Sundowners in Elderly and How to Decrease their Troubling Effects

Sundowners in elderly adults can occur when one has dementia of any type. It is estimated that 60% of seniors in long-term care communities have behavioral issues associated with dementia or Alzheimer’s disease.

Sundowning in elderly adults can occur when they have dementia of any type. It’s estimated that 60% of seniors in long-term care communities have behavioral issues and/or psychological symptoms associated with dementia or Alzheimer’s disease. Unfortunately, family caregivers might not realize what’s causing this behavior or understand how to spot sundowning symptoms in their loved ones.

In order to address elderly Sundowning Syndrome properly, you need to know the symptoms to look for and the life changes that can make those symptoms worse. Additionally, it’s vital to make sure your elderly loved one is otherwise healthy, as something as simple as a urinary tract infection can create symptoms similar to Alzheimer’s disease and sundowning behaviors.

Here’s what you should know to understand Sundowning Syndrome and give your loved one the care they need throughout the day:

Symptoms of Sundown Syndrome in the Elderly

If your loved one has Alzheimer’s disease or another form of dementia, they’re likely experiencing both the behavioral and psychological symptoms of Sundown Syndrome. This occurs when the changes in their brain cause them to act out of character in the late afternoon and early evening.

They may struggle with basic tasks, become easily confused, and even lash out in anger at someone they love. Not only can this be hard for you to handle as a caregiver, but it can also come with significant sadness at the loss of the relationship you used to have with your loved one.

That said, it’s vital that you know what to look for when it comes to elderly Sundowning Syndrome. Then, you can spot problems quickly and adjust to benefit you and the person in your care. Typical symptoms of Sundowners in elderly adults include:

• agitation and frustration, often directed at loved ones
• confusion and a lack of understanding of simple information
• increased suspicion, even of previously trusted loved ones
• irritability with people, tasks, and the world around them
• disorientation, including getting lost in their home or neighborhood
• restlessness and fidgeting with their clothes, hair, or small items
• hearing/seeing things that aren’t there (hallucinations)
• yelling at loved ones, strangers, the TV, or pets
• accusing someone of stealing from or trying to harm them
• pacing back and forth or around their home
• ignoring directions or challenging authority
• mood swings that are unpredictable

You’ll typically notice these behaviors more frequently in the late afternoon and early evening hours, and they may improve later at night. Some dementia patients struggle with these issues throughout the day, depending on the stage of their illness, but most people with dementia experience a worsening of symptoms at night.

Often, sundowning symptoms continue to get worse as dementia patients progress in their illness, so being prepared for that potential is essential. The best time to get additional help and support for a loved one you’re caring for is before you reach burnout. Asking for help is a crucial way to protect yourself and your loved one.

Why Do Sundowning Symptoms Happen?

If you’re a caregiver for a person with Sundowning, you probably want some ideas for how to help minimize this difficult situation. Recent studies show that melatonin production may be decreased in these individuals due to the degeneration of the Suprachiasmatic nucleus of the hypothalamus. This causes a person’s internal clock to be thrown off, and they have difficulty with sleep at regular hours.

When sleep-wake cycles are off, this frequently triggers sundowning, but it’s not the only issue that can cause it. Changes to their regular routine, a decline in cognitive function, and any significant changes to environmental factors can also cause problems. Dementia patients benefit most from a consistent, calm, and regular routine.

Unfortunately, the medications used to treat Alzheimer’s disease and dementia, depression, and anxiety can cause side effects, too, making it difficult to treat the problem as fully as possible. While it’s important to use medications if they provide value and support, you don’t want to choose something that could increase sundowning symptoms in your elderly loved one.

Additionally, a person with dementia or Alzheimer’s disease often has trouble communicating when they have a need or a pain, leading to frustration and anxiety issues.

Disruptions in Routine Can Cause Increased Sundowning

While there are a lot of reasons your loved one might be sundowning, disruptions in their regular routine can cause symptoms to appear or worsen. This can include moving them to a new home, taking them to appointments or excursions, changing who cares for them, or replacing/updating the furniture in their living space. Even choosing different TV programs or getting a haircut sometimes triggers sundowning symptoms, depending on how sensitive your elderly loved one is to change. 

Over time, the disruptions that cause problems may become harder to avoid. Still, if you can keep everything in a routine, especially from the late afternoon until bedtime, you can make the day easier and less stressful.

Sometimes, it’s inevitable to disrupt a senior’s routine, especially if they have medical appointments or you need to transfer them to an assisted living facility or other new location. However, daily, it’s important to keep them as stable as possible and avoid arguing with them if it can be avoided. A calmer and more routine experience can make it easier to reduce agitation and other sundowning behaviors.

What You Can Do to Reduce Sundowning Symptoms

While sundowning symptoms in the late afternoon and early evening can be frustrating, the goal is to reduce them as much as possible. That helps your elderly loved one have a better experience and can make caregiving responsibilities easier. Some of the ways you 

can reduce sundowning symptoms in your loved one include:

• Keeping them busy throughout the day, getting some exercise, and limiting daytime napping. This will benefit their wake and sleep rhythm and reduce trouble sleeping at night, so they have fewer behavioral disturbances.
• Consuming sugar and caffeinated beverages only in the morning hours. It’s important to limit caffeine later in the day to reduce sleep issues and other behaviors in elderly individuals with dementia or Alzheimer’s disease.
• Keeping the lights bright during the day. Bright lighting in the home also helps with their elderly patients’ internal clock, and light therapy can improve symptoms of sundowning and sleep quality. During the late afternoon, it’s time to start dimming the lights to help reduce sleep problems, according to the Alzheimer’s Association and other professional organizations.
• Keeping background noise to a minimum in the evening hours can improve sleep quality in elderly patients and help with sleep-wake cycles. Noise and chaotic environmental factors are risk factors for dementia sundowning, especially after the evening meal.
• Maintaining a consistent bedtime routine, starting well before you turn the lights off. This helps their internal body clock understand the time and can improve circadian rhythms. Low lighting and a quiet environment are important for elderly individuals with sundowning symptoms, so they can experience a predictable routine and get enough sleep.
• Avoid fighting, confrontation, and arguing, as these interactions will cause more issues with sundowning and late-day confusion in older adults. While you can’t always prevent sundowning or find the exact cause, you can use watching television, familiar objects, family photos, and a structured routine to help your elderly loved one feel more comfortable.
• Getting in a patient’s personal space, restraining them, or using exaggerated hand gestures should all be avoided during sundowning episodes. If they become violent or you have trouble keeping them safe in their home, talking to their healthcare provider about the increased confusion and other issues is very important.
• Avoiding violent or emotional TV programs is essential, as these can increase sundowning behaviors, as well. Using a gentle voice, providing clear but firm instructions, and not trying to touch your loved one will aid in their trust and reduce confusion.
• If TV is part of your loved one’s routine, choose simple and non-violent programming such as the Home & Garden Channel or nostalgic shows familiar to them. That can reduce anxiety and lessen behavioral changes while keeping them calm until they feel tired and it’s bedtime.
• Ensuring their basic needs are met and they aren’t in pain is vitally important, and will decrease episodes of sundowning symptoms. If you can create a treatment plan with their doctor, it will help reduce behavioral changes and confusion. Still, as dementia patients progress, their symptoms may increase.

By minimizing stressful experiences for your elderly loved one, reducing bright light after dark, and using night lights to help them see familiar objects, you can improve symptoms. Not only does that help your loved one, but it also reduces your caregiving stress and gives you more time to spend with them.

How CarePatrol Can Help

At CarePatrol, we understand the serious nature of caring for loved ones with Alzheimer’s disease or other forms of dementia. That’s why we take Sundown Syndrome seriously. The mood swings, trouble sleeping, sleep-wake cycle problems, agitation, and other issues that begin in the late afternoon and last into the early evening hours can take their toll on aging adults and their caregivers.

We can help! Our Local Senior Care Advisors are focused on working with you to find the right assisted living space or other caregiving options for your loved one. Whether they need more in-home care than you can provide or it’s time to explore a memory care facility for them, knowing where to turn matters. Contact CarePatrol today, and we’ll help you find the right care option for your loved one.