There are a lot of unknowns about Alzheimer’s disease, including why certain people act differently at different times.
The staff at Above and Beyond Home Health Care has been observing people in different stages of this disease for years, and, while no one knows the reasons for some behaviors, we are always available to give advice to family members and caregivers about what someone may be going through, what to watch for and when to seek extra help.
One area that’s particularly concerning to people in the Cedar Rapids area who are less familiar with Alzheimer’s disease is something called “sundowning.”
It’s a general term for a variety of behaviors that people may sometimes display in the late afternoon that can extend into the evening. However, these all seem to be gone the next morning.
About 1 in 5 Alzheimer’s patients may show signs of sundowning, which can include irritability, confusion, disorientation and generally different behaviors than they show the rest of the day until they go to bed. People are also more prone to wander at these times.
Research is unsure of the specific causes of sundowning but some theories include:
- Light intensity changes. A decline in natural light as evening approaches and the sun sets could increase or decrease types or levels of certain chemicals in the brain and body. This may explain why someone who suffers from dementia can be generally calmer and more relaxed in the morning but progressively decline throughout the day.
- Reality changes. Alzheimer’s may cause some difficulties processing reality. The coming of darkness may make it difficult to perceive one’s surroundings as easy as the daytime, including shadows. This could trigger fear and hallucinations as well.
- Instinctive behavior. People with Alzheimer’s may instinctively think they have something to do or some task to complete at the end of the day, perhaps a reflex or learned response from when they were working and either left work to head home, or headed to work in the afternoon or early evening if they once worked a swing shift. These behaviors could be further triggered by shift changes in communities in the afternoon or evening or other family members coming or going around this time.
- Simple fatigue. People with Alzheimer’s may not be as attentive to specific times of the day, but may simply be tired earlier in the day sooner than they used to be, or their internal clock may be disrupted because of the disease’s progression.
- Biological changes, such as urinary tract disorders, may trigger other physical or mental changes through the day.
Some security suggestions
Because so little is known about sundowning for people with Alzheimer’s disease, a variety of solutions and suggestions have been proposed. Every person’s situation may be different, but there are some alternate methods that can be attempted to minimize sundowning behaviors.
Caregivers, providers, and family members of patients in the Cedar Rapids area who are receiving palliative care may want to try a variety of ways to help the person stay as calm as possible during this time. Sometimes, it can be as easy as distracting them with a task or activity so they may not immediately notice changes in the environment. But this may be not as easy to do on a daily basis or for an extended period of time if these symptoms continue later into the evening.
Some methods to help keep someone calm and safe include:
- Creating a predictable afternoon and evening routine. This will provide some pattern to someone’s daily life and activities so they’ll generally know what is coming up in the afternoon and evening, and not be as disturbed in periods when there is less happening.
- Schedule more inside or outside activities during the morning daytime to take advantage of sunlight. Likewise, evening activities should be mellower and focused on taking things easy and eventually getting ready for bed. This approach will be less distracting than activities going on all day, especially in the person’s sundown period.
- Limit stimulants. Though coffee or tea other caffeinated products may be a daily treat, and may even have some health benefits, they could affect or disrupt sleep cycles in the afternoon or evening.
- Make things as calm as possible in the afternoon and evening, such as familiar surroundings, images, smells or sounds. At the same time, look for ways to reduce unfamiliar or unpleasant items in the environment that can put people on edge or increase tension.
Home health can help
Above and Beyond Home Health Care has been providing care to the Cedar Rapids area and Eastern Iowa since 2004. We’ve worked with a significant number of patients with Alzheimer’s disease, including many with sundowning behaviors.
We’re happy to share our perspectives with family members and caregivers, especially people who are less familiar with what is happening to their loved one or wanting to change or limit these behaviors.
We can also accommodate our visits and those of our therapists during the morning or afternoon, whenever the patient can best benefit.