“SUNDOWNING”
Sundowning is a pattern of behavior the occurs in elderly people and those who have dementia or Alzheimer’s. As the sun begins to set (hence the name) the elderly may 
may become agitated and confused. They may be fine during the day. My mother exhibited this behavior in varying degrees. When a caregiver or family member is caught of guard this experience can be alarming and quite perplexing. Once you understand what is taking place there are steps that can be taken to minimize sundowning.
The first time I experienced sundowning was one evening while I was visiting Mom. She was living in an apartment in a retirement community, but she had fallen and was not feeling well. I was staying with her for a few days while she was on the mend. As we sat together, side by side, eating dinner and watching TV, she turned to me abruptly and asked, “Where is your Dad?”
My father had been dead for eight years at that time. She was completely herself and lucid during the day at that point and her question caught me completely off guard. I didn’t know how to respond. Should I tell her the truth or go along with her delusion? I stumbled my way through it that night by reminding her that he had died. She looked surprised and was very upset, especially that no one had told her about his death. The question resurfaced again and again in addition to others over the next six months.
Sometimes I merely said, “He’s out” and she would go back to what she was doing. Other times she would push and insist until I told her the truth and then she would cry, each time experiencing his death like it had just happened. Dementia is usually caused by illness or mini strokes that have damaged a person’s brain cells. Sundowning is thought to be caused by correspondent damage of the person’s circadian rhythms, which is the internal clock that regulates the body’s physiological activities over a twenty-four hour period.
There are several things you can do to try to minimize the effects of sundowning. Here are a few:
- Keep the person active and awake during the day as much as possible. It makes it easier for them to fall asleep in the evening.
- Plan activities during morning hours and keep the afternoon activities calm and simple.
- When possible make sure the person receives morning sunlight and increase interior light before dusk.
- Keep your loved ones life and surroundings simple and uncluttered. A sudden change can make it worse.
- Sometimes confusion can be caused or aggravated by dehydration or hunger. Often the elderly turn away from food and drink, increasing the likelihood of deficiencies.
- UTI infections and other illnesses may cause sundowning and/or hallucinations.
This is an excerpt from my book Caring for Mom.
My Dad passed away at 87. My mom at 79. Am 64 as I write this. My first time to hear
(or learn) the word ‘sundowning’ and it’s meaning. I’d like to learn more about the subject
so I may be able to write about it extensively and open the consciousness of others who may have been experiencing this ‘event’ actively or passively without them knowing anything
about it. I’d like to help ease whatever difficulty it is they may be experiencing as a result
of this. Am a tv soap writer. Recommend any readings?
Thank you very much.
Many of us who work every day with people who have dementia believe that “sundowning” is really the outcome of overstimulation, environmental changes, communication issues, etc that often occur in the late afternoon/early evening hours. In many family homes, this is the busiest time of the day — adults and children coming and going, errands being run, dinner being rushed, etc. If it’s not busy in the home, it is the insecurity that comes with the thoughts of a person who has memory loss, such as “It’s getting late…where is my husband/my child…are they okay?…”.
At those times, it’s important to remember that the caregiver’s job is to provide safety and security for the person with dementia. Turn lights on brighter, make sure there is meaningful activity going on to occupy the person’s mind appropriately, tone down the “rat race”, shield him/her from family fights or heavy discussions, and maybe most importantly, GO WITH THE FLOW. Trying to rationalize with the person who has dementia serves no purpose. Instead, talk about happier times. If your mother says, “Where’s your dad?”, talk about things from her LONG term memory. Try saying, “oh, gosh, Mom, remember when we went to that cabin at Gatlinburg when I was about 10? Dad wanted to go find arrow heads and look at all the different trees. We all came back laughing about the critters we saw…that skunk was only about 25 feet away!…” — or “Dad always did like your meatloaf, Mom…how about we make that for dinner tonight. What will we need… (and then get up to make it or get out some pans like you’re thinking about making it. She just might follow along.)
One of the effects of dementia that can work to your advantage sometimes, is that the person often forgets they’ve just asked you a tough question. This will be especially true as you become more adept at distracting her and redirecting her activities.
There is absolutely nothing wrong with “going along with her”. It’s not lying. It’s therapeutic. You see, her brain is not able to handle the current truths — “current” is not a working concept for a person with short term memory loss. She NEEDS safety and security to function now. It’s our responsibility to provide that. If you ever need ideas to try, you can reach me at ellen@BeHomeLiveLife.com