Whether you are a caregiver or a family member of someone living with dementia, you may notice changes in their behavior as you enter the late afternoon or early evening. Sundowning—also known as ‘sundown syndrome’ or ‘late-day confusion’—is a common manifestation among people living with dementia.
Late afternoon and early evening can be a challenging time of day for dementia patients as well as their caregivers and loved ones. Fortunately, there are a number of strategies that may help to prevent and manage sundowning in dementia patients.
In this article, we will discuss potential causes of sundowning in dementia patients and tips for coping with and managing sundowning.
Sundowning refers to the emergence or increment of neuropsychiatric symptoms, such as confusion, agitation, anxiety, irritability, and disorientation, occurring in the late afternoon and early evening. Based on data available from the Alzheimer’s Association, researchers believe approximately 20% of patients diagnosed with Alzheimer’s disease experience sundown syndrome. This clinical phenomenon has also been reported in other causes of dementia, including vascular dementia, frontotemporal dementia, and Lewy body dementia.
Although the underlying cause of sundowning in dementia patients is not yet fully understood, researchers believe sundowning may be related to impaired circadian rhythm, environmental and social factors, and impaired cognition.
More specifically, potential factors that may contribute to sundowning in dementia patients include:
Sundowning can be aggravated by feelings of hunger, thirst, fatigue, pain, and boredom. Other factors, such as side effects from medications or changes in daily routine, can also contribute to the phenomenon.
In the early afternoon and early evening be cognizant of the patient’s behavior. Watching for signs, such as pacing, wandering, shadowing (closely following you wherever you go), crying, and other confusion- or anxiety-related behaviors.
To help patients cope with and manage late-day confusion, be sure to take the time to listen to their frustrations and concerns. Always be patient, bring a comforting presence, and try to understand the potential causes of their behaviors. Offer reassurance that they are safe and everything is alright. Take notes on the timing of sundowning and activities that occur beforehand to help identify potential triggers.
You may also consider:
In addition, keep in mind that it is not always sundowning—similar behaviors can result from other feelings or needs such as needing to use the bathroom, being hungry or thirsty, or being in pain.
While these behavioral changes are not always preventable, there are steps you can take that may help prevent sundowning and manage sleep issues associated with dementia. You may consider:
Caregivers and family members may also consider talking to the patient’s healthcare team about other solutions or other potential causes of sundowning-like behaviors, particularly if non-drug approaches are unsuccessful.
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