A person with Alzheimer’s or other dementias may experience challenging behaviours that are worse in the late afternoon to early evening, or when the sun starts to go down. Hence, the term known as “sundowners.”
Sundowning usually affects people in the middle to late stages of dementia. Late-day confusion is another name for sundowning. No one really knows the cause of sundowning as there are a few theories about what contributes to some of the triggers involved. The caregiver and the person with dementia both can benefit from reducing these symptoms.
It is known that stress and fear play the biggest role in sundowning. People with dementia may become stressed if they are feeling uncomfortable and do not recognize their surroundings and the changes in their routine, or if they are lost in their own thoughts. This makes it very important to maintain routine as much as possible. There are a few things one can do to reduce symptoms.
Let’s begin with trying to keep as much light during the evening as possible. As the sun goes down, shadows appear. Keep the room and area well lit. The sleep-wake cycle or the body’s circadian rhythm is thought to be related to sundowning. Although some people may become confused between night and day, staying busy with activities designed for the person’s cognitive ability level during the day is helpful in reducing confusion. Sleeping during the day with long naps will encourage night wandering, and in turn no sleep at night will promote fatigue. Fatigue is a known trigger for sundowning, and being well rested may help decrease it. While some of these suggestions are common, keep in mind that what works for one person may not work for another.
One of the key points is to remember or know the afternoon to evening routine of the person with dementia and try to mimic that with positive memories. If it was listening to music, then play relaxing music, or read to him if he used to read but is not able to now. Keep the activity with low stimuli and engaging so the person is not wandering in his thoughts, which can keep him uncomfortable. For some people, evening is family time.
And let’s not forget the power of a soothing touch. If your loved one seems frustrated or anxious, put your hand on his shoulder or knee and use comforting words. All people with Alzheimer’s and other dementias have the ability to sense when someone is sincere with them in the moment.
Q: Why would my granny sometimes trouble me to get dressed when I help her get dressed every day?
A: My answer to this would be to ask you, what is the nonverbal mood or attitude you are presenting to her? What is on your mind when you walk into her room to help? Are your thoughts something like this: “Another day to try and get Granny dressed; let’s hope it is better today,” while rolling your eyes and sighing? Or do you clear your mind of negative thoughts and walk in there with a positive approach to see what adoring or funny thing she will say or do today? Your granny can sense your mood. If you are in a hurry, sad or frustrated, she will pick it up. If you are uncomfortable inside, she will feel it and does not know how to respond. She just knows that it does not feel good and she wants to be away from you.
Another approach is to note if you are helping her to help herself or doing it for her. Allow her to do as much as she can to maintain independence. This is an area in which we as caregivers often treat our loved ones like children instead of like adults who need help. Even if we are hand-feeding our loved ones, we should never make them feel like children.
International Caregivers Association LLC has online video training for caregivers that can be helpful. Some of the videos are of no cost. The next Memory Care Support will be in June 2015. Date pending.
Send questions to [email protected] or call/text 486-4509.