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Making Sense of Sundowning

Updated: Oct 6, 2022

When you care for a person with dementia, it doesn’t take long before you hear someone whisper the expression, “He’s sundowning.” What is this mysterious word and what does it mean for a person with dementia and their caregivers?

What is Sundowning?

Sundowning is a syndrome and a label given to a group of symptoms commonly experienced by people with dementia in late afternoon or evening.  The symptoms can vary but typically include worsened confusion, anxiety and aggression as well as pacing or wandering.

Why Does it Happen?

Researchers don’t know exactly what causes sundowning behavior but there are a couple of theories.  It’s believed to be closely related to fatigue. As the day wears on a person with dementia gets tired, the same as a person without dementia. The difference though is that with a healthy brain, you can get a second wind to finish the day. For a person with dementia, their brain is less able to deal with the stress of the day and by late afternoon, they start to act out through their behaviors. Another theory is that sundowning is caused by changes in the circadian cycle and that sleep/wake patterns become disrupted because of dementia.

Tips for Dealing with Sundowning Behavior

What can you do if you care for a person with dementia who has late day confusion? It may take some trial and error, but the first step is to understand there are ways to help minimize the symptoms. Here are some tips:

  1. Observe the behaviors and record them in a journal to help identify patterns and possible triggers.

  2. Next, try removing the triggers. For example, the television can sometimes be problematic if the person thinks the scene is happening in real life. If it’s something scary, this can cause them to become anxious or afraid. Turn off the tv and play music instead.

  3. Stick to a routine for waking up, bedtimes, meals, exercise, and activities throughout the day. Most people benefit from a schedule, including a person with dementia.

  4. Exposure to sunlight earlier in the day can help. Get outside for a walk and fresh air.

  5. Create a soothing environment with soft music, a cup of tea, and a foot or hand massage. A rocking chair can simulate movement while at the same time be calming for a person who likes to walk a lot.

  6. Reminisce with the person by looking at photos or giving them special objects to hold in their hands and talk about.

  7. Give the person meaningful activities to occupy them. Ask for their help peeling potatoes, setting the table or tidying up from the day’s activities.

You may also want to consider having someone else help you for a few hours in the evening to prepare for bedtime. This will provide you with extra support at the end of the day and the person with dementia may respond well to a new face who presents a calm, friendly, and soothing presence.

Questions about caring for an elderly loved one with dementia? Takacs McGinnis can help. Just give us a call at 615.824.2571.


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