Residents of senior care communities diagnosed with Alzheimer’s disease and other dementia-related disorders are at risk of Sundowning in the late afternoon and early evening. Sundowning symptoms can be very stressful for both residents and caregivers and may include increased mood swings, paranoia, hallucinations and delusions, increased confusion and disorientation, agitation, combativeness, wandering and elopement, to name a few.
The importance of appropriate and effective interventions to help manage symptoms and improve the quality of life for residents who Sundown cannot be emphasized enough. A good start is to rule out other potential health problems or disorders that may not be related to Sundowning. Medical intervention may also involve a thorough physical examination and a consultation from a psychologist or psychiatrist.
Can It Be the Medications?
Reviewing the resident’s medications is also important because some commonly prescribed medications in senior care can cause symptoms associated with Sundowning. Important questions regarding medications include:
- What kinds of medications are administered to the resident?
- What time of the day or night are they administered?
- Can a dosage be changed or titrated?
- What side-effects of the medications are being observed?
Some drug-induced side effects of medications include a condition called “akathisia” which is difficulty staying still and “tardive dyskinesia” which causes unusual movements, mainly of the mouth and limbs. Other side effects include muscle rigidity, orthostatic hypotension, and anticholinergic toxicity which involves tachycardia, constipation and confusion.
How Caregivers Can Help
While there are no medications specifically prescribed for Sundowning, some medications may help, including antidepressants and mild antipsychotics. Before any medication is ordered, nonpharmacological interventions should be the first line of help for residents who Sundown.
The Importance of Light
A good place to start is examining the environment in which symptoms regularly occur. Adequate lighting is important and may reduce the possibility of shadows which may be misinterpreted as hallucinations. Some experts believe that light therapy may be helpful for those who experience Sundowning. It is the most studied and used clinical practice for many health conditions including dementia and depression. It is believed that by increasing the amount of light in the evening hours can help the individual reorient themselves.
Negative Effects of Noise
Noise levels should be low so that they do not distract or overwhelm. Staff and visitors should be reminded to help keep the environment quiet and calm and to speak in softer tones and volumes. If the care community has overhead paging, it may be beneficial to remove it and use other ways to communicate in the building, as it may increase stress for residents with cognitive impairment.
Practical Methods
Beyond the environment, the caregiver is the most important source of help in managing symptoms and improving quality of life. Caregivers can start by getting enough rest themselves to better handle Sundowning situations. They can also provide meaningful activities and high-quality personal care during the earlier parts of the day. These can keep residents active and engaged throughout the day and more restful in the evening.
Caregivers should always be observant and even take notes on the who, what, where, why and when involved in Sundowning episodes. Look for patterns that may emerge and triggers that might lead to Sundowning. Some important questions include:
- Does Sundowning take place in a specific area of the care community?
- Does it occur at roughly the same time each day?
- Are there residents who trigger the individual to Sundown?
- Are there cues in the environment like exit signs, doors or windows that lead to Sundowning?
Final Thoughts on Managing Sundowning Symptoms
Sundowning can be very stressful to both the resident and staff. It can also lead to more dangerous situations like falls and elopement. Some prescription drugs may help manage symptoms, but there is nothing like good old-fashioned tender loving care with a person-centered approach to minimize symptoms and increase quality of life.
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