Welcome to Alicia’s monthly advice column where she’ll provide tips on caring for a loved one with dementia. Alicia Seaver is the Director of Memory Care at Bridges® by EPOCH and is a certified memory impairment specialist. This month’s topic is sundowning.
Most caregivers are familiar with the agitation and confusion commonly referred to as sundowning that can occur in their loved one once daylight starts to fade, but many, particularly those new to caregiving, can be unsure of how to help.
A couple of key points to know is that sundowning occurs in about 1 out of 5 people diagnosed with dementia and typically appears during the middle stages of the disease. While experts haven’t pinpointed precisely what causes the behavior, studies indicate that many factors, including changes to an individual’s internal body clock as a result of dementia as well as end-of-day fatigue, could contribute.
If your loved one is exhibiting this behavior, try these tips to help alleviate their agitation:
- Stay calm. Your loved one can pick up on your own mood, especially if you’re feeling frustrated, which could increase their agitation. Instead, reassure them that everything is okay and remind them what time it is as they may feel disoriented by the fading light.
- Create a soothing space. Put on calming music, turn on bright lights during the evening and engage them in a calm activity—like a card game—that you know they enjoy.
- Reduce distractions. Remove clutter from the area, turn off any loud sounds—like the TV—and kindly ask guests or other family members to leave or go to another part of the house.
- Try a walk or change in scenery. If they seem too agitated and want to move around, try accompanying them on a walk down a quiet, neighborhood path if it’s still light out.
You will also want to modify as necessary daytime routines to try to avoid or reduce the chance of sundowning behaviors altogether. Try these tips:
- Maintain a regular routine. This includes keeping regular wake-up, sleep and meal times.
- Plan activities for when your loved one feels their best. It’s important to provide mental stimulation and physical activity for your loved one, but I recommend planning activities for the morning and early afternoon.
- Keep the evenings calm. A full schedule is very tiring and stressful for individuals with dementia. Allow the evenings to be a soothing time during which they can wind down and maintain a normal sleep schedule.
- Avoid stimulants. Caffeine and alcohol can contribute to agitation, so avoid serving stimulants like coffee and black tea later than the afternoon.
- Expose your loved one to bright lights during the afternoon and keep your home well lit at night. Exposure to bright lights during the day—like spending time outside in their favorite spot in the yard—and into the evening can help their internal clock differentiate between day and night.
- Avoid large meals at night. A large meal could contribute to troubled sleeping.
- Note your loved one’s triggers. Create a list of any factors that seem to contribute to sundowning behavior. Writing it down will be a helpful reminder for yourself, but will also help others who provide care for your loved one.
It’s also incredibly important that you see to your own needs, which is why I recommend that caregivers routinely attend support groups. Support groups are a great way to meet other caregivers, while providing you an outlet to share your frustrations without fear of upsetting your loved one.
If you worry that your loved one’s sundowning symptoms are particularly severe or out-of-the-norm, please consult with a doctor.
If there is a topic you would like Alicia to discuss, please send suggestions to [email protected].