There’s a rhythm to the day in my neighbourhood.
Today, I was in at 6:30 to make a special breakfast. Even though my body isn’t a big fan of getting up at 4:00 a.m., there’s something magical about the hush of the dining room when the only sound is one care partner making breakfast. I love watching sleepy residents arrive one by one, greeting them and bringing them their first cup of coffee. The early birds, the morning rush, the stragglers.
Activites of various kinds, then the much busier and noisier lunch occurs. No stragglers this time, as everyone is eating, care partners are bustling to serve them and many conversations thread through the room. There’s a joyful commotion, followed by a not-as-joyful scramble to clean up.
Somewhere around 1:30, there’s often a hush. Many residents are back in their rooms for a nap, care partners are either giving care or taking a break and a peace settles over the neighbourhood.
Until all hell breaks loose.
Sometimes around shift change at 3:00, sundowning happens. Anxious residents pace, ask the same questions again and again, hover and get angry. They imagine events that aren’t happening, want to go home to their parents and want to call the police. They wring their hands, walk without their walkers and ask again who is going to shower them tonight. Few afternoons go by when I don’t see some evidence of sundowning, and often, when it affects several people, it can be overwhelming.
Sundowning is a phenomenon that occurs in people with various forms of dementia, where their behaviour changes mid-afternoon. Sometimes, it can feel like they are two different people. It doesn’t happen to everyone or every day, and doctors can’t scientifically explain why it happens. Agitation, anger, fear, paranoid behaviour, suspicion, delusions, disorientation, restlessness–all these can be a part of sundowning. If you’ve never seen it before, it can be frightening. Even if you have.
What can you do about it?
Sometimes, nothing. But here are a few strategies and suggestions.
1. Look for solvable problems. Is there anything causing this that can be fixed? Is the person in pain?
Are they tired? Are they hungry or thirsty? Are they bored or too stimulated? All of these are solvable problems that can lessen sundowning.
2. Create a calm environment. Try to keep excessive, startling noises to a minimum. Play soothing music at this time. Plan to take a walk together or spend time in the garden, or any activity that is both enjoyable and calming.
3. If sundowning is a regular occurrence, plan your day around it. Visiting or outings should probably be in the morning and quieter activities later in the day.
4. Don’t try to reason or argue when you hear outrageous statements. As much as you can, agree and try to distract. It may not work, but sometimes it will.
5. Don’t take anything personally. If your elder is agitated and angry, you might get attacked both verbally and physically. Remember, it’s the disease talking.
6. Maintain your sense of humour. Today I was told that all my brains were in my bum, and that was why it was so big. My biggest triumph was that I maintained a straight face when everything in me wanted to laugh!
7. Make sure your doctor is aware of what you are dealing with. Keep a diary and document each incident. Although medications aren’t a first or even second stop, there may be times when they can help with a severe form of sundowning. Either way, your doctor needs to know.
8. Get help. Sometimes a different face will elicit a different response. If there are other friends or family members who have offered to give you some respite, take them up on it. If not, perhaps you need to pay someone one afternoon/evening a week to give yourself a break.
Sundowning is challenging, and sometimes no matter what you do or say, things get out of control. That’s okay. There is no formula for dealing with this, and as with many things dementia, what works today might not work tomorrow. Fix what you can and ride the waves of the rest. Tomorrow is another day.
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