Managing Sundowners Syndrome: #1 Minimize Triggers

[agoyer]

If your loved ones have dementia (and sometimes other conditions as well), they may experience "sundowners syndrome". You may be seeing changes in their behavior in the late afternoon or early evening (onset of behaviors varies for different people and some of these behaviors may happen throughout the day). There may be sudden emotional, behavioral or cognitive changes. These might include:

• mood swings
• anxiety
• sadness
• restlessness
• energy surges
• increased confusion
• hallucinations
• delusions

These may lead in turn to challenging behaviors like wanting to leave or "go home", pacing, rocking, screaming, crying, disorientation, resistance, anger, aggression — or even violence. Many people experiencing sundown syndrome feel the urgent need to go somewhere or do something, but they can’t always explain why. Often that goes back to a deep-seated routine like coming home from work most of their lives. 

Here is my first tip to help you manage Sundowners Syndrome: 

Observe and Minimize Triggers

Watch for fatigue and other things that seem to spur on sundowning behaviors. Afternoon transitions and activities that you consider normal can be anxiety-producing for your loved ones. Observe all sensory stimulation, including sights, sounds, things they touch, taste and smell. Try to get a sense of what calms them and what causes anxiety.

For example, does the household change or get chaotic and noisy as people get home from work? Even the slightest change like a caregiver shift change or you coming home from work can set off anxieties. Does the TV get switched to something loud or intense, like a crime show or the news? Is there are a lot of cross-talk during mealtimes? 

Watch, too, for nutritional triggers and adjust eating and drinking schedules. Cut back on caffeine and sugar, which can be too stimulating, and limit liquids later in the day, as they can cause increased toileting needs that can make them feel uncomfortable.

Light can be a trigger too - if it's getting darker outside or in the house - try to minimize light changes by keeping the house bright until you want your loved one to wind down for bed. 

Your loved one may have other triggers, so it's important to observe carefully the environment, routine, behaviors etc. Then manage the triggers by either eliminating them, changing time schedules, or adjusting things so they aren't quite so pronounced.

Share your tips about how you manage triggers too! 

Take care,

Amy Goyer, AARP Family & Caregiving Expert

Author, Juggling Life, Work and Caregiving