Understanding Sundowning in Seniors: Strategies for Managing Evening Agitation

As the sun gracefully sets on the horizon, some seniors enter a puzzling state of agitation known as “sundowning” in the evening hours.

The phenomenon casts a shadow of confusion and restlessness in seniors with dementia or cognitive impairments and presents unique challenges for caregivers in providing unwavering support and comfort.

In this exploration, we will delve into the depths of sundowning syndrome and shed light on how it impacts the elderly. Moreover, we’ll help you navigate this challenging phase with care and understanding.

What is Sundowning?

Sundowning or sundown syndrome is a condition that affects aged seniors with dementia, Alzheimer or cognitive impairments. It causes increased restlessness, agitation, aggression, disorientation, and behavioral changes in seniors as the day progresses and the sun sets. To navigate the complexities of sundowning, caretakers should provide seniors with the necessary support and comfort with patience, empathy, and understanding.

Possible Causes and Triggers of Sundowning

The possible causes of sundowning are unknown, but Alzheimer’s-related brain changes can cause sundowning behaviors. Some of the possible causes and triggers are:

  • Being Overly Tired
  • Depression
  • Pain
  • Overstimulation from Crowded Spaces
  • Medication Side Effects
  • Mental and Emotional Stress
  • Underlying Medical Conditions
  • Environmental Changes

Factors Contributing to Sundowning

Several factors contribute to sundowning in seniors with dementia or cognitive impairments. The factors that may play a role in the development of sundowning behaviors are:

Biological and Neurological

The alteration in the brain structure of seniors with dementia, Alzheimer’s disease, or other cognitive impairments has neurotransmitter imbalance. It affects the mood and sleep-wake cycles of seniors.

Sleep Disruptions and Circadian Rhythm Changes

Seniors with sleep disorders experience restlessness in the evening. The disruptions in the body’s internal clock contribute to the onset of sundowning.

Impact of Sundowning on Seniors

Sundowning impacts seniors’ well-being and quality of life significantly. They become restless, irritable, disoriented, and withdrawn during the evening, which causes added stress to family members.

Managing Evening Agitation

Managing evening agitation in seniors with sundowning requires a multifaceted approach. Here are some strategies that can create a calming and supportive environment for seniors during the evening hours.

Set Consistent Routine:

The caretakers should establish a consistent routine of wakeup and sleep patterns, schedule meals simultaneously, and get a 20-30-minute nap in the afternoon. The consistent routine provides a sense of stability among the seniors and helps manage sundowning symptoms.

Engage Seniors in Calming Activities

Try to engage seniors in calming activities such as painting, gardening, practicing mindfulness techniques, and deep breathing exercises. Playing soothing music, reading books, listening to audiobooks, encouraging them to share memories, solving crossword puzzles, sudoku, or brain-training games tailored to the senior’s interests and abilities can also be a great help. All these practices are scientifically proven to promote relaxation and help manage the symptoms of sundowning.

Implementing Behavioral Strategies

Each person’s experience with sundowning is unique, and what works for one individual doesn’t work for another. So behavioral strategies, such as redirection and validation therapy, help seniors to manage challenging behaviors associated with sundowning. These strategies allow the caregivers to shift the seniors’ focus away from confusing thoughts and help them break the agitation cycle.

Practicing Sleep-Enhancing Techniques

The techniques such as deep breathing exercises or reading a calming book, progressive muscle relaxation exercises, aromatherapy, limiting screen time, and going to bed at the same time each night make it easier for seniors to transition into a peaceful sleep. Practicing these sleep-enhancing techniques consistently improves sleep patterns and the overall well-being of seniors with sundowning.

Speaking in a Calm and Reassuring Tone

The caretakers should be gentle and composed while speaking to the seniors. Even if the seniors may seem unrelated or confused, the caretakers should respect their thoughts and opinions. It reduces seniors’ anxiety, frustration, and confusion and promotes a sense of security and comfort.

Create a Quiet and Safe Space

A quiet and safe space reduces agitation and promotes relaxation among seniors. Avoid noise in the surroundings, use soft and warm lighting, and incorporate natural elements such as potted plants or a small tabletop fountain. It gives seniors solace during times of agitation and impacts their overall well-being and quality of life positively.

Training Caretakers and Family Members

Familiarizing caretakers and family members with sundowning symptoms, causes, and common triggers helps them respond empathetically and effectively to seniors. Equipping caretakers with the knowledge and skills helps them create a caring and supportive environment for seniors and minimize environmental triggers that may worsen sundowning symptoms.

Wrapping Up

Sundowning is a challenging condition that affects seniors with dementia, Alzheimer’s, or cognitive impairments. It causes increased agitation and behavioral changes in the seniors as the day progresses. Implementing a comprehensive and compassionate approach to navigate this challenging phase with care and understanding manages evening agitation in seniors. It provides necessary support and comfort to seniors with sundowning and promotes seniors’ well-being and quality of life.


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