Wednesday, January 2, 2013

Sundowning Syndrome -- What Do I Do?

Sundowning Syndrome is frequently considered one of the most challenging behaviors facing caregivers and persons with dementia. And while some persons struggle with this behavior daily, others persons never exhibit any symptoms. Sundowning is a behavior, presented with or without aggitation, in which the person with dementia attempts to leave his or her current environment (home, community, etc.) or is exhibiting a higher or unusual state of agitation.  
This behavior may present at anytime after 2 p.m., but most often it occurs between 3 p.m. and 6 p.m. Most likely connected to a hardwired human feature of changing afternoon activites to prepare for evening activities, i.e. going home from work, preparing a meal, preparing for bedtime. Sundowning is frequently considered to one of the most challenging aspects of caregiving, for both the at home caregiver or the professional in a community.
There are a variety of activities designed to address Sundowning and each caregiver has to find the one that will hopefully work best for your loved one. And remember, if you find one that works at home, be sure to let the staff know should your loved one be moved to a dementia community.
1. For the majority of persons with dementia in Stages Three, Four, Five and Six, design activites that allow your loved one to use up energy during the day. But remember that these physical activities, such as dancing, walking, exercise, etc., need to take place in the morning (10 a.m.) and in the afternoon (around 2 p.m.). Starting the afternoon activity after 2 p.m. appears to help increase Sunndowning, rather than burnng up energy that would be used in Sundowning.
2. Other persons react better to earlier physical activities (10 a.m. and 1 p.m.) and then respond positively to an afternoon "nap." Remember the nap needs to take place in an area other than the bedroom, as waking up in the bedroom can further confuse your loved one into thinking it is morning time again.
(But because humans are unique, other persons react negatively to too much activity. Caregivers are tasked with finding which schedule works best for their loved ones)
3. During the day, keep the home or community as well lighted as possible. High wattage bulbs, all lights on, blinds pulled, etc. to allow maximum daylight helps your loved one stay better acclimated to day activities.
4. Should Sundowning begin, look for activities to engage your loved one. This might mean a walk, music, favorite movie, helping with a task, or rubbing lotion on the hands, paying special attention to the palm area. (This is often a soothing activity.)
5. If your loved one becomes physically aggressive, back away from him or her and try to reduce noise and movement in the environment. If your loved one is agitated by your presence, try stepping out of his or her sight for several minutes. (Make certain your loved one is safe however.) You might even try to change your shirt or hairstyle before your reapproach, at times this change in appearance will result in a change in behavior.
6. In the event your loved one is able to leave the home, keep a recent photo and medication list handy and do not hesitate to contact the authorities. Remember a dementia alert bracelet can be ordered from your local pharmacy and can be worn on the wrist or ankle.

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