“Sundowners’ syndrome,” commonly known as “sundowning,” is frequently observed in hospitals and long-term care facilities when elderly patients, particularly those with dementia, exhibit confusion or agitation during the late afternoon, evening, or night time. However, it’s worth noting that the concept of sundowning is met with controversy within caregiving and medical circles due to its casual use to explain problematic behaviours. This controversy stems from concerns that relying on this term might lead to overlooking potential opportunities for improved care and treatment of individuals with dementia.
To comprehend sundowning and its implications, it’s crucial to gain a deeper understanding of what it entails and what it doesn’t. Exploring the application and misapplication of terms like “sundown syndrome” in relation to various behaviours can empower caregivers and loved ones to enhance the well-being of the individuals under their care.
Defining Sundowning:
Sundowning refers to a subjective phenomenon experienced by older adults or individuals with dementia, characterised by heightened confusion, agitation, or other distressing behaviours that emerge during sunset or after darkness falls. These individuals are often labelled as “sundowners.” It’s important to clarify that sundowning isn’t a distinct medical condition; rather, it represents a collection of symptoms or observable behavioural patterns. The lack of a universally accepted definition or scientific consensus about the phenomenon makes it difficult to formally diagnose or categorise as a standalone issue.
Although sundowning terminology appears in various medical literature, its definitions and conceptual frameworks often diverge across sources, and its origin remains uncertain. Ultimately, sundowning describes the observable late-day or night time behavioural challenges, but it doesn’t provide an explanatory framework. Pinpointing the underlying cause requires a personalised approach, as these causes can vary from one individual to another.
Dementia and Sundowning:
In the majority of cases labelled as sundowners, dementia plays a substantial role. According to studies, sundowning behaviour has been observed in a range of dementia patients, with estimates varying from as low as 2.4 percent to as high as 66 percent. This phenomenon is reported to affect up to 20 percent of individuals with Alzheimer’s disease. It’s worth noting that sundowning-like behaviour can also manifest in elderly hospital patients without diagnosed dementia, particularly following invasive surgeries.
Recognising Sundowning Symptoms:
The experience of feeling irritable and restless after a taxing day is a common human occurrence due to exhaustion, work demands, and familial responsibilities. However, individuals exhibiting sundowning behaviour tend to demonstrate more extreme mood swings and disruptive conduct during the hours between sunset and sunrise. Such behaviours can include:
- Confusion
- Agitation
- Disorientation
- Heightened anxiety
- Paranoia
- Restlessness
- Anger
- Aggression
- Delusional thinking
- Refusal to follow directions
- Difficulty distinguishing dreams from reality
- Crying
- Moaning
- Yelling
- Screaming
- Rocking
- Wandering
- Pacing
- Hiding objects
- Acting out hallucinations
Root Causes of Sundowners Syndrome:
While a single underlying cause for sundowners syndrome remains elusive, it’s more plausible that various factors contribute to distinct individuals’ behaviours. Dementia is a predominant factor, particularly in the middle and late stages of Alzheimer’s disease and other forms of dementia. Caregivers sometimes suggest that excessive demands placed on dementia patients throughout the day can lead to sundowning behaviours, as fatigue and anxiety accumulate, impairing their ability to communicate and function.
Caregiving routines and environmental factors, such as staffing changes, can also trigger or exacerbate sundowning behaviour. Unbalanced or inadequate caregiving, along with various medical, psychological, and environmental factors, can play a substantial role in individuals exhibiting sundowning behaviours.
Care and Intervention:
When addressing sundowners syndrome, it’s essential to approach treatment with care, considering the lack of a clear causal understanding. Avoiding excessive use of terms like “sundowning” can be beneficial, as it may not accurately reflect the individual’s needs. Instead, focus on identifying underlying issues driving the behaviours and addressing those directly.
Engage in self-reflection regarding caregiving routines and the care environment, and consider potential medical or psychological triggers. Maintaining a detailed journal of daily activities and observations can help uncover patterns and triggers over time. In instances of new and concerning behaviours, involving a physician is crucial to rule out medical emergencies.
Customised strategies are key when managing sundowners syndrome. Providing adequate periods of rest, maintaining a regular schedule, ensuring proper lighting, and avoiding stimulants are a few approaches that can be effective. Medical interventions, when necessary, should be discussed with healthcare professionals.
Caregivers must also prioritise their own well-being and seek support when needed. Organisations like the Alzheimer’s Association offer local and online support groups for caregivers.
In conclusion, while sundowning remains a complex and debated phenomenon, adopting a personalised approach to caregiving, rooted in understanding and addressing underlying causes, can significantly improve the quality of life for those affected by it.
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