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Sundowning

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Alzheimer’s Challenges at the End of the Day

Jeff D. Williamson, M.D., chief of gerontology and geriatric medicine at Wake Forest Baptist Medical Center, Winston-Salem, N.C.

Jeff D. Williamson, M.D., chief of gerontology and geriatric medicine at Wake Forest Baptist Medical Center, Winston-Salem, N.C.

People with dementia often have certain problems when it gets dark at the end of the day and stays dark through the night. This problem is called “sundowning.” The problems that get worse include increased confusion, anxiety, agitation, and not being able to get to sleep and stay asleep.

“Sundowning is a very common problem for Alzheimer’s patients and, of course, for caregivers,” says Jeff D. Williamson, M.D., chief of gerontology and geriatric medicine at Wake Forest Baptist Medical Center in Winston-Salem, N.C. “It’s very challenging to manage.”

Sundowning Symptoms
As anyone who has cared for someone with Alzheimer’s disease (AD) knows, the patient will have good days and bad days. According to the National Institute on Aging (NIA), some of the personality changes that may intensify with sundowning late in the day or during the night include the following:

Health-related problems other than AD can contribute to behavioral changes:

Problems in their surroundings are also contributors for the caregiver to consider:

Sundown can present challenges for loved ones with Alzheimer’s.

Sundown can present challenges for loved ones with Alzheimer’s.

Treatments
Almost all Alzheimer’s patients will have some manifestation of sundowning, notes Dr. Williamson. “So, it’s important that caregivers understand that sundowning is not caused by something they did or didn’t do,” he says. “But there are some strategies to get through this.”

According to Dr. Williamson and NIA research, there are certain behavioral strategies that can help caregivers with sundowning:

Take the person to places where they can move around and exercise during the day, such as shopping malls. If the person who has dementia has an angry outburst, try not to touch or restrain them. Touch or restrain them only if you need to for safety. Instead, try to stay calm and distract them during outbursts. Do not take their behavior personally.

When to Call the Doctor
In addition to behavioral steps that canhelp with sundowning, there are medication issues that can be a factor, according to Dr. Williamson.

“Depression is often an underrecognized part of sundowning,” he says, “And the patient may not be able to articulate it. There are antidepressants and anti-anxiety medicines that a physician may recommend. So, it’s important that you talk to your healthcare provider, especially when you have questions about medications.”

On the other hand, sometimes currently prescribed medicines or over-the-counter products may be creating or contributing to sundowning symptoms. Talk to the patient’s doctor any time you think that medicines may be the cause of changes in the behavior of someone who has dementia, Dr. Williamson recommends.

When Caregivers Need Help
Children of an Alzheimer’s patient often wonder how they can help the primary caregiver—especially when the caregiver is a mother or father. This is especially important when an Alzheimer’s patient is showing signs of sundowning, which is even more stressful on caregivers.

“I find a lot of caregivers are embarrassed to ask for help,” says Dr. Williamson. “It’s a fork in the road for some families. Children can offer to help by volunteering to stay with the patient for short periods while the primary caregiver gets a break. Church members and social club members who know the patient can do that, as well.

“And there are times when a person can be a better caregiver with the person they love by regularly taking the patient to an Alzheimer’s care center while they take a break,” says Dr. Williamson. “Families shouldn’t feel guilty about these things. Caregivers should realize that this is a good thing.”

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