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Combating the symptoms of Sundowning

Thanks to breakthroughs in medicine and nutrition in recent years, we are living longer than ever before. But this increase in life expectancy also brings an increase in the number of diseases, injuries and impairments that affect older adults. With this in mind, we at the local Visiting Angels office in Salem have created this series of articles to keep our older population and their families informed and to offer some practical advice for meeting the challenges faced by seniors and those who care for them.

Sundowning, or Sundown Syndrome, is a condition affecting older adults in which they may become agitated, aggressive or confused as natural sunlight starts to fade at the end of the day. While it is primarily found in people with Alzheimer’s disease and other forms of dementia, it can occur in adults without dementia.

Scientists are still unsure of the physiological conditions that cause Sundowning, but it is believed that neurological changes, including those often associated with Alzheimer’s and dementia, affect the areas of the brain that control the body’s circadian rhythms, otherwise known as our “internal clock.” Sundowning symptoms tend to get worse throughout the night, but they often improve in the morning.

In addition to agitation, confusion and aggression, other common symptoms of Sundowning include restlessness, pacing and mood swings. The person may hallucinate or display signs of paranoia. They may seem disoriented and wander. Yelling and irritability are also common.

Environmental and physical conditions may both play a part in causing the symptoms of Sundowning. If a person with the condition is hungry or thirsty, depressed, or experiencing physical pain, boredom or difficulty sleeping, symptoms may be more likely to appear.

Shadows caused by the fading light of the setting sun may lead to confusion and fear. Confusion may also occur in a person who is unable to distinguish the difference between their dreams and their experiences while awake. Another source of fear and confusion for older adults living in facilities can be all the activity that accompanies shift changes in the afternoon.

People with Sundown Syndrome may also be picking up on the physical cues they receive from an exhausted caregiver. If their caregiver is tired, upset or frustrated after a long day, the person may sense these feelings and begin to experience them too, even if the caregiver hasn’t said anything to express them verbally.

Since researchers are still unclear about the causes of Sundowning, there are no established treatments for the condition. However, symptoms can be managed through observing and identifying the conditions that trigger them and avoiding those conditions as much as possible.

Regular daily routines also help. Doing activities such as waking up, exercising, eating meals, bathing and going to bed at the same time each day can eliminate anxiety by keeping things consistent. It is also a good idea to schedule busier activities such as appointments and bathing for earlier in the day, when the person is less likely to experience the symptoms of Sundowning.

Sweets and caffeine should be limited to the morning, since they may contribute to agitation and irritability later in the day. Keeping a food journal can help caregivers understand which foods may be causing Sundowning symptoms. Those with symptoms should also avoid alcohol and tobacco, and they may want to eat a big lunch and a smaller dinner in the evening, when symptoms are more likely to occur.

In order to keep evenings calm, televisions and other electronic devices should be replaced with relaxing music. Guests should be asked to visit earlier in the day, and family members living with the person may want to avoid making noise. Turning on interior lights early and closing curtains or blinds to keep lighting at a consistent level as night falls can reduce feelings of anxiety.

When interacting with someone experiencing the symptoms of Sundowning, it’s important for family members and caregivers to stay calm. They should talk to the person in a reassuring voice and let them know that things are going to be OK. They should not try to restrain the person but should stay close enough to monitor them for safety and to help if needed.

Locking doors and windows can help keep the person safe at night, and stairways should be blocked by gates. Baby monitors, cameras and motion detectors can help family members keep track of loved ones from an unobtrusive distance, and any items that could potentially be dangerous, such as kitchen knives or power tools, should be kept where they are not accessible.

If attempts to avoid the conditions that trigger symptoms are unsuccessful, it may be necessary to see the doctor to ensure that all medications are working as they should be. Medications meant to help with relaxation or sleep can sometime lead to confusion or disorientation.

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Information provided by Visiting Angels, America’s choice in homecare. Visiting Angels non-medical homecare services allow people to continue enjoying the independence of their daily routines and familiar surroundings. To set up an appointment for a no-obligation in-home assessment, call 330-332-1203.

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