Confusion and Agitation at the End of the Day
The Mayo Clinic defines “sundowning” as a state of confusion at the end of the day and into the night. Sundowning isn’t a disease, but a symptom that often occurs in people with dementia, such as Alzheimer’s disease. The cause is not known. It typically peaks in the middle stages, then diminishes as the disease progresses.
There are some factors that may aggravate sundowning. They include:
- End of day exhaustion (physical and mental)
- Low lighting
- Increased shadows
- Disruption of the body’s “internal clock”
- Sundowning often occurs a the time of day when there have been significant changes–coming home from work, kids coming home from school, making dinner, shift changes at assisted livings or skilled nursing facilities.
There are some things you can try to reduce the agitation and increased activity that are a part of this syndrome:
- During the morning and afternoon hours, avoid foods containing sugar or caffeine
- Weather permitting; spend some time (15 minutes) outdoors in the sunlight during the day (remember to use appropriate protection–sunscreen, a hat, sunglasses)
- In the afternoon, a short nap or a period of quiet time might reduce sundowning (avoid napping if sleeplessness is a problem at night)
- Anticipate the sundowning and increase the light level prior to the time it usually starts
- Try some quiet soothing music for 45 minutes before the time the sundowning usually begins
- Make certain physical comforts are met; hunger, feeling to cold or too hot, or other discomforts can increase agitation
- Avoid arguing or asking for explanations
During a period of sundowning, the person you are caring for may be upset and agitated, but they may have no idea why they have those feelings, and the confusion only adds to the agitation. The best thing you can do is simply stay calm and offer understanding.
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