Sundown syndrome affects majority of adults with dementia

By Sharon Oliver, Contributing Writer

REGION – Before people became familiar with Alzheimer’s or dementia due to a loved one being stricken with either disease, there was once another term often used to describe an elderly person’s mental deterioration: senile. Actually, they all describe a group of symptoms affecting memory, thinking and social abilities.

Symptoms peak late in the day

However, there is another condition called sundown syndrome which is characterized by agitation and confusion which peaks during late afternoons and evenings. Elderly people with sundowners are filled with panic and exhibit behavioral changes. According to one source, approximately two-thirds of adults with dementia are also affected by sundowning. To be clear, Alzheimer’s disease is a specific type of dementia with dementia being the umbrella of this cognitive decline.

Caring for a person with sundowners can be extremely taxing. Part of the mission of the Massachusetts Senior Care Association, a non-profit organization, is to educate the public and policymakers about issues relating to the care of older adults and individuals with disabilities. Tara Gregorio, President of Massachusetts Senior Care Association, said this about staff professionals, “These are mission-driving individuals,” she emphasized. “They are inspiring. They are resilient and for all those reasons, I am motivated to do all I can to help support them through a living wage and through opportunities to advance them in their profession.”

Causes are varied

Some of the factors that may influence or contribute to sundowning are:

• Physical changes in the brain, including altered neurotransmitters (the body’s chemical messengers) and melatonin release
• Changes to blood glucose levels and body temperature caused by disrupted circadian rhythms (internal biological clock)
• Chronic pain
• Fatigue
• Low blood sugar
• Sleep disorders
• Medications
• Environmental factors, overstimulation and minimal exposure to sunlight and overstimulation
• Mental and physical exhaustion
• Unfamiliar or confusing environments
• Increased stress
• Moving to a new environment

When or if it comes times to place a family member in a care facility, it is important to look into everything that matters, including environmental conditions. Is the facility well-staffed? Is there adequate natural lighting so as to cut down any night and day confusion? You might also want to be sure your loved one won’t be awakened at dawn in order to receive a head start in their day. Early risings may contribute to sleep deprivation.

Reducing symptoms

One thing a provider will look for when taking into account the patient’s medical history is delirium. Since delirium is also a disorder characterized as a disturbed state of mind, it must be ruled out as the condition behind the patient’s suffering. Here are some suggestions for reducing sundowning symptoms.

• Plan appointments and activities during daylight hours
• Establish a consistent routine for as much as possible. Knowing what’s next will help lower anxiety and give a sense of being in control.
• Ensure that bedtime allows plenty of time for rest. Melatonin is a natural food supplement that often helps people fall asleep.
• Include outdoor activities and walks during the day
• Make note of what worsens sundowning in your loved one to identify and reduce triggers
• Reduce stimulation in the evening hours, including limiting electronics and caffeine and sugar late in the day
• Offer a larger meal at lunch, smaller one at dinner and no late-night meals. A light snack would be fine.
• Keep adequate lighting in the evening and make sure sleeping arrangements are comfortable. Being surrounded by familiar objects and family photos may have a calming effect, especially when placed in a new environment. Plugging in night lights may help them feel safe as well.
• Identify which soothing activities are well suited for your loved one. Reading a book or listening to music are some options.

Massachusetts has a roster of public and private organizations specializing in helping families dealing with forms of dementia. Caring.com contains a wealth of information regarding memory care for residents of Massachusetts.

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