It is not uncommon for people living with dementia to experience increased confusion, irritability and agitation towards the afternoon or early evening. Often described as sundowning, these types of dementia behaviours can be difficult for carers to manage.
A person experiencing sundowning may start to wander, become more demanding and upset or even see and hear things that aren’t there as the day progresses.
Researchers don’t really know what causes sundowning but along with changes in the brain, several factors seem to contribute.
End of day fatigue. It’s easy to forget that confusion can be mentally and physically exhausting making it more difficult to cope with stress.
Changes in our sleep/wake cycle. Dementia can disrupt the bodies internal clock. A person may not respond to day and night.
Reduced lighting and shadows. In the early evening, shadows may contribute to hallucinations and increased confusion as objects are harder to identify.
Misinterpretation of caregiver cues. Exhausted caregivers at the end of their day can give off non verbal messages that are misinterpreted by people living with dementia.
Things you can try
Managing sundowning comes with practice but the focus should be on trying to understand an individual’s feelings and perceptions. What are they experiencing that is making them scared and agitated?
Learn the triggers. Behaviours are most often associated with an unmet need. A person may feel scared and anxious if they don’t recognise their environment or the people around them. For instance, a person living with dementia may shadow a carer (follow them closely) if they’re fearful of being left alone.
Keep afternoon commotion to a limit. It can be easy to turn on the TV as a distraction but often it’s unnecessary background noise. Reduce chaos in the environment by controlling sound and lighting. Limit visitors or outings in the late afternoon.
Go through the basics. A person with living dementia may start to wander if they simply need to go to the toilet. Make sure a person is toileted, well hydrated and not hungry. Is the person in pain? Discomfort can lead to aggressive outbursts.
Focus on providing reassurance. Make sure your reactions are non-confrontational and consistent with the person’s reality. Avoid arguing and pay attention to non verbal signals that can create distrust (rolling eyes, hands on hips).
Ensure a staff member who elicits a positive response from a person with dementia is close at hand. Simple acts like smiling and greeting by preferred name, patting a person on the back and giving a hug can help. Providing a favourite food can distract a person.
Don’t try and restrain a person if they start to wander. To ease agitation and restlessness take a person for a stroll outside. Wandering need not be a bad thing, it can be a way to use up excess energy and manage stress. It can also help a person make sense of the world around them.
If you work or visit a loved one in an aged care home you will know that at a certain time of day a number of residents can be heard calling out repeatedly or pacing up and down. Others begin approaching the nurses station asking to go home or use the phone to call a relative.
In many aged care homes sundowning occurs during shift changes and just before dinner. With less aged care staff available it can be challenging to give a resident experiencing sundowning the attention they need. Aged care homes with a diversional therapist on shift in the afternoon may be better able to give your loved one the attention they need.
Sometimes afternoon agitation may simply be a sign of exhaustion. If a resident is encourage to rest when they show signs of fatigue the usual chaos in a dementia ward can often be diminished and reduce the use of psychotropic medications.