What is Sundowning in the Elderly

Imagine an elderly parent, confused and exhibiting increasing symptoms of agitation, anxiety, perhaps crying, pacing, exit seeking, and/or paranoid hallucinations every night from dusk until the early morning.

This alarming phenomenon can be a nightly occurrence for some suffering with dementia, and is known as sundowning or sundowner’s syndrome. When an elderly person is affected by sundowner’s syndrome, these behavior changes are distressing and alarming for those providing care. A loved one may appear to be competent during the daylight hours until sundowning appears in the late afternoon and early evening. While there is no cure for sundowning, there are strategies for coping with the disorder’s symptoms.

Sundowning or sundowner’s syndrome frequently occurs in those with Alzheimer’s and other types of dementia. Sundowner’s syndrome is characterized by an escalation of bizarre behaviors including confusion, crying, rocking movements, agitation, depression and fear. Paranoid hallucinations and wandering are additional symptoms, which are the most troublesome for relatives and caregivers. Symptoms often increase at sunset and continue until the early morning hours. Suspicious and paranoid behaviors, such as accusing a loved one of stealing a wallet or having auditory or visual hallucinations can be common. No one knows what causes sundowning syndrome. According to the Mayo Clinic, there may be a correlation between decreased levels of melatonin in elderly dementia patients and distress in the evening. Other theories suggest that symptoms in those suffering may be due to their inability to cope with the stimulation or stressors they experience during the day.

If someone you love begins exhibiting these behaviors, the first step is a visit to a physician to rule out other issues that may be contributing to the behavior.  For instance, a simple urinary tract infection can wreak havoc on the mental state of a person with dementia, as can undiagnosed pain or reactions to certain medications.

While symptoms of true sundowning cannot typically be prevented, there are strategies for reducing disruptive behaviors in your loved one during the evening hours. Some suggestions include establishing a predictable routine to reduce anxiety and help loved ones feel secure during the day. When sunset occurs, closing the blinds and engaging in quiet and calming activities with your loved one can also reduce symptoms. Exercise during the daytime hours may help those with sundowner’s relax during the evening and sleep better at night. Other suggestions to relieve symptoms include light therapy and ensuring rooms in the house are well lit prior to sunset. Lastly, medication may reduce symptoms of depression, anxiety and paranoia, and can help establish nighttime sleeping patterns.  For those who are consistently up all night, or may be at risk of wandering out of the home, secure memory care facilities and some residential care homes can be the right solution.  Compassionate, trained staff are able to provide an increased level of care and supervision, as well as care during the nighttime hours. While there is no cure for sundowning syndrome, with patience, and treatment interventions, symptoms may decrease over time.

Author:  Michelle Graham, CSA, Certified Senior Advisor, CIRS-A, CAP, Eldercare Consultant, CEO and Founder of Graham & Graham Eldercare Consultants LLC

 

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