The beginning of fall marks the start of the back-to-school season and excitement for holidays such as Halloween and Thanksgiving. However, this season also leads to more confusion, agitation, and anxiety for those living with dementia and their caregivers through sundowning.

Sundown syndrome or sundowning is when people with Alzheimer’s disease and dementia experience increased agitation, disorientation, confusion, pacing, and anxiety during dusk. These symptoms may last into the evening and can disturb sleep as well if individuals confuse nighttime with daytime. In extreme cases, people may experience delusions, paranoia, hallucinations, wandering, and exhibit violent behaviors. 

Sundowning not only increases anguish for older adults, but it also puts pressure on caregivers. For people with dementia living at home, caregivers are often family members who are not professionally trained to address symptoms of sundowning. Their families become more anxious about the well-being of their loved ones while they are at work, and consistently seeing their own family member with dementia confused and agitated can cause distress.

Additionally, if long-term care staff are not able to handle the patients’ extreme symptoms then they may be removed from the facilities which force families to find more expensive care or stop working in order to care for their loved ones.

What causes sundowning?

The Alzheimer’s Association suggests several factors that may contribute to sundown syndrome:

• Exhaustion from an unfamiliar environment
• Disturbance of their circadian rhythm by confusing day and nighttime
• Fear from misinterpretation of more of their own shadows
• Others’ nonverbal behavior leading to more agitation
• Disorientation due to confusion between dreams and reality
• Overstimulation from the environment can further agitation and confusion

What can you do to prevent sundowning?

CareBand offers a wearable device that provides real-time indoor and outdoor tracking using LoRaWAN technology. It does not require Wifi or cellular technology to work and offers long-range communication while optimizing battery life. When an older adult is wandering due to sundowning, a caregiver can accurately be alerted when they wake up, leave their home, and wander outside in the dark. The ability to pinpoint their exact location can avoid further confusion and anxiety by the unfamiliar environment they wandered into. 

Additionally, CareBand is currently working on a study in collaboration with Indiana University and American Senior Communities’ Bethany Village focused on developing an objective measure for agitation. Agitation is a common symptom of sundown syndrome and among dementia patients in general. It leads to increased costs, caregiver burden, and diminishes the quality of life. Currently, CareBand is looking at the feasibility and usability of CareBand technology to assess agitation levels. In Phase II, the company hopes to explore the relationship between data from validated agitation scale data and motion variable data. 

Thankfully, there are also some other ways to remedy sundowning at home provided by healthline.

1. Maintain a schedule

Make it easy for them to remember and keep up with routines to minimize confusion and distress. Try to work around their schedule and change their routines as little as possible.

2. Brighten up their life

Since sundowning may be affected by one’s circadian rhythm, you can try brightening lights about them when they feel agitated or confused.

3. Encourage exercise

Promote exercise and activities during the daytime so they are not restless at night. This can also improve their quality of sleep and mood throughout the day.

4. Change their diet

Eliminate caffeine and alcohol from their diet as much as possible or encourage consumption for earlier in the day. Serve small meal portions to prevent agitation and restlessness at night. 

5. Reduce their stress

Avoid challenging activities in the later hours of the day. The frustration and stress can compound into their agitation and confusion. Promote a calming environment by playing some soft, soothing music.

6. Provide comfort and familiarity

Surrounding your loved one with comforting items and energy can help combat their feelings of anxiety and confusion. Even if they move into new assisted living center, you can place items from home to bring them more comfort and familiarity

7. Record their behavior

Monitoring their behavior allows you to more easily identify triggers in the environment that cause sundowning. This can be tracked by writing in a journal, or taking notes on a phone or ipad using an app. 

8. Self-care

Seeing your loved one constantly anxious, agitated, or confused can take a toll on you as well. Take some time to rest, and address your physical and mental health so you can properly provide care. It is always okay to ask for help from family and friends too.

As the days grow shorter, more sundowning is likely to arise. However, with CareBand’s technology to address wandering and agitation paired with other tips above, you and your loved one with dementia can stay calm and stress-free.