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Sundowning traits and how to manage them

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Posted on 23rd May 2018.

When you spend the early evening with a loved one who has dementia, you may start to notice changes in their mood and behaviour. It is incredibly common, with one in five people with dementia experiencing these symptoms, and is often referred to as sundowning.

Clock showing 4pm

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Sundowning is a term used to describe a period of behaviour changes in individuals who have dementia. Although it is most commonly associated with Alzheimer’s, it has also been found in vascular, Lewy-body and frontotemporal dementia.

During the late afternoon or early evening, many people who are living with dementia will exhibit behaviour changes such an increased sense of anxiety, agitation, or even anger. This neurological phenomenon can sometimes be challenging, especially if you are watching it happen to a loved one, but by learning to recognise the symptoms and find the possible causes, there are a number of ways you can help.

Jayne Vale, who is credited by Worcester University as a Dementia Specialist and is Helping Hands’ resident expert, explains, “Sundowning normally occurs from about 4-7pm, when the sun goes down and the mood in the atmosphere changes.” Read on to discover her select tips.

Reasons behind sundowning

While the direct causes of sundowning are not always clear, in many situations a number of ‘triggers’ or reasons behind the behaviour can be found.

Here are a few things that could heighten sundowning behaviour:

Daylight savings

Altering the clocks bring a change in routine and schedule. It can mean that people with dementia want to go to bed earlier or eat a different time. This can then result in a disruption of their usual sleeping pattern.

Routines from the past

Three to five in the evening is often a common ‘peak time’ for sundowning as this is when many parents would be collecting their children from school and cooking their evening meal. People who have dementia revert back to their younger selves and so the absence of this routine can be unsettling and can cause anxiety.

Feeling of being in the wrong place

As the evening rolls in, most people return to their homes where they settle in for the night. For someone who may not recognise the room they’re in, this can be quite distressing. They may say that they need to leave, insisting that they need to go home even though they are already there.

Pain relief medication wearing off

Their lunchtime medication may just be starting to wear off, resulting in some aches or pains returning. If a person is experiencing pain, it is natural for them to be agitated and unsettled.

Shadows cast around the room

In the early evening and as the sun is setting, many shadows can be cast from furniture, trees outside windows, and other people. People who are living with dementia can start to hallucinate and see these shadows as something ominous or frightening.

Helping to prevent sundowning

Resident dementia experts, like Jayne, regularly offer advice, support and insights to carers and families who are supporting someone with dementia. These are just a few tips of her tips on how to manage sundowning.

Try to keep the home well-lit in the evening or encourage them to sit by a window where they can be in natural sunlight. This can help towards reducing the chance of them hallucinating or seeing something in the shadows, but also works to reset their internal body clock.

Encourage your loved one to engage in something meaningful in the late afternoon, or mimic their past routine. By using their previous activities as a guide, you are allowing them to still feel productive and will help to avoid feelings of restlessness.

It is also important to establish whether they are experiencing sundowning or if there are any other factors contributing to their behaviour. They may be struggling to communicate and therefore becoming agitated in the process or experiencing pain they cannot describe.

Managing it as it happens

Handling sundowning as it happens can sometimes be difficult, especially if you are seeing your loved one showing signs of pain or anxiety but there are ways that you can help.

Jayne suggests,  ”Talk to them in a gentle, soothing voice and you may be able to reassure them. If you find that this does not work, suggest an activity to distract them from any fears.”

You could use distraction as a technique by suggesting going into a different room together to make a drink, going for a short walk or preparing dinner together – they can all be very effective. This method can help your loved one feel that they are still completing what they need to do.

During sundowning, you should also remember to listen carefully to the individual and try to find the source of their anxiety. A light touch can help to ground someone who is experiencing a sense of nervousness, and is also a good way of offering comfort.

Often, it can be as simple as being there for your loved one. Jayne shares, “Sitting close to them and gently placing a hand over theirs can be sometimes all they need.”

Kerry Wright