Does your Alzheimer’s loved one get worse towards evening?
As the day winds down, people with dementia and Alzheimer’s Disease may get wound up. Their increased restlessness, confusion or anxiety is called “sundowning” because the symptoms appear near day’s end — just when caregivers are tiring.
Suzanne Faith, RN, CDP who manages Cape Cod Healthcare’s Dementia and Alzheimer’s Caregiver Support program, said sundowning can begin as early as 2 p.m.
“We teach caregivers about sundowning, so they know not be alarmed. But they almost always are alarmed, especially at first,” she said.
Faith, who has been a psychiatric nurse and certified dementia professional for 35 years, offered these tips to help caregivers understand and prevent sundowning:
Know the Triggers
Faith has observed three causes but said all three or any combination can cause sundowning. She explained each:
Exhaustion
“As the day progresses, individuals with cognitive impairment become restless. Having dementia is mentally exhausting as one is always trying to figure out who they are, where they are and who is around them. No sooner do they get it figured out, than they forget. Then the exhausting cycle continues.
“Short-term memory is the first memory to go, and other cognitive functions are lost as the disease progresses.
A hidden memory
“During their lifetimes, most people have worked. Near the end of the day, they often feel it’s time for a shift. It’s time to go home from work. Or, it’s time to make dinner for the family. They revert back to an old memory of what was familiar years ago,” Faith said.
Common refrains for people with dementia are, “I have to go home,” “What about the kids?” or “My parents are going to be worried about me,” she said.
Shifting light can cause fear
“When daylight moves to evening, light changes and different shadows are created. There’s an uncertainty that takes hold in the mind of the person with dementia. They don’t feel safe. They will often walk around their houses, check the windows, doors and blinds. They forget they’ve done that, then they do it again and again. This repetitious behavior often upsets caregivers,” she said.
Introduce a Failure-free Activity
Faith said dementia places people in reverse growth and development. They become childlike. It is important to give them dignified adult activities aligned with interests they had when they were healthy. They derive satisfaction and a sense of peace from activities that involve repetition and create a sense of calm, such as:
- Folding towels
- Finding matching socks and folding them
- Sorting buttons or coins
- Organizing a silverware drawer or a tool drawer
- Rolling yarn
Faith recalled patients in an assisted living facility being given Rosary beads for tactile stimulation while everyone repeated the Lord’s Prayer again and again. This repetitive, dignified, failure-free activity calmed and quieted everyone.
Reduce Stimulation
According to Faith, “Too often, people think patients are bored, so they try to take them places or keep them busy. Traveling and being introduced to new stimulants disrupts those with dementia. They easily become overwhelmed.
“Make early evening a quiet time of day to help prevent sundowning. Playing soft music is an appropriate activity.”
Medication Can Help
Faith said it is common in the home environment for someone to need medication to help manage the anxiety of sundowning. When you are a single person at home caring for your spouse or parent, for example, you don’t have backup to give you a break. And it can be mentally exhausting to deal with the repetition of questioning. Therefore, medicine is often used as an adjunct to reduce anxiety.
“Behavior takes place along a spectrum,” Faith said. “If it’s not quelled, anxiety can become agitation. If agitation is not quelled, it can lead to aggression. Aggression can lead to a combative state. Medication can stop the problem before it advances along the spectrum.”
Validate and Defer
Faith created the formula, “Validate and Defer.” She said it’s easy for caregivers to remember and works by validating the dementia patient’s feelings.
Here’s an example:
Patient: “I want to go home to make dinner now.”
Wrong answer: “This is your home. Don’t you remember?” (They cannot remember.)
Validate and Refer answer: “Oh, you want to go home? OK, just let me finish what I’m doing.”
In this way, the caregiver validates the patient’s feelings by reiterating what was said, then defers the request.
Everyone has the need to know someone is listening to them, Faith summarized. Validate and Defer is central to the new behaviors caregivers have to learn to successfully cope with dementia patients.
To find out more about the specialized support services offered by Cape Cod Healthcare’s Dementia and Alzheimer’s Caregiver Support program, or to register for a group or the family educational series, call 774-552-6080 or email dementiainfo@capecodhealth.org.
