Starting at 1am on November 1, days will start getting shorter. For people suffering from dementia, this change will bring on more symptoms of sundowning. With the arrival of darkness occurring earlier, symptoms may get worse quicker and faster. The Atlanta metro area has time to prepare for this change. Pasted text
Preparing for this change means looking for patterns in behavior during the end of the day and making minor modifications to everyday activities. This can help ease symptoms brought on by changes to the clock.
Symptoms of sundowning include agitation, irritability, restlessness, and confusion. Each individual does not necessarily experience these symptoms at the same time. Many factors contribute to the onset of these symptoms including exhaustion, disruption of normal routine, and changes in the environment including the presence of light.
You may notice a family member becomes restless in the later part of the day and begins to walk around. He or she may begin to ask repeated questions or become anxious.
Symptoms may occur at different times for different family members. You should pay the most attention to the patterns of your family member to understand when the symptoms may begin.
Not all behavioral changes are easy to explain. For a few days before the changes occur, write down everything you can think of, like what did the person do beforehand? Were they tired? Did they eat? Were they around a lot of noise? Were the rooms becoming darker?
Those things can help you understand what may be causing the change.
What is it about the change to daylight saving time that can make sundowning worse?
Changes to daylight saving time can disrupt a lot of things. For example, the change can move the time when it gets dark, and that can disrupt a person’s schedule. Also, a person’s mealtime and bedtime can become out of synchronization with a person’s schedule.
That can all be very confusing for a person with dementia.
There can also be a sudden change to the person’s surroundings. That can change a person’s perception of time, and that can also make a person feel confused and worried about what is going on.
All of that can also make a person feel very tired and stressed.
That is why it is not a good idea to wait to change all of those things at once. If a person knows that 5 o’clock is a problem, a person can change things to help ease the stress and confusion before that time. For example, the person can change the room to be dark, set up a relaxed meal, and help the person with other relaxing activities.
Sundowning is when a person with dementia becomes confused or disoriented in the late afternoon or evening. Although complete prevention of sundowning is not possible, there are ways to lessen the symptoms. The following are six changes that may reduce symptoms of sundowning.
1. Adjust your use of light
Throughout the day, when possible, utilize natural light. As the day turns to night, increase the use of artificial light.
The goal is to soften the change from a well-lit room to no light or a few dark, hard edges.
As the goal is to remove stimuli, consider the use of a night light to provide some light for orientation.
2. Consider an earlier dinner
If your family member appears restless before dinner time, consider moving dinner to an earlier time.
Also, if dinner is currently at a time that makes your family member restless, consider if a change is needed, even if the time on the clock has not changed.
3. Change your afternoon schedule
If possible, limit your afternoon activities. Save your more stimulating activities for the morning.
Afternoon errands and activities should be less.
Pare down your schedule in the days preceding the change. Simplifying your routine may allow you to better manage your stress and help you prepare for the transitions that lie ahead. Consider having a quiet conversation while you fold laundry or listen to calming music.
Keep a general schedule.
You should aim to have your child get up, eat, and go to bed at the same times each day.
Exact times are not essential.
The important thing is that your child can identify and anticipate general events in their day.
Avoid making a lot of changes to your child's schedule at the same time. If your child seems tired during the day, it may be beneficial for them to take a break. A long, late-afternoon nap may make it harder for them to go to bed at the end of the day.
If you think that your child is worried about something or uncomfortable for any reason, try to help them before they become confused and agitated. This may help them feel more secure about the situation and ease their anxiety.
Offer reassurance and redirect your child to an activity of his/her choice.
If you need to take a break from the care demands at night, let yourself acknowledge the demands. Caregivers need breaks. You may need to ask for help in order to continue to give care.
When is Help From Another Family Member Needed at Night?
Nighttime demands should be evenly distributed among the caregivers.
If your parent is getting out of bed and moving around the house, attempting to leave the house, and/or becomes distracted and requires constant supervision, this may be hard on you and other caregivers and increase your care demand at night.
It is okay to acknowledge that you have not taken a break to recharge in a very long time. You may think that you have to be superhuman and care for your parent 24/7, but in reality you are putting yourself and the other caregivers at risk for burnout.
At what point do you and the other caregivers begin keeping track of the demands placed on you at night?
What time do you think your parent goes to bed?
How many times do you think your parent gets out of bed at night?
Do you think your parent is just awake or is getting up to leave the house?
How much help does your parent need to manage before they are able to go back to bed?
How many hours of good quality sleep do you think the caregiver gets in a night?
If your parent is getting out of bed and leaving the house, you may want to talk to your parent's doctor. It is best to get a medical evaluation to rule out other possible causes.
If there is an immediate safety emergency, seek emergency assistance.
How In-Home Dementia Care Works
Families can keep doing what they’re doing while also allowing an in-home dementia care team to provide support and decrease risk during the most challenging parts of the day.
Team members can assist family members with a wide range of activities from help with meal preparation to providing direct, one-on-one, therapeutic, and safety-related activities of daily living, to household tasks, to aid in managing behavior and providing structure for the family.
When asked to describe behavioral problems that occur with a family member diagnosed with dementia, I encourage the family to be as specific as possible. For example, they should identify the time of day (i.e. 4:00 p.m. or 6:00 p.m.), or state what comes before, after, or during bedtime routines. The family should provide specific information about the routines that are still working and the ones that are problematic.
The same direction is provided when a family is seeking additional support and Alzheimer’s and dementia care in Decatur.
Our dementia team members receive person-centered Care Pro training. Families should be sure their Care Plan describes the dementia team member’s schedule and the level of continuity and consistency that will be provided.
It is important that the team member partners with the family to create a new routines, or to recognize the existing ones, and to identify the structures and supports the family needs the most to help manage the behaviors.
What Home Instead Does Not Do
Home Instead is a private duty, non-medical home care company. Home Instead does not provide medical care, clinical services or substitute for any professional health care provider.
Care Pros are not trained to perform comprehensive health or nursing assessments or provide clinical interventions, including the administration of medication. Care Pros can be instructed to provide reminders to the client to take medication and/or to perform a task in accordance with the care plan.
Sundowning, a behavior sometimes associated with an Alzheimer’s disease and other dementias, can sometimes be confused with other psychiatric and medical conditions that may require the attention of a health care professional.
It is best to always contact the health care professional to determine the cause of new, or unexpected changes and/or behaviors of the client. Home care services may help to address the client’s health and/or behavioral concerns so that the client may better benefit from the medical care services.
The following questions provide general information concerning care and sundowning.
Can sundowning indications suggest that Alzheimer’s Disease is getting worse?
Not necessarily. Sundowning refers to symptoms occurring later in the day.
Can changing the clocks to daylight savings time cause sundowning?
The time change causes no harm to a person with dementia, but it creates an environment of increased stress and confusion due to unnatural changes in light and loss of routine. The easier you can make things to adjust to the new change, the less stress it will cause your loved one with dementia.
Should I keep lights on?
Using additional lights during the day and in the evening will help with the transition to bedtime, and using distracting lights or outdoor lights will help when it gets dark.
What should I do if my loved one with dementia tries to leave the house?
If your loved one is at risk of harming himself or others, contact his or her doctor, and make a safety plan. If your loved one is not at risk of harm, you can call the police to help you locate your loved one.
Can Home Instead help?
Home Instead can provide respite care for families if they have a plan and the need for care is scheduled in advance. Contact your local Home Instead office for more information.
Where should I start with Home Instead in Atlanta? Decatur? Tucker?
We'd first like to understand your parent’s current daily activities and routine in order to determine the time of day when care challenges occur. For example, is there a time of day when your parent’s sundowning occurs? If that is the case, our Care Team in the Atlanta area is available to assist and provide more information on support options for your family. Families in Tucker can also explore local Home Instead support options.
You do not need to wait for all of the evenings in your family to become challenging in order to reach out for assistance. If you are already questioning how your parent will manage the change due to the recent time change and increased darkness, then this means that the time has come for you to assess your parent’s current activities to determine if there are other support and safety challenges that you need to address.
For families living in the Atlanta area, we can provide you with more information about the support options and services that we offer to assist you and your family.
About the Author
Matt Cohn has spent more than 25 years helping older adults and their families understand senior care and support at home. He owns Home Instead locations serving communities in Georgia and Louisiana and focuses on helping families make care decisions that respect each person's routines, preferences, dignity, and independence.
