Dementia & Alzheimer’s Tips for Caregivers and Family Members: Tip #2 – Recognize Sundowning

Memory Support Tip #2 – Recognize Sundowning

By Douglas Motter
President at Homestead Village Enhanced Senior Living.

One of the biggest challenges that caregivers experience with their older adult who suffers from
Alzheimer’s or Dementia is the agitated state known as “Sundowning.”  Sundowning is a well-recognized behavior symptom of Alzheimer’s due to its occurrence in the late afternoon and throughout the evening.  Behaviors exhibited include heightened confusion, anxiety, aggression, pacing and wandering.

According to the Mayo Clinic, Sundowning’s exact cause is unknown but a variety of environmental and internal factors might contribute or exacerbate the symptoms. These include low lighting, increased shadows, disruption of the body’s internal clock, fatigue and a possible infection such as a urinary tract infection.¹

The Mayo Clinic also offers tips² that might reduce the effects of sundowning. These include:

1. Structured day including routine for waking, meals, activities and bedtime;
2. Plan for exposure to light during the day to encourage nighttime sleepiness;
3. Limit daytime napping;
4. Limit caffeine and sugar to morning hours;
5. Keep a night light to reduce agitation due to surroundings that are dark or unfamiliar;
6. Reduce background noise at night such as TV;
7. Surround your older adult with familiar items such as photographs or cherished belongings;
8. Play familiar, gentle music such as sounds of nature – birds, waves;
9. Talk to your doctor if you experience a quick onset of sundowning as a medical condition could be contributing.
10. Some research suggests that a low dose of melatonin in combination with bright light during the day might reduce the symptoms of sundowning.

For family members visiting their loved ones in a memory support home, it is generally good to avoid sundowning times unless the staff request visits during that time to provide structure.  Likewise, making and receiving phone calls during sundowning is not recommended as the increased confusion and agitation often results in stressful interactions.  Plan your visits and phone calls when your loved one is most able to interact with you.  There is nothing wrong with letting the phone ring in the afternoon and evening if your loved one with sundowning is calling repeatedly at that time.  Answering those phone calls will only lead to stress and agitation for everyone.

For family members or caregivers caring for a loved on at home who is sundowning, it is not an easy task; but here some additional suggestions from the National Institute of Health (NIH)³:

• Reduce noise, clutter, or the number of people in the room.
• Try to distract the person with a favorite snack, object, or activity. …
• Make early evening a quiet time of day. …
• Close the curtains or blinds at dusk to minimize shadows and the confusion they may cause.

Remaining calm, practicing validation with your loved one and arranging for breaks periodically in the afternoon will help you cope with this very challenging behavior.

^{1, 2}  Mayo Clinic – https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/sundowning/faq-20058511#:~:text=The%20term%20%22sundowning%22%20refers%20to,lead%20to%20pacing%20or%20wandering.

³ National Institute for Health  – https://www.nia.nih.gov/health/tips-coping-sundowning