The image above gives us a sense of beauty, an incredible sign that our day will soon end and we will rest. For some people with dementia the sun going down causes anxiety, behaviors, and agitation.
This is known as Sundowners Syndrome.
People with sundowners syndrome think they need to "go home" when the sun goes down. They aren't cognizant that they are "home" already, whether it be in a nursing facility or in their own home.
Sundowning refers to agitation and hyperactivity that begins in the early to mid afternoon and worsens over the course of the evening. Nocturnal agitation or sundowning is common in persons with dementia and as many as 25% of mid-stage demented patients will develop this symptom. The appropriate intervention for sundowning is: 1) assessment, 2) behavioral management, and then 3) pharmacological interventions. Sundowning can be a troublesome behavior in the nursing home and exhausting to family caregivers.
Common Sundowner's Syndrome Symptoms:
These symptoms, which are also symptoms of Alzheimer's Disease and other types of dementia, include:
Rapid mood changes
Anger
Crying
Agitation
Pacing
Fear
The most difficult symptoms to deal with are:
Hallucinations
Hiding Things
Paranoia
Violence
Wandering
These symptoms can be dangerous, both for the person with the Syndrome and for anyone around them.
No one is sure what causes sundowning, although it seems to result from brain disease. People with dementia tire more easily, even with very few demands on their thinking ability. They generally become more restless and hard to manage when tired.
Treatment for sundowners syndrome is generally limited to the underlying condition which triggers it. Alzheimer's disease or clinical depression. Antidepressants may lessen the severity of the confusion, while the Alzheimer's drugs, such as Aricept may improve cognitive function. Since sundowners syndrome is closely associated with sleep disorders and fatigue, sedatives and other sleeping aides may also help. Caregivers suggest encouraging several naps throughout the day and limit stimulating activities to the morning hours.
In my many years of caregiving I have nearly always worked evening or night shift. Sundowners syndrome is real. Usually right after dinner the behaviors begin. Some pack all their clothes up and wait for the taxi, some want to call their parents because they may be worried, some just pace, with no apparent destination. These behaviors account for increased falls during the evening hours, increased elopement risk, violence at times, directed at staff and other residents.
Each case is very individual and as caregivers you learn to deal with each resident. We call the resident's mom which may be as easy as calling the next nurses station and reassuring the resident that spending the night is okay. We give out phone books so the resident will try and locate the number of their family. Therapeutic fibs are used, not to deceive but to make things tolerable for the resident. The anxiety they are feeling is very real.
"What lies behind us and what lies before us are tiny matters compared to what lies within us."
-Ralph Waldo Emerson-
