Sundowning in the Dementia or Alzheimer’s Patient

The term, “sundowning” is used to describe the period of increased agitation and confusion experienced by people with dementia that normally occurs at the end of the day and into the night. In the past, sundowning was described as more anecdotal than scientific but new research may indicate a biological factor that eventually may be treatable.

The Challenges of Sundowning

Sundowning in dementia or Alzheimer’s patients can be difficult enough to manage in the home but can become a real issue for larger residential facilities where many patients may display the behavior simultaneously.

“It’s a big problem for caregivers. Patients can get aggressive and very disruptive,” said Tracy Bedrosian, lead author of the study and a doctoral student in neuroscience at Ohio State University. One of the theories about sundowning is that it is tied to disruptions that often occur in the biological clocks of older people, where their sleep-wake cycles are fragmented.

Studies done on aged mice showed an excess amount of a particular enzyme, acetylcholinesterase, a vital element of nerve activity, before sleep than earlier in the day. Heightened levels are associated with anxiety, confusion and agitation. Researchers found comparable behaviors in these mice to the dementia patients with regards to attention, emotion and arousal. Middle-aged mice in the study showed no time of day difference in their acetylcholinesterase levels. This study may hold promise of a treatment to combat sundowning and make dementia patients more comfortable and reduce their stress levels.

Steps to Combat Sundowning in Senior Care Facilities

So while research is ongoing what can be done in the meantime to combat sundowning? There are several steps that can be taken that may reduce the effect and keep a patient calm.

• The increase in activity at end of day shift changes may increase the effect of sundowning so distractions may be used to occupy patients and reduce confusion.
• Serve dinner early and limit sugar and caffeine to early in the day.
• Keep a light on during the night to reduce confusion in an unfamiliar location.
• Encourage family or other loved ones to bring items that are familiar and comforting for a patient. Photographs with images of both the patient and loved ones together will encourage a feeling of belonging or grounding and may decrease agitation.

Putting Systems in Place to Protect Alzheimer's Patients

Higher levels of agitation may increase a patient’s urge to wander. It’s estimated that 31,000 Alzheimer’s patients will wander each year and they are unable to reasonably judge dangerous situations or places. It’s imperative that systems be in place to reduce the chances of wandering patients and keep them in a safe environment. Accutech’s ResidentGuard wander management systems give dementia patients the ability to move freely while still preventing them from leaving a facility. RFID (radio frequency identification) technology can give both staff and families the piece of mind that their loved one is protected and secure. Accutech offers several systems as well as a system comparison chart to determine the system that’s appropriate for any facility.