When someone has been diagnosed with Alzheimer’s or dementia, agitation, confusion, and aggression are some of the most challenging behaviors for caregivers to handle. These behaviors can worsen in the late afternoon or evening, a syndrome known as “sundowning,” which affects 1 in 5 people with Alzheimer’s. Other symptoms of sundowning include anxiety, yelling, restlessness, and hallucinations.
It’s distressing to watch, especially when you feel like there’s nothing you can do to fix the situation. We sat down with Dr. Elaine Healy, our vice president of Medical Affairs, to find out more about these difficult behaviors and what we, as caregivers, can do about them.
Q. What are the causes of sundowning?
A. Dr. Healy: We don’t really exactly what provokes the body’s response in this way, but we do know it has to do with the deterioration of the brain’s architecture and changes in brain chemistry resulting from Alzheimer’s and dementia. It may be the body clock is not functioning, as it should. It can be brought on at the end of the day by fears of lower lighting, shadows, and the dark as night approaches. Those with dementia or Alzheimer’s may not be able to articulate their anxiety, which provokes a stress response. There may also be environmental factors that worsen sundowning symptoms.
Q. What are some of those environmental triggers that worsen sundowning?
A. Think about it this way: consider one’s basic hierarchy of needs, starting with physiological. Is your loved one in pain? Does he need to use the bathroom? Is she hot or cold or hungry? Then go up the chain to other things: the person may be too stimulated or irritated by loud music or television or noise. Or, perhaps there’s not enough stimulation and boredom has set in. It could be a yearning for something the person can’t articulate. It may be that at that at that time of day, she used to make dinner for a spouse or take the dog for a walk.
Q. So, what are some ways caregivers can cope with sundowning?
A. First, you want to address their physiological needs: take them to the bathroom; adjust the temperature or remove a layer or clothing; check their skin for a rash; ask them if anything hurts or if they have eaten; turn down the TV or change the music to something they prefer. Second, to address the symptoms more holistically, think about the flow of their days. Is there a structure? Do they get exercise and fresh air? Have you built in time to rest? As evening approaches, can you plan calming activities? Our approach to memory care is to tailor activities to individual interests but also structure our residents’ days. If you keep to a routine, build in active periods during the day and quiet times in evening, it can reduce the agitation associated with dementia.
Q. When should I seek outside help?
A. If you have tried everything to cope with sundowning and other challenging behaviors associated with Alzheimer’s and dementia but you are still struggling as a caregiver, you may need to consider asking for help. That may mean turning to others in your family for help, or seeking the services of a healthcare provider. If you want to keep your loved one at home, a home care agency can provide a clinical and environmental assessment and make some recommendations. If you need to recharge your batteries, you may consider respite care, which may help you keep your life in balance. You may also consider moving your loved one to a facility dedicated to caring for those with Alzheimer’s and dementia.