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Dementia Care: What is Sundowning?

Sundowning is a distressing symptom that affects people in mid- to late-stage Alzheimer’s and other forms of dementia. Also known by the term ‘late-day confusion’, it refers to the agitation and confusion often experienced by those with dementia towards the end of the day - hence the term ‘sundowning’.

What are the Symptoms of Sundowning?

Sundowning doesn’t affect everyone with Alzheimer’s and dementia, but up to 20% of those with Alzheimer’s can expect to experience these symptoms at some point.

Early signs of sundowning are often seen in people who have been living with dementia for some time, and as the condition progresses, the symptoms tend to worsen. Those with dementia can become hyperactive, agitated and confused, and these symptoms can extend into the night, causing sleep disruption.

What Causes Sundowning?

The exact causes of sundowning are not known, but it is thought that dementia damages the body’s circadian clock, which dictates the body’s daily rhythm. Moreover, the strain of dealing with dementia on a daily basis means that people with dementia have low energy reserves by the end of the day, with a tendency to become tired and irritable.

People heading towards the later stages of dementia may be depressed by the condition, but unable to express their feelings appropriately. They could be bored, tired, hungry, thirsty or in pain, but with no way of making their feelings properly felt, they become agitated. This can disturb their sleep, leading to further problems the following evening.

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How to Deal with Sundowning

Watching a loved one becoming irritated and hyperactive can be distressing for other family members, but it’s important to remember that the individual is not in control of their actions. Raising your voice or becoming angry will only worsen the situation, so try to remain calm, no matter what the provocation.

The most important thing to do is to ensure that your loved one has a routine tailored around the sundowning behaviour to eliminate it as far as possible. To this end, it is helpful to draw up a timetable or schedule, ensuring that busy activities and outings are arranged for the morning when your loved one is feeling at their best. Once you have a routine in place, it’s essential to stick to it, as changes can encourage further bouts of sundowning.

During the afternoon, try to engage your loved one in calming activities that don’t require too much thought. The aim is to undertake simple and engaging activities at this time, ones that aren’t too stimulating. Make sure that any clutter is tidied away, as this can cause aggravation later in the day.

Try not to let your loved one have an afternoon nap if possible, as this may contribute to confusion later - if they have to take a nap, ensure that it doesn’t last too long.

Make sure that food and drink are made available throughout the day. Also, try to rule out anything causing pain or fear, as these can contribute to sundowning behaviour.

Consider the use of light therapy, which makes use of bright daylight-tones to help stimulate the brain. Some families find that light therapy is helpful in the mornings, while others favour its use around twilight, to reset the body’s biological clock and restore the circadian rhythm.

Every person with dementia is unique, and there is no ‘one size fits all’ approach. Keeping a detailed diary of your loved one’s symptoms and behaviour can be a useful way of identifying triggers.

Sundowning and Care at Home

Alzheimer’s and dementia can be difficult conditions to live with, not just for your loved one but also for the extended family. That’s why more and more people are turning to live-in carers to help with loved ones who are in the late stages of dementia. Employing a highly trained and compassionate caregiver can be a relief to families who are struggling to cope with the demands of the disease, and the peace and calm that a skilled carer can bring to a household are beneficial for everyone.

Live-in carers can provide a range of elderly care services, from simple companion care through to the specific demands of dementia care. They remain calm under pressure and can cope with emergency situations, making them a great option for families who are concerned about residential care for their loved ones. They can provide genuine support throughout the day and night, which can make a significant difference for families who are finding things challenging.

Even if you think that you are coping well with your loved one, a period of live-in respite care can be helpful for anyone dealing with the particular demands of sundowning, allowing you to return from a short break or holiday refreshed and ready to face the challenges ahead.

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