Sunday, July 22, 2012

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. 

In an attempt to explain this phenomenon to younger women, I have compared it to the struggle parents have when helping young children transitioning from daycare or school into their evening activities and then to dinner and then to their bedtime routine.  

These transitions can happen in the space of just two hours, stressing the young child. They suffer similar behavioral and emotional upset as older adults with dementia.   Older adults might need to transition from the common rooms to the dining room, to their bedrooms and then into their pajamas before retiring for bed—all within just two hours.    

Experts speculate that those with dementia have fewer reserves for managing the stress and fatigue that comes at the end of the day. Some speculate that the body’s circadian rhythms are disrupted by dementia, making it harder to transition from daytime activities to a full night’s sleep.

Even though I am not currently a caregiver, that might change.  Family caregivers and professional caregivers have developed ways to address the agitation that often accompanies nightfall.  Strategies to reduce sundowning include the following:
  •  Limiting caffeine late in the day
  •  Limiting sugar late in the day
  •  Encouraging exercise
  •  Limiting naps during the day
  •  Keeping to a regular routine
  •  Moving meal times earlier in the evening and then providing a bedtime snack
  •  Moving activities such as visitors, bathing, doctor’s appointments, rehab visits, etc. away from late afternoon hours and into morning or mid-day hours.
  •  Limiting distractions such as blaring radios and televisions.
  •  Encouraging soothing activities, such as low lighting, white noise, warm milk, soft-textured blankets


  1. I once worked in a nursing home with an Alzheimer's Unit and this is definitely true. Nice blog.

  2. Thank you for your work in eldercare, mmurfy!