Disorientation and Agitation
Disorientation and agitation tend to go together. A familiar room that suddenly seems strange to the elderly person is an example. Disorientation can often provoke fear and hostility.
Cortical disinhibition
During a sundowning episode an elderly person who has never cursed before may begin to use language that shocks relatives.
Paranoia
An increase in suspicion toward relatives and caretakers can occur. “Mom” in the above example accused her husband of hiding some important piece of information from her.
Cause
The cause of sundowning is still unknown. One of the most popular myths about the cause is the decreased light in the late afternoon and evening. Some sources have compared it to Seasonal Affective Disorder (SAD), which causes a person to become more depressed in winter because of the fewer daylight hours. The recommended treatment based on this so-called cause of sundown syndrome then becomes “keep the lights on.” Professional research, however, has found that added illumination in the late afternoon or evening does not curtail the problem.
Some Possible Causes
Although research is very sketchy when it comes to Sundowners Syndrome some theories have been suggested: Unmet psychological needs due to the lower number of evening/night shift staff Disordered circadian rhythm Afternoon fatigue due to high levels of activity earlier in the day.
Treatment
Very little data exist to support the effectiveness of the following treatment measures. However, as caregivers we like to feel that we are doing something so here are some suggestions that have been made by professionals.
Structured Activity
Some have suggested that planned activities that interest the elderly person might decrease the incidence of agitation.
Redirection, Reassurance, Distraction
Speaking in gentle, loving tones and not being directly confrontational may help to prevent or lessen agitation in an elderly person. It might, then, be possible to involve the person in a new activity. Meeting Physical Needs Be sure basic physical needs like toileting and relief of pain or hunger have been met
