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Understanding Sundowner’s Syndrome in the Elderly

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Sundown syndrome (also known as sundowning or sundowner’s syndrome) refers to a set of neuropsychiatric symptoms that occurs in older adults suffering from middle to late-stage Alzheimer’s or other forms of dementia. Alzheimer’s is a progressive neurological condition.

Dementia is considered one of the most prevalent forms of Alzheimer’s. Dementia symptoms can include memory loss, mental confusion, difficulty performing routine day-to-day tasks, drastic changes in mood and behavior, and increasing forgetfulness.

Symptoms of dementia can worsen over time. In most cases, it culminates in the patient’s complete inability to care for one’s self.

Contrary to what many people believe, sundowning is not an illness. Rather, it is a group of symptoms that manifest at certain times of the day. Also known as “late-day confusion,” agitation and confusion often begins in the late afternoon and evening.

Awareness of sundowning should be a part of dementia care planning. Inability to deal with the symptoms effectively can be very stressful for both the patients and the caregivers.

Sundowning in a Nutshell

While the definite reason for sundowner’s syndrome is not known, some researchers believe it is caused by a disruption in the Circadian rhythm or the individual’s natural body clock. Circadian rhythm disruption may cause frustration and irritation.

Symptoms of Sundowner’s Syndrome

In its early stages, symptoms of sundowner’s syndrome may be subtle and inconsistent. That said, they are always challenging to notice at first. However, early signs of sundowner’s syndrome include agitation, restlessness, confusion, irritability, and disorientation.

As the condition progresses, it is possible for some of the symptoms to become more pronounced and consistent. At its peak, sundowning symptoms often manifest late in the afternoon and can go long into the night. Other common symptoms of sundowning include:

  • Delusions;
  • Anxiety;
  • Anger;
  • Fear;
  • Paranoia;
  • Extreme agitation;
  • Hallucinations;
  • Crying;
  • Restlessness;
  • Wandering or pacing;
  • Rocking;
  • Depression;
  • Emotional outbursts;
  • Difficulty sleeping.

The onset and timing of behaviors often varies from one patient to another. In many cases, symptoms interfere with the patient’s sleep. For patients with poor eyesight or hearing difficulties, some of the behaviors can be compounded. Symptoms can also fade over time, stop abruptly, or change.

Factors that Aggravate Sundowning

Many individuals with Alzheimer’s and other forms of dementia can become quickly disoriented. That said, they become more prone to sundowning and some of the difficult behaviors that are often associated with the condition. While the exact cause is still unknown, some factors are believed to worsen the symptoms.

Some of the factors that can provoke sundowning include:

  • Fatigue, mental exhaustion, and lack of sleep;
  • Consuming an alcohol close to bedtime;
  • Faded and low light and increased shadows that often cause confusion and fear;
  • Underlying health issues like infection;
  • Dehydration or hunger;
  • Boredom, depression, or stress.

Sundowner’s syndrome can increase the likelihood of injury in individuals with dementia. In some cases, patients can fall or remove a necessary medical device. They can also become violent and highly agitated, which sometimes results in injury to themselves or others.

Research published in Psychiatry Investigation indicated that sundowner’s syndrome might speed up the mental decline of patients with Alzheimer’s disease.

When to See a Doctor

At times, it can be difficult to distinguish between sundowner’s syndrome and delirium. In older adults, underlying conditions such as urinary tract infection (UTI) can cause identical symptoms to sundowner’s syndrome. Changes in the medication or adding a new medication may also result in similar symptoms.

If an elderly loved one starts to behave in an unusual way, especially during the evening, seeking medical attention is recommended. While no definitive test can detect sundowner’s syndrome, doctors will ask about the patient’s symptoms so other possible causes can be ruled out.

Ways to Manage Sundowner’s Syndrome

Several factors can worsen the symptoms of sundowner’s syndrome. Fortunately, there are proven methods that can help manage sundowning behavior. If you are looking after a loved one with Alzheimer’s or dementia, it is ideal that you pay attention to whatever it is that triggers their behavior, so you can decide which of the following tips can help:

Establish structured activities and routines

Avoiding napping and maximizing activities early in the day can help patients fall asleep faster and more soundly at night. Any challenging or stressful tasks should be completed in the morning or early afternoon. Establishing a routine can also bring comfort and predictability to seniors and minimize confusion or agitation.

Simplify the surroundings and adjust their sleep environment

As much as possible, it is ideal to avoid too much sensory stimulation at home as it might lead to anxiety and confusion. It is also best to remove any excessive physical, visual, or auditory clutter.  Ensuring the patient’s environment is cozy and comfortable can also go a long way towards helping them relax.

Modify lifestyle behaviors

There are specific lifestyle changes patients can make to help effectively manage sundowner’s syndrome. Some lifestyle modifications that can help manage sundowner’s syndrome include:

  • Getting some exercise or light movement during the day
  • Avoiding tobacco, caffeine, and alcohol
  • Refraining from using electronic devices during the night or before sleeping

Minimize their stress

Keep your loved ones calm during the evening by encouraging them to engage in simple activities that are not too frustrating or challenging. If they become too stressed or frustrated, it might only add to their irritability and confusion.

If they have advanced or mid-stage dementia, even reading a book or watching television can be difficult for them. In line with this, consider fostering a quiet and calm environment. Playing soft music for them would be a good start. It would also be a good idea to encourage them to snuggle with a beloved pet to help them relax.

Provide familiarity and comfort

People who are sick would like to be surrounded by comforting things, people, and thoughts. Your elderly loved ones are no exception. For patients with dementia, the world can be a scary place.

Ensuring they are comfortable in a place that’s familiar to them can help them effectively cope with this challenging time in their lives. Create a familiar and comfortable environment for your loved one by furnishing their place with items they cherish.

If they move to an assisted living facility, have them bring their favorite blanket with them or anything else that provides comfort and makes them feel safe and at home.

Sundowner’s Syndrome and Assisted Living Facilities

In some instances, patients with sundowner’s syndrome can become impossible to manage at home. If you doubt your ability to provide a safe environment and the best care for your loved one, it might be a good idea to move them into an assisted living facility.

Benefits of Assisted Living Facilities

Assisted living facilities offer peerless benefits for patients with sundowner’s syndrome. For instance:

  • It provides your elderly loved ones access to staff that are trained to manage difficult symptoms such as hallucinations or agitation.
  • Many assisted living facilities have special units that are designed to keep seniors safe, especially when they start to wander or become violent.
  • Loved ones of patients who experience sundowner’s syndrome can rest assured their loved ones are being cared for and looked after accordingly. This can help improve the quality of their lives and their ability to be there for their loved ones.
  • Families of patients with sundowner’s are spared from making any in-home modifications that can help warrant their loved one’s safety. Also, assisted living facilities are designed with the comfort and safety of their elderly residents in mind, so you are assured they are taken care.

Final Thoughts

Sundowner’s syndrome occurs in older adults and can lead to hallucination, confusion, sleep disorders, and frequent bouts of yelling or crying, among other things. Managing the symptoms is vital to ensure they are kept safe at all times.

If you notice signs of sundowner’s syndrome in your loved one, speak with a doctor immediately so you will be given guidance on how to manage the situation accordingly.

About the Author

Melissa Andrews is the Content Marketing Strategist for Paradise Living Centers, an assisted living center for seniors with locations in Paradise Valley and Phoenix, Arizona. In her spare time, she enjoys cooking and going on hiking trips with her siblings and cousins.

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