Caregiving

“SUNDOWNING”

Sundowning is a pattern of behavior the occurs in elderly people and those who have dementia or Alzheimer’s. As the sun begins to set (hence the name) the elderly may may become agitated and confused. They may be fine during the day.  My mother exhibited this behavior in varying degrees. When a caregiver or family member is caught of guard this experience can be alarming and quite perplexing. Once you understand what is taking place there are steps that can be taken to minimize sundowning.

The first time I experienced sundowning was one evening while I was visiting Mom. She was living in an apartment in a retirement community, but she had fallen and was not feeling well. I was staying with her for a few days while she was on the mend. As we sat together, side by side, eating dinner and watching TV, she turned to me abruptly and asked, “Where is your Dad?”

My father had been dead for eight years at that time.  She was completely herself and lucid during the day at that point and her question caught me completely off guard. I didn’t know how to respond. Should I tell her the truth or go along with her delusion? I stumbled my way through it that night by reminding her that he had died. She looked surprised and was very upset, especially that no one had told her about his death.  The question resurfaced again and again in addition to others over the next six months.

Sometimes I merely said, “He’s out” and she would go back to what she was doing. Other times she would push and insist until I told her the truth and then she would cry, each time experiencing his death like it had just happened. Dementia is usually caused by illness or mini strokes that have damaged a person’s brain cells. Sundowning is thought to be caused by correspondent damage of the person’s circadian rhythms, which is the internal clock that regulates the body’s physiological activities over a twenty-four hour period.

There are several things you can do to try to minimize the effects of sundowning. Here are a few:

• Keep the person active and awake during the day as much as possible. It makes it easier for them to fall asleep in the evening.
• Plan activities during morning hours and keep the afternoon activities calm and simple.
• When possible make sure the person receives morning sunlight and increase interior light before dusk.
• Keep your loved ones life and surroundings simple and uncluttered. A sudden change can make it worse.
• Sometimes confusion can be caused or aggravated by dehydration or hunger. Often the elderly turn away from food and drink, increasing the likelihood of deficiencies.
• UTI infections and other illnesses may cause sundowning and/or hallucinations.

This is an excerpt from my book Caring for Mom.