a senior man with dementia

People living with Dementia can often lead happy and fulfilling lives following their diagnosis. However, as the disease advances, physical, mental, and behavioural symptoms will present themselves, making it difficult for the person to live safely and comfortably alone.

These symptoms vary based on the individual. Some of the factors that can impact the advancement of Dementia (advancing through the different stages of mild, middle, and late) include age, physical health, and if the person has other concurrent medical issues.

As symptoms increase in propensity and begin to evolve past the mild stage, those living with Dementia, and the loved ones who support them, may need to seek more consistent support from a family Caregiver, or to secure person-centred Home Care from experienced Dementia Caregivers — like those here at Integracare Home Care. As the most qualified provider of Dementia Care in Toronto and Mississauga, we understand the many facets of Dementia — including sundowning — and how to pivot and adapt our care to suit our Clients’ personal needs.

As much as it’s important to understand the early signs of Dementia and how the disease can evolve, it’s also essential to be able to identify and understand some of the unique symptoms and behaviours that can arise throughout the stages following a loved one’s Dementia diagnosis.

Here, we’ll be exploring a collection of behavioural symptoms commonly referred to as sundowning. While an Integracare Caregiver will be able to handle and manage such situations, it’s also important for you to understand a behavioural pattern like this. That way, you’ll also be able to help your loved one relax in a safe and effective way should they begin to express or experience sundowning behaviours while in your company; being equipped with this brief education will also empower you to keep calm and collected.

Why Dementia Affects Those Living with Dementia Behaviourally

First, it’s important to understand why Dementia causes people to act in a way that’s not in keeping with their usual selves.

Dementia is an umbrella term for a series of chronic diseases that cause progressive damage to the brain. In greater detail, Dementia causes neurons and their connectors to die. Behavioural change happens when the person’s frontal, parietal and temporal lobes sustain damage like this. These are the areas of the brain that are collectively responsible for thinking and memory, hearing, learning, emotion, language comprehension and behaviour.

As different symptoms begin to present, people living with Dementia may no longer act like themselves. Many will internalize frustration at their inability to follow conversations or situations. They may also mirror the behaviours of those around them — and for this reason, it’s essential to remain calm and collected when you’re in the company of someone who’s living with Dementia. Becoming upset or frustrated yourself can cause them to experience greater distress.

Behaviours can also shift if the person living with Dementia is experiencing a medical problem. In this case, they may struggle to find the words to describe how they’re feeling or that they’re not well. You may also notice a behavioural shift if the person is on a new medication, or if they’ve been experiencing issues with their sleeping patterns.

a senior couple battling dementia

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Behavioural Symptoms of Dementia

Some of the behavioural changes that may come with Dementia include:

  • Irritability — getting upset, agitated, angry or overstimulated more easily and readily.
  • Hallucinations and imagining things that aren’t real.
  • Depression and apathy.
  • Physical and verbal outbursts.
  • Leaving the home in a state of confusion or without real cause — often referred to as wandering syndrome.

Dementia sundowning is a term used to describe a combination of some of these behavioural symptoms — but uniquely, at a specific time.

Understanding the particulars of this behavioural shift and its consequential personality swings can help you support your loved one much better. Let’s explore Dementia sundowning syndrome further.

What Is Sundowning in Dementia?

If you’re caring for a loved one and you’ve noticed a heightened frequency of behavioural symptoms in the late afternoon and the early evening — with some symptoms persisting into the night — they may be experiencing Dementia sundowning. This is an amalgamation of behavioural symptoms that affects approximately 66% of people living with Dementia, and one in five people who are living with Alzheimer’s.

What Are the Most Common Signs of Sundowning?

The most commonly seen signs of those experiencing sundowning include:

  • Agitation.
  • Restlessness.
  • Suspicion and paranoia.
  • Disorientation and confusion.
  • Irritability.
  • Shouting or yelling.
  • Pacing.
  • They may also experience visual and auditory hallucinations.

Each of these behaviours can cause the person to leave their bed and wander, putting them at risk.

How Long Does Sundowning Last in Dementia?

It’s often noted that those experiencing sundowning display these behaviours around the same time each day. The behaviours last for approximately four hours.

In What Stage of Dementia Is Sundowning Most Common?

Dementia affects people living with the illness differently and at different times. However, those caring for someone living with the disease report that sundowning is experienced during the middle stage and that it reduces in frequency as the late-stage symptoms present themselves.

An increase in behavioural symptoms in the evening can make life incredibly difficult for family Caregivers, causing those in the home to experience loss of sleep themselves, either due to activity or worry. For this reason, live-in, at-home help is highly recommended during the mild to late stages from person-centred home health care services — a decision that will benefit both you and your loved one.

a seniors woman managing her dementia through gardening

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Why Do Some People Experience Sundowning?

At this time, the exact cause of sundowning in Dementia isn’t precisely understood. One assumption is that it’s tied to a person’s internal clock, which has already been negatively affected by the changes in the brain caused by Dementia leading the person to struggle to identify day from night.

Other events that have been attributed to causing sundowning include:

  • Exhaustion: This can stem from sundowning itself which may keep the person up at night, from pain or discomfort from a disease like arthritis, from an underlying medical condition, or from a sleep disorder.
  • Lessened physical and mental activity leading to overstimulation later in the day: Some Seniors may experience mental health issues like depression and anxiety, which makes it difficult for them to feel motivated to participate in activities during the day. They may also experience physical symptoms associated with Dementia which make movement more challenging.
  • Changes in light: The darkness that comes with an early evening can cause people to experience hallucinations and confusion.
  • Pain or discomfort.
  • Hunger, thirst, or other unmet needs: This can cause the person to feel restless and irritable.
  • Side effects of medication.
  • Hormonal disruptions that fluctuate throughout the day.

These symptoms and behaviours can be exacerbated by the changing of seasons in fall and winter when the days are shorter, and by the twice-annual changing of the clocks.

Some Strategies for Managing Sundowning

If your loved one is experiencing sundowning, finding a system or strategy that works best for them could take some time. But know that with some trial and error, it’s possible to find a way to reduce and manage the effects.

Creating a steady and consistent routine that includes a combination of some of the following strategies at a set time each day can help:

  • Keep your loved one busier during the day. Gentle physical and mental exercise and reduced napping (or shorter naps) are great places to begin. Exercise like light gardening, meal preparation or an accompanied walk to the end of the road are all safe forms of activity for people living with Dementia.
  • Distraction at strategic times. If you’ve noticed a pattern and that sundowning occurs at the same time each day, try to distract your loved one at this time. Offer a light snack, put on a favourite upbeat television show, record, or audiobook or complete a simple household chore — these are all great distraction methods.
  • Create a relaxing and calming atmosphere. Soothing music or a visit from a loved one can offer comfort, but it can also be a form of distraction. Reducing outside noise by closing windows and doors can also help to lessen stress and irritation.
  • Manage light levels throughout the day. Let bright daylight in during regular waking hours and turn on soft lamps in the evening, making sure to close the curtains or blinds to minimize shadows, which can sometimes be distressing.
  • Reduce sugary foods and drinks later in the day and remove the availability of caffeine and alcohol.
  • Monitor your loved one’s diet. If you notice certain foods or drinks potentially worsen their behaviours in the evening, try paring them back or offering them at different times.

It’s vital that you continue to communicate with people living with Dementia. If you notice your loved one becoming agitated later in the day, try talking calmly to soothe, comfort, and reassure them. It’s important not to correct or challenge your loved one too firmly. Doing so can cause stress and agitation, as your queries may be interpreted negatively and perceived as questioning what they identify as reality.

Setting up safety nets in case your loved one leaves their bed in response to agitation or confusion is essential. Minimizing clutter, putting night lights in hallways and bathrooms, and hiding house and car keys are all good places to begin. You can also install a bell on the front door just in case you’re worried about your loved one wandering outdoors.

senior hands

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What Should You Do If Sundowning Escalates?

When it comes to sundowning and Dementia, it’s always easier with professional help. If you find that sundowning is escalating for your loved one, it’s important to seek medical advice to rule out any medical issues, such as a side effect to a current medication, pain, infection, a sleep disorder, or other matter.

Talk to Us About Live-In Care

Seeing a friend, beloved neighbour, or partner’s personality and behaviours changing in unexpected and unpredictable ways — perhaps entirely contrary to their usual personality — can be incredibly challenging and upsetting. It can also pose major issues for those in their support network.

However, understanding sundowning and Dementia — its nuances, symptoms, and effects — can go a long way towards helping your loved one as you navigate the different stages of the disease and their mental, physical, and behavioural patterns.

It will likely become increasingly more challenging for you and your family to manage your lives in tandem with your loved one’s needs — especially in the mid to late stages when challenges like sundowning can begin. You shouldn’t take too much on at once. Burning out isn’t helpful for your family, for you, or the person in your care.

There’s no easy solution when a loved one is diagnosed with Dementia. However, we believe that with professional help, the process will be much more manageable and less overwhelming for you and your family.

Integracare Home Care offers a series of Care services, including at-home, around-the-clock care. We match our Clients with highly trained, licensed and qualified Caregivers based on the Client’s needs and on their personality. We have over 30 years of experience offering Seniors and their families high-quality care that takes the pressure off family members and provides a joyful way of life for our Seniors.

We have an exclusive partnership with the Alzheimer’s Society of Toronto. Through this partnership, every Integracare Home Care Caregiver and Personal Support Worker (PSW) is receiving education and training on all facets of Dementia Care. We are also a recent recipient of the 2023 Canadian Business Excellence Awards for Private Businesses, an exclusive award given to businesses who have excelled in three performance areas: Delighted Customers; Engaged Employees, and Innovation.

You are not alone! Let us work with you in creating a Dementia Care Plan that works best for you and your loved one. Connect with us at Integracare Home Care today to learn more about our services and how we can support you and your family during this difficult time, all from the comfort of their own home.