Sundowning In Persons With Dementia

Sundowning refers to an increase in dementia behaviors beginning at dusk.  These behaviors include increased confusion, disorientation, agitation, and aggression.  Therefore, sundowning is not a disease but a reflection of various symptoms associated with dementia.

It is not entirely clear why seniors with dementia experience sundowning.  Some research shows that as many as 20% of seniors with Alzheimer’s disease experience enhanced confusion, agitation, and anxiety at the end of the day.  While it is not entirely clear why sundowning occurs in seniors with dementia, certain factors correlate to the rise of these behaviors at dusk.  Low lighting can cast shadows that seniors with Alzheimer’s disease and dementia misinterpret leading to confusion and disorientation.  Seniors with dementia may react to non-verbal signs of frustration by caregivers ending a long day shift.  Alzheimer’s residents may experience a disruption in their “internal clock” which causes them to be alert at night. Furthermore, simple exhaustion at the end of the day can contribute to disorientation and confusion.

Sundowning can be mitigated by the adoption of simple dementia care practices.   To begin, provide ample light in rooms before bedtime so seniors do not misinterpret shadows.  If caregivers are in rotation it’s best to have the shift-change occur well before dusk.  (At Wild Rose a shift-change occurs at 3 PM with new caregivers on duty before dusk).  Do not cook a large dinner or provide caffeine at night.  Limit the volume of televisions and radios in the background and be mindful of overstimulation.  Encourage residents to engage in activities before dinner to avoid napping in the evening.  Lastly, provide a comfortable sleeping environment.  Add nightlights to help seniors orient themselves at night and keep the room at a comfortable temperature.