Sundowning, sometimes called Sundown Syndrome, is the label given to late day anxiety, irritability, disorientation and general agitation in people with Alzheimer’s. Sundowning frustrates home caregivers and professional care staff alike, as they often feel completely unable to comfort the person affected.

Researchers and care staff alike are looking for answers. One nursing home in particular has made some dramatic changes in end-of-day care, resulting in a major reduction in the need to medicate residents for late day anxiety. Home caregivers can learn from their work, as well.

An Alzheimer’s Association of New York news letter tells the story:

Staff at the nursing home on the Beatitudes Campus in Phoenix, Ariz. knew that they had a serious problem with sundowning, and were determined to find some solutions. They noticed that at the evening shift change, residents would become vocal, calling out and often provoking anger in each other. Many hollered for help from the staff or paced the floor as if looking for a way out.

Team observers wondered if the residents would be more comfortable if they were to lie down and rest at any time they seemed tired. Thus began a policy that no matter how inconvenient the timing was to the staff, if a resident was tired and needed a rest, the opportunity would be provided.

The result? As residents started to sleep whenever they were tired, and wake when they were rested, sundowning behaviors declined. Residents seemed happier and didn’t require as much psychotropic medication.

The Beatitudes team later noted that during the time staff members left for the day and others came on, the general commotion increased significantly.  Staff members spoke all at once. Those going off the shift rushed around to complete tasks. Those coming on were busy getting ready to begin their work. This “cacophony and disruption” was made worse by a television in the common area and generalized noise in the environment.

Beatitudes worked to calm that atmosphere. The staff members spoke more quietly as they handed over the shifts. The television set that babbled in the background was moved to a different area. These changes increased calmness and in turn helped the residents with dementia feel more relaxed. In other words, changing the environment around the people with Alzheimer’s changed their behavior.

Make changes at home at home and observe what happens

If the person with Alzheimer’s disease is cared for at home, you don’t have “staff changes” at the end of the day – or do you? Do you hurry home from work to take over duties from an in-home caregiver hired from an agency, or from another family member? If so, you are likely tired and stressed from your day at work. Your body language, the tone of your voice – the very essence of your presence – may scream stress. Yet you are now taking over the care of a person who is extremely sensitive to environmental changes and stress at their most vulnerable time.