Caregivers for the elderly may notice a change in the patient’s behavior in the late afternoon or early evening, when the sun begins to set. The patient might become confused and irritable, even demanding and suspicious. They’ll do and say things they otherwise wouldn’t. The symptoms may escalate to a state of delirium. This condition is called sundowning, or sundown syndrome.
Sundowning doesn’t affect every elderly person, but it’s seen in one in five patients with Alzheimer’s disease. The symptoms usually emerge during the middle stages of Alzheimer’s. Older people without Alzheimer’s can also be affected – especially those with memory problems, or those in nursing homes.
What causes sundowning? Scientists aren’t sure. The area of the brain that signals when you’re awake or asleep breaks down during Alzheimer’s, which may adjust the body’s internal clock. The collection of symptoms probably has a biological basis, according to researchers at Ohio State.
We do know that certain risk factors make patients more likely to slip into late-day confusion. Sundowning may be aggravated by:
- Low lighting and increased shadows
- Trouble falling or staying asleep
- Trouble separating dreams from reality
- Environmental factors (i.e. a noisy, bright hospital)
- Physical pain
If you’re a caretaker, you can take protective measures to reduce the risk of sundown syndrome for your patient.
- Maintain a predictable routine for waking, meals, and bedtime.
- Limit caffeine and sugar to morning hours. Avoid alcohol and nicotine.
- Limit naps during the day.
- Plan activities during the day, and include exposure to light.
- Schedule appointments and visits in the early part of the day.
- Limit evening exercise.
- Keep the evening meal small and simple, with a larger midday meal.
- Turn on lights in the evening, and close curtains and blinds.
- Reduce background noise and stimuli – including TV watching – in the evening. Play gentle music or relaxing nature sounds.
- Keep a night light on at night.
If your patient is in a hospital or care facility, here’s what you can do to prevent sundowning there.
- Bring equipment such as hearing aids, glasses and dentures.
- Let the staff know how the patient normally behaves, so staff members are alert to changes.
- Bring familiar objects and hobbies, such as crosswords and family photos, to orient the patient more comfortably. Keep them engaged in conversation.
- Encourage the patient to stay active if possible.
- Activity during late afternoon staff shift changes, or unstructured times in the evening, may cue late-day confusion. Try to have something planned for those times if you can.
Your patient may start to show symptoms of sundowning anyway. Here’s what to do if that happens.
- Remain calm and relaxed.
- Ask if they need something.
- Remind the patient what time it is.
- Don’t argue with the patient. Be reassuring.
- Let them get up and walk around if they want to. Stay close by.
- Keep the patient safe. Use locks on the doors and windows, and gates at the stairs.