Dementia is a progressive condition with changes over time. If you notice sudden changes in a person’s cognition or sudden increased confusion, then always seek your General Practitioners (GP) support in the first instance. The person may be experiencing a medical condition called ‘Delirium’ and this requires medical attention.
As always, it is important to remember that every person is unique and so these suggestions may not work for everyone and what works this week may not work next week. However, we hope learning about sundowning will help you understand what could be happening and ways you may be able to assist the person with dementia. Not everyone who has a dementia diagnosis experiences sundowning.
What is Sundowning?
Sundowning or Sundown Syndrome is a neurological phenomenon associated with increased restlessness and confusion in people who have a dementia diagnosis.
Sundowning can affect a person’s quality of life and can be very tiring for family/care partners to manage.
What to look for
The person who has a dementia diagnosis may become more confused, restless or insecure late in the afternoon or early evening.
- Be more demanding, restless, upset, suspicious, and disorientated.
- See or hear things around them that are not real.
- Pace, wander, argue and ignore directions.
- Have a limited attention span
- Have mood swings and energy surges
Some people may become more impulsive, respond to their own ideas of reality and act on it. This may place them at risk of harm. E.g., they may hear their mother calling and try and ‘go home’ and leave the house.
The person may be restless because they are hungry, in pain or need to use the toilet, and are unable to communicate this need verbally to care partners.
Sundowning behaviours can be worse after a move to a new home or when there is a change to the person’s daily routine. Sundowning tends to occur in the middle and later stages of dementia. Sundowning always needs to be discussed with the GP.
What causes Sundowning?
No one is sure what causes Sundowning. It seems to result from changes occurring in the brain and may be related to changes/disturbances in the person’s 24-hour clock. People with a dementia diagnosis tire easily, and they can become more restless and difficult to care for when tired. They can also have difficulty distinguishing between night and day. At night there tends to be fewer environmental cues with dim lights and absence of noise from routine day time activities.
Other conditions can affect Sundowning:
- Sight and hearing losses.
- Prescribed medications may be ‘wearing off.
- Some prescribed medications may increase confusion/agitation as the day progresses.
- The person may have an infection. E.g.: urinary tract infection.
- The person may be experiencing pain or boredom or have other unmet needs.
How to respond
Stay calm. Ask the person what is the matter? Listen to their concerns/frustrations. Try to reassure the person. ‘Everything is ok, you are safe’. Use short, simple sentences.
Think about what the person has done during the day – what may they be trying to communicate to you?
Check they are not in pain, need to go to toilet, are they hungry/thirsty? Offer reassurance. Focus on the person’s feelings, e.g., ‘you seem worried’? ‘You are safe with me’. ‘We are going to the bathroom’. Redirect them, go into another room, have a hot drink, walk around garden.
If the person is confused and speaks re their wish to go home-rather than trying to rationalize with the person that they ‘have lived here for 5 years’- try and focus on and validate on what the word ‘home’ may mean to them.
Always try and see the situation from the person with dementia’s perspective. Try not to take it personally. Treat them with respect/kindness and be patient. Avoid arguing with them.
How can you help?
Always discuss your concerns re changes in a person with dementia behaviour with the GP. Consider keeping a journal/diary of when sundowning type of behaviours occurred, what did you observe and what strategies appeared to have assisted with managing the behaviours. Show this journal record to the GP.
Try and keep to a structured daily routine.
During the daytime encourage the person to engage in purposeful activities and participate in regular physical exercise. Do not plan too many activities during the day.
Keep daytime rests short and earlier rather than later in the day, if possible. Encourage the person to spend some time outside each day (exposure to sunlight/Vitamin D). Offer their favourite snack, object or familiar/calming activity. e.g.: simple repetitive tasks such as folding tea-towels or small towels.
Try and ensure the evening routine is calm.
Encourage the person to assist with setting the table, have a pre-dinner snack/drink. Encourage them to watch reruns of favourite TV programs/sporting events/concerts etc. Arrange for a family member or friend to phone the person, on a regular basis during the time of day when the person with dementia tends to be restless/confused. Use gentle touch if they respond well to this.
Prepare evening meal earlier in the day when the person you are supporting requires less supervision/assistance. Consider adjusting the time when the person has their evening meal. Limit caffeine to earlier in the day.
Avoid making appointments later in the day. Avoid activities which may upset the person you are supporting. Try not to arrange bath/showers late in the day if these are known to cause upset.
Consider the Home Environment
Try and minimize clutter. Simplify room layout and ensure clear pathways for person to move inside their home. Create a calm environment with pleasant smells, flowers, or family photos on display.
Ensure good lighting-to help reduce shadows and reduce falls risks. As it gets darker outside, increase the lighting inside the house. Close curtains at dusk to minimise shadows and the confusion they may cause.
Consider the person’s bedroom environment and consider installing light blocking curtains. Set up dimmer night lights to ensure safe access to night-time toileting.
Reduce noise and distractions where possible. Encourage the person to go into a different room, go out into garden or accompany them on a short local walk.
When planning an overnight trip away from home consider taking familiar pillow, duvet, favourite family framed photo.
A rocking chair may help to calm a person. Some may benefit if you switch off the TV – try calming, meaningful music.
Finally, Be Kind to Yourself
You are human. None of us are perfect-especially during these times at home.
Sundowning occurs at the time of day when family/care partners are often tired themselves and in need of a break. Look after yourself and try to get enough rest.
Take care of yourself, as well as your family member who has dementia.
Feel free to contact us at Dementia Waikato if you need to talk about any issues you are having with the person you are caring for. Dementia Waikato staff are all working from home and can speak with you on the phone 07 929 4042 or via email email@example.com