Sundowning: Agitation in the Evening

Photo by Fr Antunes

I have to admit that I avoid visiting skilled nursing facilities (SNF) in the late afternoon and early evening. I have a handful of friends who live in SNFs, and I have observed a phenomenon called sundowning or sundowner’s syndrome, which affects a number of residents.  

People with Alzheimer's disease and other dementias are prone to experience confusion and agitation as the sun goes down, making it difficult to communicate with them and care for them.  For some reason, people in the mid-stages of dementia seem to be most affected.   Symptoms include the following: yelling, crying, confusion, hallucinations, tremors, and pacing. 

Put Down the Book and Go Visiting

Photo by SP8254

Today I delivered an early birthday present to my friend Gladys, who will turn 102 at the end of this month. I gave her a book about the 1875 Chinatown wars in Los Angeles.  Gladys remembered her parents talking about this event plus the Tong wars in San Francisco, so she wanted to read this new book after seeing it reviewed in the local paper.

I told her that I didn't know much about these events, but I had recently finished The Buddha in the Attic and  the Hotel on the Corner of Bitter and Sweet, which are very engaging novels about hardships endured by Japanese immigrants and their children. I shared with her what I learned about picture brides and the Japanese internment.

Gladys is an avid reader, but she replied, "Well, I haven't read either of those books, but I can tell you a little bit about my experience with the Japanese internment."

Chasing the Older Boomers

Photo by Renato Pequito

I have recently learned that as one of the youngest members of the Baby Boomer generation, I can be described as a Generation Jones-er, (b. 1954 - 1964).

The name implies that I am constantly trying to catch up with those spear-heading our Boomer cohort.  

The term Generation Jones-er comes from the phrase “Keeping up with the Joneses.”   This well describes my vantage point within the Baby Boomer generation.

The Baby Boomers are defined as those born between 1946 and 1964.  

However, the tail end of this group—those born 1954 to 1964--missed some key events of this generation. 

We were too young to be drafted into fighting the Vietnam War, too young to drive a VW to Woodstock, and too young to participate in the Summer of Love. 

I have been chasing the older Boomers my entire life. 

Hospital-induced Delirium

Photo by Dan Bolton.

[Updated April 9, 2013 to add info on PTSD for patience experiencing delirium while hospitalized.]

When an older adult is hospitalized, family members are already upset and concerned.  Then often the patient falls into a state of agitation, delirium or even psychosis—making an already stressful event even more traumatic.  

Family members may not realize that older adults are more prone to hospital-induced delirium.  

Note: This post does not offer medical advice. It's purpose is only to raise awareness. If you have any questions about managing hospital-induced delirium (or any other health issue), please meet with a licensed medical professional.

"Delirium occurs in up to 56 percent of hospitalized patients and nearly 80 percent of patients admitted to intensive care units," according to a study conducted by University of Medicine and Dentistry of New Jersey. Note, these statistics are for patients of all ages; everyone is at risk. 

 

Symptoms include restlessness, agitation, anxiety, confusion, lack of focus, disorientation, speech problems, memory problems, sleep disturbance, trying to pull out lines, trying to rise out of the bed, picking at skin, hair pulling, nightmares, hysteria, hallucinations, paranoia and aggression (spitting, hitting, biting). 

Although this set of symptoms generally show the patient is more worked up than usual, he or she could also be more inert showing symptoms such as fatigue, slurred speech, withdrawal, and unresponsiveness.

This is a difficult situation for medical professionals to diagnose because physiological causes for these symptoms need to be treated or excluded.