The Caring Corner®
Sundowning in Elderly: Understanding and Managing Late-Day Confusion
Sundowning, also known as late-day confusion, is a group of symptoms that can affect some elderly individuals, particularly those with dementia like Alzheimer’s disease. It typically occurs in the late afternoon and early evening, as daylight begins to fade. During this time, a person may experience increased confusion, anxiety, restlessness, and even hallucinations.
Understanding sundowning and its potential causes can help caregivers provide better support and create a calmer environment for their loved ones.
Symptoms of Sundowning
The most common symptoms of sundowning include:
- Increased Confusion: The elderly person may become disoriented, have difficulty following conversations, or struggle to recognize familiar faces and places.
- Anxiety and Agitation: They might appear restless, pace around, or express nervousness and worry.
- Changes in Mood: Irritability, anger, or tearfulness are common during sundowning episodes.
- Sleep Disturbances: Difficulty falling asleep or staying asleep is frequent.
- Hallucinations: The person may see or hear things that aren’t there, which can be frightening for them.
- Wandering: They may have the urge to wander or leave their home, potentially due to confusion or a desire to find something familiar.
It’s important to note that not everyone with dementia experiences sundowning, and the severity of symptoms can vary greatly.
Causes of Sundowning
The exact cause of sundowning is unknown, but several factors are believed to contribute:
- Changes in the Sleep-Wake Cycle: Dementia can disrupt the body’s natural sleep-wake cycle, making it harder for the person to distinguish between day and night.
- Reduced Light Levels: Decreasing daylight may contribute to confusion and disorientation, especially for those with vision problems.
- Unmet Needs: Hunger, thirst, or pain can worsen sundowning symptoms.
- Sensory Overload: Loud noises, bright lights, or too much activity can be overwhelming and lead to agitation.
- Environmental Changes: Being in an unfamiliar environment can increase anxiety and confusion.
Managing Sundowning
While there’s no cure for sundowning, there are ways to manage the symptoms and create a calmer evening routine:
- Maintain a Consistent Schedule: Sticking to a regular sleep schedule, mealtimes, and activity times can help regulate the body’s internal clock.
- Maximize Light Exposure: Ensure the person gets enough natural light during the day and keep the home well-lit in the evenings.
- Create a Calming Evening Routine: Engage in relaxing activities like listening to soothing music, taking a warm bath, or reading familiar stories before bedtime.
- Reduce Stimulation: Avoid loud noises, bright lights, and stimulating activities like watching television in the evening.
- Address Underlying Needs: Ensure the person’s basic needs for food, hydration, and comfort are met.
- Provide Reassurance: Speak calmly and patiently, validate their feelings, and avoid arguing.
- Create a Safe Environment: Secure windows and doors to prevent wandering, and remove any potential hazards from the home environment.
When to Seek Help
If sundowning symptoms become severe or difficult to manage, it’s important to consult a doctor. They can rule out any underlying medical conditions that might be contributing to the problem and recommend additional support or medication if needed.
Remember, you are not alone. There are many resources available to help caregivers cope with sundowning. Support groups, educational programs, and professional in-home care services can provide valuable guidance and assistance.
By understanding sundowning and implementing these strategies, caregivers can create a more comfortable and manageable evening routine for their loved ones.
