Sundown Syndrome

Reading about Dementia, you may have come across the term “Sundown Syndrome”.  Sundown Syndrome presents as confusion increasing in the late afternoon and early evening.  The person with dementia can be increasingly restless, less secure, more anxious and emotional, looking for familiar cues/people and has difficulty identifying reality e.g. misinterpreting sounds/shadows.

 

Potential options to consider or trial in managing Sundown Syndrome:

Communication

  • Acknowledge that the ‘behaviour’ has a purpose.  The person is attempting to communicate something.  Try to enter into THEIR world of reality, respect their point of view.  Acknowledge their emotions (sad, happy, anxious, fearful) and personality.
  • Trial: ‘What are you thinking about?’ or ‘You look worried’ Avoid questions if verbal skills are impaired.
  • Avoid argument, finger pointing, threatening, being condescending or rushed even when feeling frustrated or guilty and unable to interpret the emotions or meaning of your loved one.
  • Sit at their level if appropriate and allow space/ avoid crowding.
  • Establish eye contact and speak with a clear, respectful tone of voice and positive statements.  Express one idea at a time by touch or using simple phrases.
  • Respond with compassion.  Maintain positive appropriate non-verbal facial expression and body language and listen – this is more important than words to communicate thoughts and emotion.

 

Observation

  • Establish through observations a possible trigger for this ‘behaviour’ and a possible reason for it reducing or ceasing the behaviour.
  • Is this a sudden change or an ongoing pattern of behaviour?
  • Has there been a recent or past trauma e.g. fall, arguments, abuse?
  • Has there been a recent change in medication? Request a medication review.
  • Are there unmet basic needs such as hunger, thirst, pain, fatigue, need to toilet, feeling insecure or bored.
  • Will meaningful distraction and comfort food or fluids relieve anxiety.
  • Have stimulating fluids or products been given after lunch e.g. alcohol, caffeine & nicotine.

 

Environment

  • Check that the environment or clothing is not too hot or too cold.
  • Avoid too much activity.
  • Allow pacing in safe area if needed – do not restrain.
  • Limit noise e.g. keep soft music, turn TV/Radio down or off.
  • Increase light to orientate and minimise shadows as daylight decreases but draw curtains to eliminate external cues.
  • Expose to morning sunlight daily.
  • To assist orientation and aid a sense of security
  • Ensure living area is well lit
  • Leave light on in toilet
  • Facilitate meaningful/individualised activity which may distract and calm e.g. related to past interests, hobbies, afternoon routines.
  • Compensate for sensory impairment e.g. put on eye glasses, put in hearing aid.
  • Slowly stroke or massage neck, shoulders and back, hand or foot.

 

Valued Routines

  • Maintain routine including e.g. meal time, morning activity, rest early afternoon, similar bed times or shower times but also be open and flexible.
  • Avoid afternoon showers if distressing.

 

Medical

  • For behaviours that are less severe with less risk of harm, non-pharmacological actions listed above should be trialed before medication.
  • Consider seeking assistance for persistent and/or escalating behavioural and psychological symptoms e.g. related to severe delusions, paranoia or hallucinations causing distress or high risk to the carer or the person with dementia.  Behaviour management specialist, GP, geriatrician and psychiatrist may be able to assist.
  • If the change in behaviour is of sudden onset (over hours or days) and not typical behaviour, potentially a medical assessment or intervention is required e.g. for infection – urine, chest, ear – constipation, dehydration or pain.
  • Discuss with doctors and pharmacists about the benefits, disadvantages and review plans related to pharmacological solutions as these may produce side effects such as a decrease in balance, stability and alertness; and/or a decline in mobility and increase in falls risk or effect heart health.

To discuss further with our knowledgeable staff, please call 1800 639 331.

 

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Words: Noela Cunningham