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Living With Alzheimer's >> Behavior Basics | 04.24.15

Sundowning: the tendency toward late evening confusion

As the evening hour approaches, as many as 20% of people with Alzheimer’s tend to experience restlessness, confusion, anxiety and other disorienting symptoms. This condition is called sundowning, and it can make late afternoon and evening an especially trying time for caregivers.

Why is this happening?

The precise causes behind sundowning behaviors are unknown, but several factors could be to blame. Many people with dementia tend to wear out during the day, making the evening hours a time of physical and mental exhaustion. Their ability to cope with their environment is at its weakest as the day turns to night. Dementia also affects a person’s internal clock, making day/night confusion common. Visual cues such as lengthening shadows, decreased light, and reflections from mirrors can also trigger confusion associated with sundowning.

How should you respond?

In general, try to schedule any activities, appointments and trips toward the earlier part of the day. You want to use up as much of the person’s energy as possible before late afternoon arrives. Some brisk walks during the day can help while providing valuable exercise. Also, keep any caffeinated foods or beverages, such as coffee, soda or chocolate, restricted to the morning hours.

As evening approaches, quiet the environment by replacing loud television programs with soft music. If disorientation occurs, remind the person where they are and what is happening. Arguing will only further confuse and upset them. If restlessness continues, try to calm the person with the quiet activity, such as reading a favorite book to them.

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