1. TRIGGERS AND MANAGEMENT
SUNDOWNING SYNDROME
TRIGGERS AND MANAGEMENT

2. DEFINITION
SUNDOWNING IS A PSYCHOLOGICAL PHENOMENON ASSOCIATED WITH INCREASED CONFUSION AND RESTLESSNESS IN RESIDENTS WITH SOME FORM OF DEMENTIA. FOR RESIDENS WITH SUNDOWNING SYNDROME A MULTITUDE OF BEHAVIOR PROBLEMS BEGIN TO OCCUR IN THE EARLY EVENING WHILE THE SUN IS SETTING. SUNDOWNING SEEMS TO OCCUR MORE FREQUENTLY DURING THE MIDDLE STAGE OF DEMENTIA.
RESEARCH SHOWS THAT 20%-45% OF ALZHEIMER’S RESIDENTS WILL EXPERIENCE SOME SORT OF SUNDOWNING CONFUSION
WIKIPEDIA

3. COMMON SUNDOWNING TRIGGERS
TOO MUCH ACTIVITY IN THE FACILITY: SHIFT CHANGE OFTEN BRINGS ABOUT A FLURRY OF ACTIVITY AND INCREASED PERSONNEL. RESIDENTS WHO DO NOT UNDERSTAND WHAT IS GOING ON CAN FEEL ANXIETY AND CONFUSION.
FATIGUE: OFTEN RESIDENTS ARE EXHAUSTED AT THE END OF THE DAY. THIS IS EXACERBATED IF STAFF MISTAKENLY AVOIDS DAYTIME SLEEPING TO INCREASE THE CHANCE THE RESIDENT WILL SLEEP THROUGH THE NIGHT (THIS DOES NOT WORK)
LOW LIGHT: AS THE SUN GOES DOWN, THE QUALITY OF AVAILABLE LIGHT DIMINISHES AND SHADOWS INCREASE, MAKING ALREADY COMPROMISED VISION WORSE. REMEMBER WHEN YOU WERE LITTLE AND SAW SCARY SHADOWS ON THE WALL…. SO DO YOUR RESIDENTS.

4. MORE TRIGGES
INTERNAL IMBALANCES: THE INTERNAL SYSTEM WE ALL HAVE THAT TELLS US WHEN WE ARE TIRED, HUNGRY OR NEED TO GO TO THE BATHROOM INCREASINGLY BREAKS DOWN IN THE ELDERLY WITH DEMENTIA. DISRUPTIONS IN THE BIOLOGICAL CLOCK THAT REGULATES COGNITION BETWEEN WAKING AND SLEEPING HOURS MAY BE A PRINCIPLE CAUSE OF SUNDOWING.
WINTER: IN SOME CASES THE ONSET OF WINTER’S SHORTER DAYS EXACERBATES SUNDOWNING, WHICH INDICATES THE SYNDROME MAY ALSO BE LINKED TO SEASONAL AFFECTIVE DISORDER.

5. MANAGING SUNDOWNING SYMPTOMS
TREATMENT FOR SUNDOWING, JUST LIKE ITS CAUSE IS NOT WELL ESTABLISHED. THERE ARE HOWEVER, A NUMBER OF APPROACHES THAT HAVE HELPED CALM DOWN SUFFERERS OF THIS CONDTION.
IN ADDITION TO THESE STRATEGIES, USE INFORMATION YOU KNOW ABOUT YOUR RESIDENTS. EACH RESIDENT IS UNIQUE IN THEIR WANTS AND PREFERENCES, USE THIS INFORMATION TO EASE THEIR SUFFERING.
IF YOU NEED MORE HELP, ENGAGE THE FAMILY IN FINDING STRATEGIES THAT WORK FOR YOUR RESIDENTS.
REMBER THIS IS NOT LIKE GIVING BLOOD PRESSURE MEDICATION TO STABILIZE, THERE IS NO ONE TREATMENT THAT WORKS FOR EVERYONE

6. THINGS YOU CAN DO TO HELP MANAGE BEHAVIOR
SOME OF THE MORE SUCESSFUL APPROACHES TO MANAGING SUNDOWNING BEHAVIOR INCLUDES:
ESTABLISH A ROUTINE: ROUTINES MINIMIZE SURPRISES AND SET UP A DAILY RHYTHM THAT CAN BE RELIED ON. RESIDENTS WITH LIMITED COGNITIVE ABILITIES ARE UNABLE TO DEAL WITH UNPREDICTABILITY AND THIS CAN CAUSE UNNECCESSARY ANXIETY AND INCREASED CONFUSION.
CONTROL NOISE: OVERHEAD PAGING, LOUD MULTIPLE TV’S, RADIOS ALL CAUSE INCREASED CONFUSION. MAKING THE EARLY EVENING HOURS QUIETER AND HAVING QUIET ACTIVITY CAN HELP CUE THE RESIDENT THAT IT IS TIME TO REST.
LIGHTING: THERE HAS BEEN INCREASED RESEARCH DONE TO INDICATE THAT LIGHT THERAPY WORKS WONDERS FOR SUNDOWNING RESIDENTS.

7. MORE THINGS YOU CAN DO..
LIGHTING: ALSO AVAILABLE ARE LIGHT BULBS THAT SIMULATE NATURAL LIGHT, IT SUGGESTED THAT DECREASED OUTDOOR LIGHT INCREASES SUNDOWNING IN RESIDENTS AND THAT DAYLIGHT LIGHT BULBS WHICH MIMIC NATURAL DAYLIGHT HELP RESIDENTS COPE BETTER. KEEPING LIGHTS ON IN THE EVENING, SO THERE ARE NO SHADOWS, OR DARK AREAS OF THE ROOM TO CONFUSE THE RESIDENTS HAS SHOWN POSTIVE RESPONSES IN RESIDENTS.
SUNDOWNING BEHAVIOR SHOULD BE MONITORED AND RECORDED FOR THE INTERDISCIPLINARY TEAM TO DISCUSS. THEY, ALONG WITH THE RESIDENTS FAMILY WILL DETERMINE IF MEDICATION OR SUPPIMENTS ARE INDICATED TO HELP THE RESIDENT DECREASE THEIR DISTRESS.

8. BEHAVIOR PATTERNS
ONE ESSENTIAL FACTOR IN WORKING WITH RESIDENTS WHO DISPLAY BEHAVIOR IS MONITORING THE BEHAVIOR. TIME, PLACE, WHO WAS THERE, ARE ALL IMPORTANT FACTS THAT CAN DRIVE THE TREATMENT DECIDED UPON BY THE TEAM. THIS WOULD ALSO IDENTIFY IF THE BEHAVIOR IS RELATED TO SUNDOWNING OR IF THERE ARE OTHER NUANCES TO CONSIDER.
WHILE MANY RESIDENTS EXPRESS THEIR BEHAVIOR THROUGHOUT THE DAY, SUNDOWNING BEHAVIOR IS OFTEN MORE SEVERE AND PRONOUNCED.
SYMPTOMS INCLUDE BUT ARE NOT LIMITED TO: RAPID MOOD CHANGES, ANGER,CRYING, PACING, SHOWING FEAR, DEPRESSION, RESTLESSNESS OR ROCKING.

9. MORE BEHAVIOR….
AT TIMES YOU MAY FIND YOUR RESIDENTS SHADOWING YOU CLOSELY FROM ROOM TO ROOM. THIS HAS BEEN USED WITH A HIGH RATE OF SUCCESS IN BUILDINGS WHERE THE CENA’S HAVE GIVEN RESIDENTS WASH CLOTHS OR THINGS TO CARRY, SO THEY ARE INCLUDED IN THE DAILY ROUTINE OF PREPARING FOR BED.
BABY DOLLS OR STUFFED ANIMALS CAN PROVIDE SOOTHING AND DISTRACTION TO RESIDENTS WHO ARE SEARCHING FOR SOMETHING TO DO OR CARE FOR.
ANOTHER HELPFUL ACTIVITY IS WALKING IN THE MID AFTERNOON BEFORE SUNDOWNING SETS IN.

10. IN CONCLUSION
SOME THINGS TO REMEMBER: OFTEN THE BEHAVIOR DISPLAYED WILL EVENTUALLY DECREASE AS THE RESIDENT’S DEMENTIA MOVES FORWARD.
ALWAYS LOOK FOR PATTERNS IN BEHAVIOR, TRIGGERS IN THE ENVIRONMENT, ANYTHING YOU CAN DO TO CAUSE THE RESIDENT LESS STRESS.
IT IS IMPORTANT TO NOTE THAT SUNDOWNING BEHAVIOR IS NOT PURPOSEFUL. THESE RESIDENT’S BEHAVIOR IS JUST AS DISTRESSING TO THEM AS IT IS IT YOU.
WORK TOGETHER TO FIND WHAT WORKS. REMBEMBER NOT EVERYTHING WORKS ALL THE TIME.