially if tired from a long day. Most of the aggression is directed at the caregiver.

This can quickly lead to caregiver burnout.

We are always encouraging caregivers to care for themselves. Especially when dealing with a person with dementia, it is important to take time for yourself. It is imperative to focus on your own needs, care for your own health and get support and respite every chance possible. Schedule respite for an hour, an afternoon, a day or longer.

If possible, schedule paid caregivers, friends, family members or others to relieve you when you need time for yourself. Allow others to help with household tasks or caregiving duties. It is vital for caregivers to sustain their well-being in order to continue be a caregiver.

Connect with Other Caregivers

Also, get emotional support for your journey from others who are in the same situation. Learn from them and their experiences. They may have tips and techniques that could help you deal with your senior loved one.

How can you connect with other caregivers? Support groups locally or online, twitter chats, or blogs that can offer a wealth of information for you. Engage with organizations such as the Alzheimer’s organization for resources and knowledge.

Learn what is coming next in your senior’s disease process so you can be prepared.

The most effective way to deal with a sundowning senior is to learn from each experience they have with the symptoms. What might have triggered it? How was the day different? What physical signs might they have had? What worked to calm them down? Using what you learn to handle the next occurrence will make it easier. If you can learn to lessen each experience or reduce the frequency of each episode, your job as a caregiver will be easier too.

Do you have any tips for others who are going through sundowning with their senior loved one? We would love to hear your suggestions to make others’ caregiving journeys more pleasant.