We’ve all heard the term “Sundowning” for years, but what exactly is it? Why does it happen, and how do we provide better care to the person who experiences Sundowning? This phenomenon is associated with cognitive impairment from certain types of dementia, especially Alzheimer’s disease. Not everyone with Alzheimer’s will Sundown, making it somewhat baffling to experts in the field.
What is Sundowning?
Sundowning has been characterized as not a condition, as much as a set of symptoms experienced by some individuals diagnosed with various forms of dementia. These symptoms include increased confusion, agitation, disorientation, anxiety and restlessness in the later afternoon and early evening.
The condition can be worse after the individual moves into a senior care community, after a hospital stay or when his or her routine has been dramatically altered. Older adults and seniors living in care communities may become more demanding of staff, upset more easily, become suspicious of others, and experience hallucinations or delusions. Their attention span and concentration may also become more impaired. Some individuals may become more impulsive and act out in ways they normally would not.
Some experts believe that Sundowning is the second most disruptive behavior (after wandering) among residents with Alzheimer’s or dementia living in senior care communities. It is estimated that around 20% or 1 in every 5 residents with Alzheimer’s, vascular dementia and mixed dementia will experience Sundowning.
Some experts believe that this syndrome causes disruption in the body’s sleep-wake cycle leading to more behavioral issues later in the day. Some behaviors can last much longer throughout the night.
Behaviors Exhibited During Sundowning Episodes
There appears to be a hyper-alert response in many people who experience Sundowning, which generate a number of behaviors including:
- Increased confusion and disorientation
- Anxiety and agitation
- Pacing and restlessness
- Hallucinations and delusions
- Impulsiveness
- Wandering
- Screaming and yelling
These behaviors can also lead to more serious problems including falls, accidents, increased wandering or elopement, and harm to one’s self or others. Studies show an increase in Sundowning and related behaviors, as well as accidents, between 6pm and 8pm. This phenomenon has also been associated with greater difficulty managing behaviors and providing care. It is no wonder why Sundowning is also associated with greater caregiver stress and burnout. Some behaviors, like aggression or agitation, can put caregivers at higher risk of physical injury.
Final Thoughts on Sundowning
Sundowning has been a puzzling occurrence among individuals diagnosed with Alzheimer’s disease and other dementias, as well as those who care for them. It is not a diagnosis itself, but rather a set of neuropsychiatric symptoms that occur later in the day. These behaviors, unfortunately are associated with many negative outcomes including falls and accidents and caregiver stress. Much research is needed to determine why it happens, and to only certain individuals with Alzheimer’s and other dementia-related disorders.
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