1. Dementia – Sundowning BY: JESSICA E & JESSICA D

2. Overview  This presentation will cover topics regarding sundowning in dementia. 1- Introduction 2- Sundowning Effects 3- Causes of Sundowning 4- Circadian Rhythms & Sundowning 5- Melatonin & Sundowning 6- Nursing Interventions 7- Conclusion

3. Introduction  Sundowning is a syndrome that affects people suffering from severe dementia. Generally, morning and early afternoon hours are when these individuals act like themselves. By late afternoon to evening, they may become mentally distressed though feelings of anxiety and agitation.

4. Sundowning Effects  Usually taking effect between the hours of 4:30pm and 11:00pm, someone suffering from sundowning will experience a drastic difference in mannerisms and personality from the time they wake up until it begins to take affect later in the day  A noticeable rise in the individual’s level of agitation and restlessness  20% of people living with severe dementia have experiences with sundowning  May make individual more susceptible to injuries such as falls or violent towards other people  Attention, emotion and arousal are areas that are affected by sundowning  May prevent people with dementia from sleeping well

5. Causes of Sundowning  “Evidence suggests contributing factors for sundowning may be sensory deprivation or overload, unmet physical needs (fatigue, hunger, pain, elimination), altered levels of light, inadequate orienting cues, altered mobility, increased stress, decreased sense of security, social isolation, anxiety or fear, unfamiliar environment and/or prevailing or disrupted circadian rhythm” (Sparks, 2011).

6. Circadian Rhythms & Sundowning  Circadian rhythms are based on the 24 hour biological clock that our bodies follow naturally  The circadian rhythm reacts to darkness and light  A theory about circadian rhythms is that a distressed sleeping pattern can result in agitation  Researchers are lead to believe that a change in circadian rhythm is the cause of sundowning syndrome  Using light therapy on patients experiencing sundowning has proven to be effective

7. Melatonin & Sundowning  Melatonin is a hormone that serves the main purpose of circadian rhythm regulation  Melatonin helps regulate the body’s sleep and wake cycles  It has been suggested that using melatonin in patients suffering from sundowning can be beneficial  Melatonin clears free radicals, boosting the immune system, and hindering oxidation of bio-molecules  Natural melatonin in the brain decreases as Alzheimer's disease progresses

8. Nursing Interventions  Nurses should make sleep and relaxation a main priority for patients with dementia who suffer from sundowning syndrome  Discourage day time naps  Encourage family support as it has shown to improve symptoms of the patient  Keeping the patient on a schedule  Promote independence  Encourage walking or repetitive tasks

9. Nursing Interventions Cont’d  Promote a healthy diet  Lack of communication leading to unmet needs is a trigger for sundowning behaviours  Bright and noisy rooms can overwhelm and increase the chances of the patient having severe symptoms  A resolution may not be found if the patient has unmet needs from their past  Knowing the patient’s past is important in understanding their current situation  The patient’s past lifestyle can be influential to how they present with sundowning

10. Conclusion  Sundowning syndrome is characterized by the increase of neuropsychiatric symptoms such as agitation, confusion, anxiety, and aggressiveness in late afternoon, in the evening, or at night. Sundowning is highly prevalent among individuals with dementia. 20% of people living with severe dementia have experiences with sundowning. A variety of treatment options have been found to be helpful with the symptoms associated with sundowning such as making sleep and relaxation a main priority, discouraging day time naps, encouraging family support as it has shown to improve symptoms of the patient, making the room well-lit can decrease aggression, keeping the individual on an authoritarian schedule, promoting independence, encouraging walking or repetitive tasks and encourage a healthy diet.

11. References  Sparks, M. (2011). Preventing and managing sundowning. Long-Term Living: For The Continuing Care Professional, 60(10), 58-61.  Biological Basis for "Sundowning.". (2011). USA Today Magazine, 140(2795), 2-3.  Sharer, J. (2008). Tackling Sundowning in a Patient with Alzheimer's Disease. MEDSURG Nursing, 17(1), 27-29.  Li, L., Qiong-Xia, H., Shu-Sheng, Y., Jiang, C., Jian-Zhi, W., & Qing, T. (2013). Melatonin in Alzheimer's Disease. International Journal Of Molecular Sciences, 14(7), 14575-14593.  Martin, J., Marler, M., Shochat, T., & Ancoli-Israel, S. (2000). Circadian rhythms of agitation in institutionalized patients with Alzheimer's disease. Chronobiology International, 17(3), 405-418.  Sundowning in older people with dementia: evidence base, nursing assessment and interventions. (2003). Nursing Older People, 15(8), 24.