In the world of dementia care, the phenomenon known as “sundowning” has become a widely recognized term; however, our understanding of it remains limited. Many still struggle to recognize and effectively manage its manifestations. Sundowning, also known as “late-day confusion” or “sundown syndrome,” can be a distressing syndrome that affects individuals with dementia.
It is a term used to describe a cluster of dementia symptoms that typically worsen in the late afternoon or evening. Sundowning can vary in severity from person to person and can fluctuate from day to day. This phenomenon not only challenges the affected individuals but also puts significant strain on their caregivers and loved ones.
Some of the more common symptoms of sundowning include confusion, where the person struggles to recognize familiar faces or places, leading to disorientation. Restlessness and agitation are also common, often accompanied by pacing or fidgeting. Feelings of anxiety or fear may intensify during the late afternoon or evening hours. Additionally, some individuals may undergo distressing visual or auditory hallucinations. Sundowning can trigger a dangerous urge to wander, increasing the risk of disorientation and potential harm.
In severe cases, unmanaged or mismanaged sundowning may escalate to aggressive behaviour, such as yelling, hitting, or throwing objects. These symptoms underscore the complexity and challenges associated with sundowning, necessitating careful management, and support for individuals with dementia.
Possible Causes Sundowning
The exact cause of sundowning is not fully understood, but several factors may contribute to its onset. Biological clock disruption or changes in the internal biological clock, which regulates sleep-wake cycles, may play a role in sundowning.
Fatigue and overstimulation during the day, among individuals with dementia may make them more vulnerable to sundowning symptoms in the evening. In long-term care facilities, birthday celebrations, special holidays, and loud or excessive activities (and interaction with people) that are not part of the expected daily routines can also trigger sundowning.
Another possible cause for sundowning is sensory deprivation. For example, reduced light and increased shadows in the evening can contribute to the person’s confusion and disorientation.
People caring for someone with dementia should also pay attention to and consider medication side effects. Some medications commonly prescribed for dementia may worsen sundowning symptoms. Additionally, new medications or alterations in dosages may cause confusion, and disorientation, and affect sleep patterns, which can then trigger sundowning behaviours.
Last but not least, consider underlying medical conditions that can cause pain, infection, or other discomforts that can exacerbate sundowning symptoms.
Managing Sundowning Behaviours
When managing behaviours that occur during sundowning, it is important to remember that there is always a reason behind the behaviour. As discussed in the previous section, there are factors that can trigger these behaviours. Addressing the underlying conditions should always be the first-line approach to supporting someone with dementia exhibiting responsive behaviours. Medications, while appropriate in certain circumstances, may exacerbate these symptoms or create new side effects not expected, and should therefore be considered carefully before administering to a person with a diagnosis of dementia.
The following are non-pharmacologic approaches that have been shown to be effective in preventing and managing sundowning behaviours.
Establish a Routine
Maintaining a consistent daily routine can help regulate sleep-wake cycles and reduce anxiety.
Limit Stimuli
Minimize noise, light, activities, people interactions and other stimuli in the evening to create a calm and soothing environment.
Encourage Physical Activity
Engaging in gentle exercise or activities during the day can help reduce restlessness and promote better sleep at night.
Monitor Medications
Work closely with healthcare providers to review medications and address any potential side effects that may exacerbate sundowning symptoms.
Provide Reassurance
Offer comfort and reassurance to the individual during episodes of confusion or agitation, using a calm and soothing voice.
Consider Environmental Modifications
Installing night lights or using white noise machines can help reduce sensory deprivation and promote a sense of security.
As a Dementia Consultant and Educator, I have learned that despite the challenges of sundowning, there are more inspiring stories of resilience and adaptation that come from meaningful engagements between people living with dementia and their caregivers.
Through education and connecting with peers, caregivers have learned to employ creative solutions to manage changed behaviours. Finding humour, and gratitude and practicing calmness while caregiving can easily transform a stressful encounter into moments of joy, meaningful connections, and cherished memories.
By understanding the symptoms, causes, and management strategies associated with sundowning, caregivers can provide better support and care for their loved ones. While sundowning presents challenges, it’s also an opportunity for families to come together, find moments of joy, and celebrate the resilience of the human spirit.
Karen Tyrell CPCA, CDCP is a Dementia Consultant, Educator, Author & Advocate, and Founder of Personalized Dementia Solutions Inc. (www.DementiaSolutions.ca). Karen offers her expertise on dementia care through speaking engagements; workshops; support groups (both online and in-person) and by working one-on-one with families/caregivers to provide emotional support and practical solutions. She was also on the design team for The Village Langley (Verve Senior Living) and provides ongoing education to the Village team, families and the community. If you would like to learn more, please feel free to reach out.
DISCLAIMER:
The contents of this blog are provided for information purposes only. They are not intended to replace clinical diagnosis or medical advice from a health professional.