I recently did an informal survey to find out how many people were familiar with Sundowner’s Syndrome (or sundowning behavior) in dementia. The results were mixed…professionals who had worked in eldercare, especially in care facilities, were pretty aware of this concept. Most family caregivers and the general public were not, or had never heard the name for it even if they had experienced it.

Sundowner’s syndrome or sundowning describes the worsening of symptoms, especially confusion, agitation and restlessness, in persons with dementia in the late afternoon/evening (sundown) hours. The exact causes are unknown, but likely to relate both to the light/environment and habits from throughout life of this time being a time of change or expectation (i.e. time to leave work and return home, time to have dinner ready for the family, etc.) that thus impact our circadian rhythms/internal clock.  You can read more along with tips for Alzheimer’s caregivers who experience Sundowners Syndrome.

As an Alzheimer’s caregiver, you can anticipate this time frame and try to plan accordingly. It may be a bad time to have your loved one running errands or attending an event, especially if it has already been a long day and he/she is feeling tired.  A calm, quiet environment may be best.  Or, at least, you may be better able to manage things in an environment where you have more control.

At the same time, distraction and activity can help. It may be a good time for “busy work” or an activity which keeps your loved one engaged yet calm. He or she may also need more reassurance and redirection during these hours. Music can be soothing, or consider engaging the person in reminiscence or storytelling.

Sometimes finding the root cause of the agitation can help you find solutions. Your loved one may get hungry or have a drop in blood sugar at this time. There may be a “worry” that agitates him or her, such as the need to get home or imagining some scenario.  Without arguing about the reality of these situations, you can often “find a solution” (whoever said caregiving didn’t require creativity?).

Additionally, there may be things your medical provider can suggest to help with physiological causes. Light therapy has shown some success in this area. Your loved one’s doctor may wish to adjust medications or timing of dosages.

For someone with dementia, transitions can be especially tough. You may want to read our previous blog article, Hospitalization Considerations for Persons with Alzheimer’s Disease.  If your loved one suffers from sundowning behaviors, make sure that providers know about this and understand what might trigger or worsen the behaviors and what helps. If your loved one does not have a one-on-one caregiver, the sundown hours may be a time to have that one-on-one care available (whether at home, at hospital or an assisted care facility, especially after a transition).  Consider hiring an Alzheimer’s Specialty caregiver or rotating family members to stay and help.

Shannon Martin, M.S.W., CMC, is Director of Communications at Aging Wisely, LLC (http://www.agingwisely.com), a professional care management and patient advocacy organization and EasyLiving, Inc. (www.easylivingfl.com), a licensed home care agency, in Clearwater, FL.  Shannon served as adjunct professor at Eckerd College in St. Petersburg, FL, where she created a course on “Eldercare”.  Prior in her career, Shannon served as social services director and admissions coordinator in an assisted living/skilled nursing facility and worked as a social worker and volunteer coordinator for a large hospice.   

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