Sundowners Syndrome: Understanding End of the Day Behavior in Elderly Patients
For most people, the end of the day is a time to unwind and let the stress of the day go. It’s a relaxing time of day–a moment of transition between the frenetic energy of the daytime and the downtime of evening. But for the elderly, especially those suffering from dementia and Alzheimer’s disease, sunset can actually mean an increase in confusion, memory loss, agitation and anger. And for the caregivers and family members of those dealing with dementia and Alzheimer’s, facing these increasingly disorienting symptoms–known as sundowners syndrome–can be not only frustrating, but exhausting, painful, and downright frightening to witness.
Understanding the Triggers of Sundowners Syndrome
When it comes to dementia and Alzheimer’s patients, certain things will exacerbate or trigger the patient when it comes to the symptoms of sundowning. Among the most common reasons a patient might become agitated, angry, and confused at the end of the day or when their routine becomes compromised include:
Fatigue: Tiredness, especially after a busy day or when visitors have stopped by, is a particularly difficult trigger for many patients. Try and stick to a steady routine whenever possible, and get the patient to bed at the same hour every evening.
Excitement towards the end of the day: If the patient is in hospital or an assisted living facility, shift changes and extra activity towards the end of the day can often lead to confusion and anxiety, which in turn can cause anger and difficulties within the patient’s mind
Lower levels of light: As shadows increase and light levels begin to fall, patients with already bad eyesight can find themselves struggling to focus their vision even more–leading to frustration and anger
Seasonal Changes: As spring and fall fade into winter, the onset of shorter days and the decrease of available sunlight can increase depression, leading to a spike in sundowner symptoms in many elderly patients. Additionally, many researchers now point to internal, hormonal imbalances that can disrupt the patient’s biological clock, interrupting the wake and sleep rhythm
Helping a Patient Manage Sundowning Symptoms
Like its root cause, a cure for sundowners syndrome hasn’t been clearly established. However, a number of approaches and treatments have been known to help soothe and calm sufferers, alleviating the symptoms of confusion and agitation. Among the most successful of these approaches are:
Establishing a Regular Routine
Minimizing surprises and establishing a regular, daily routine will help your elderly patient feel safe. A daily schedule will help your loved one acclimate to a rhythm of activities, meal times and sleep, even if they aren’t necessarily aware of it. It also minimizes confusion and anxiety–especially as their cognitive function becomes more limited and they lose the ability to react to unpredictability. As a caregiver, try and schedule all high energy and out of the norm activities–including doctor’s appointments and family visits–for the morning hours whenever possible.
Keeping an Eye Out for Your Loved One’s Best Interests
As the caretaker for an elderly patient, you already know that there are a multitude of stressful situations that could make a sundowning loved one lash out in anger or confusion. But when that situation is something serious–or if you’re worried that your loved one simply isn’t receiving the kind of proper care they need, don’t be afraid to look into senior care and coordination with a skilled Connecticut elder law attorney. In the end, it may be the best step you could take for the one you love most.
Let Plenty of Light In
Light is a sundowning patient’s best friend. As sunset approaches, ensure that their room and surrounding areas are as well lit as possible before the sun begins to go down. Keep a nightlight on in their room at all times in case they need to get up in the middle of the night to use the bathroom. Many researchers and physicians suggest keeping full spectrum lights in the patient’s room to keep seasonal depression at bay, as well, as this can often contribute to sundowners symptoms.
Reduce Noise Levels
Like lights, noises can have a great effect on your loved one during a sundowning episode. You may find it helpful to turn down radios, televisions, and other loud household devices during the evening and late afternoon hours. If possible, do activities like laundry, vacuuming, and other loud chores earlier in the day. It’s also a good idea to encourage visitors to stop by during earlier hours whenever possible.
Understanding the triggers and causes of sundowning is essential to learning to control it; and providing some relief to both patient and caregiver.