Column 8 – “Sundowning” With Dementia

Years ago when I was working as a personal care worker I worked a variety of hours. My shift of choice was nights, but I worked many evenings as well. At the end of the 7 a.m. – 3 p.m. day shift, many people were having naps so the first thing the evening shift did was to help people get up, assist them to the bathroom and then get freshened up for supper.
On the evening shift, one issue we sometimes had to consider is now called ‘sundowning’. Some people with moderate or advanced dementia can at times exhibit mood swings, become suspicious of others, or even experience hallucinations where they hear or see things that aren’t really there.
As a caregiver living with someone with dementia it can be difficult to cope with the routines and approaches that are needed to deal with responsive behaviours, especially sundowning. And that is because of fatigue; you are tired as the result of round-the-clock care. The strain of sundowning can turn stress into distress if the caregiver is unable to help relieve the sundowning actions.
Although sundowning decreases as the disease progresses there are steps that can be tried to reduce the behaviours – understanding why sundowning is occurring can help. Although it’s not known what causes sundowning, one theory is that as the disease affects more and more of the brain, over time it can hit the part of it that controls the body’s 24-hour clock. Some things that may heighten the risk for sundowning and not sleeping well are health concerns such as constipation, infections and pain. Other risks are too many medications, poor diet – including drinking too much caffeine – and a lot of background noise in the late afternoon or evening.
But there are things that can be done to help, like talking to your doctor or nurse practitioner about reviewing medications to ensure they are currently needed, up-to-date and being taken correctly. It is also very helpful to have a routine that includes lots of light and movement throughout the day, followed by a more calm evening. Some people find that having a couple hours of exposure to sunshine or a full-spectrum light in the morning can reduce problems later in the day. Pastimes like watching TV or reading may be too difficult in the evening for someone with dementia. Calm and soothing activities such as listening to music or a CD with sounds of nature, may be preferable in late afternoon or evening. Keeping the home well lit can also be good to keep the brain informed that it is still day time. If the person living with dementia is feeling distressed, a hand massage, especially using lavender or lemon balm scents, can be helpful. Planning to spend a half-hour before or after supper listening to music and holding hands with your loved one as part of the regular routine can sometimes make a big difference as well.
Keeping a brief journal of what the day can look like and how the person responds and appears to feel about their day can help identify if something triggers an agitation. Whether the person living with dementia is being cared for by family members or by professional caregivers, having a routine and identifying situations that cause distress are important.
It can be very difficult for caregivers to remain healthy themselves through these difficult times that sundowning can create. Not only will taking steps to reduce sundowning help, but reaching out for help and support is also important. Please take the time to call the Alzheimer Society of New Brunswick at 1-800-664-8411, for information that could help you to better understand how your loved one is being affected by dementia. There are also great resources right here in our community, like the monthly Memory Café held the last Sunday of each month from 2-4 p.m. at the Sackville United Church where you and your loved one living with dementia can go and socialize in a safe environment. There is also the Sackville Caregiver Support Group that meets the first Thursday of each month at 7 p.m. at the Bill Johnstone Memorial Park building where caregivers can share, learn and support each other in a safe, confidential environment.
Learning to deal with the issues of sundowning can make life easier for both you and your loved one as you live each day with the effects of dementia.