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.
You may not be able to alter this end of day changeover, but you may be able to become more conscious of the effect a stressed arrival could have. Perhaps you can take time, before arriving home, to exercise or at least do some meditation or deep breathing. You can watch the tone and volume of your voice as you speak those first words while you walk in the door. You can arrange for the caregiver in charge while you were gone to encourage an earlier rest time for the person with dementia, so he or she isn’t tired when you arrive.
If you are home with your loved one all day, you could use the "rest when tired" approach during the afternoon. You could also tap into the idea that a calm late afternoon, with soft music rather than TV news or some other environmental change in the atmosphere may reduce late day stress.
Asking caregivers to examine and perhaps change their own behavior may seem unfair. However, Beatitudes found that changing the behavior of the care staff changed the behavior of the residents.
A calm atmosphere isn’t going to harm anyone, and it may just help both you and your loved one with AD have a more enjoyable evening. Will this calm atmosphere completely eliminate sundowning? Probably not. But as the caregivers at Beatitudes found out, even small changes can make a difference.
Carol Bradley Bursack is a veteran family caregiver who spent more than two decades caring for a total of seven elders. She is a newspaper columnist and the author of Minding Our Elders: Caregivers Share Their Personal Stories. Bradley Bursack is also a contributor to several books on caregiving and dementia, and is passionate about preserving the dignity of elders. Her website is www.mindingourelders.com. Follow Carol on Twitter @mindingourelder and on Facebook at Minding Our Elders.