The Caring Corner®
Navigating the Shadows: Understanding Sundowning in Older Adults
If you are caring for a loved one with Alzheimer’s or another form of dementia, you might notice a striking shift in their behavior as the afternoon fades into evening. A family member who was calm and cooperative at breakfast might become anxious, agitated, or deeply confused by dinner time.
If this sounds familiar, you aren’t alone, and your loved one isn’t doing this on purpose. You are witnessing a phenomenon known as sundowning.
What is Sundowning?
Sundowning (sometimes called sundown syndrome) is not a disease itself. Instead, it is a group of symptoms—including confusion, anxiety, aggression, and pacing—that emerge or worsen during the late afternoon and evening hours.
According to the Alzheimer’s Association, it affects up to 20% of people living with Alzheimer’s, though it can occur in individuals with other forms of dementia or cognitive decline as well.
Common Signs to Look For
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Mood shifts: Sudden irritability, anxiety, suspiciousness, or intense mood swings.
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Restlessness: Pacing, wandering, rocking in a chair, or fidgeting with clothing.
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Verbal disruption: Repeating the same questions, yelling, or crying out.
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Disorientation: Becoming unsure of where they are, what time it is, or who familiar family members are.
Why Does It Happen?
Scientists are still working to pinpoint the exact cause of sundowning, but it is generally thought to be tied to a disruption in the body’s internal biological clock (circadian rhythm). For a person with dementia, brain changes can scramble the signals that dictate when to be awake and when to sleep.
Other common “triggers” that make sundowning worse include:
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End-of-day fatigue: Pure physical and mental exhaustion from trying to navigate a world that feels confusing all day.
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Changing light: Shadows casting strange shapes in the room, or low lighting making it harder to see clearly.
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Subconscious cues: Seeing family members cook dinner or get ready for after-work routines can trigger a restless feeling that they “need to go home” or “need to get to work.”
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Physical discomfort: Unmet needs like hunger, thirst, pain, or a full bladder that they can no longer easily articulate.
4 Practical Strategies for Caregivers
While you cannot always prevent sundowning entirely, you can take predictable steps to minimize its impact and bring comfort to your loved one.
1.Establish a strict daytime routine: Morning to Mid-afternoon.
Take Care of Yourself, Too
Caring for someone who experiences sundowning is incredibly draining. The end of the day is often when your energy is lowest, making intense behaviors even harder to handle.
Remember that your safety and well-being matter just as much as theirs. If the evening hours are becoming overwhelming, look into local respite care, ask another family member to take an evening shift, or speak to your loved one’s doctor about medical options that might help stabilize their sleep-wake cycles.
A Quick Reminder: Sundowning is a medical reality of cognitive decline—not a behavioral choice. Take a deep breath, control what you can in their environment, and meet them with reassurance.
