As many families care for an aging Loved One, the impact of dementia can enter the picture. Statistically, the numbers are staggering. In 2011, 747,000 Canadians were living with cognitive impairment, including dementia – which is 14.9% of Canadians aged 65 and older. By 2031, this figure will increase to 1.4 million. (From: A new way of looking at the impact of dementia in Canada. Alzheimers Society)
The impact on the number of people taking on a caregiving role is dramatically affected by this statistic, with one in five Canadians aged 45 and older now providing some form of care to seniors living with long-term problems.(From: Eldercare: What We Know Today (2008) Statistics Canada)
Between 2 per cent and 10 percent of all cases of dementia start before the age of 65. The risk of dementia then doubles every five years after age 65. (From: World Alzheimer Report 2012, A public health priority.(2012) WHO)
These statistics may be astounding to the general public, but when a family is personally trying to manage the care of someone they love with dementia, it is the day to day issues they face that impact them.
A symptom associated with Alzheimer’s disease or other dementias that can be difficult for families to deal with is a term called “sundowning”. This is a state of increased agitation, activity and negative behaviors which happen late in the day and through the evening hours. It used to be thought that sundowning was caused by the lowering light and shorter days. However, research now indicates that being overly tired may have more to do with sundowning. This increase in agitation behavior is often associated with the “inability to deal with stress” and may be the only form of communication your Loved One has to express their emotions. Some suggestions for caregivers on how to minimize some of the behaviors associated with sundowning are:
1) Make sure that your Loved One is well-rested: It does help if you can get your Loved One to take a nap just before their normal period of sundowning. If they cannot or will not nap, an hour of quiet time (reduced stimulation and activity) will work. Turning off the TV, putting on some soft music and doing a quiet activity may be helpful. Or, just sitting quietly for an hour, talking softly or just relaxing. Sometimes, taking a nap with them is soothing both for them and for you!
2) Limit outings and activities to the morning hours: Generally an individual with Alzheimer’s disease is better able to tolerate outings, activities and increased stimulus during the earlier part of the day. Plan your trips to the grocery store, involvement with kids and so forth during the earlier hours of the day. This should be followed with a time of decreased stimulus and quiet time to allow your Loved One to wind down and relax.
3) Decrease the length and amount of stimulus: Even during the earlier part of the day the individual with Alzheimer ’s disease can only tolerate so much stimulation and commotion. Take steps to eliminate over-stimulation such as television, children, and any noise making item, quick movements and too many things going on at one time. Sometimes excessive stimulation cannot be avoided. When that happens, allow your Loved One to have a quiet area to retreat to.
4) Identify and minimize physical discomfort: Other types of physical discomfort can also play a part in sundowning. Hunger, being wet or soiled, feeling cold/hot and other sources of discomfort can increase agitation, especially in the late afternoon and early evening. Light snacking during the day can be helpful. Apples and other fruits can help replace lost energy – even if your Loved One is pacing back and forth, that does not mean they have an endless supply of energy. Make sure that your Loved One’s personal needs are attended to and that the climate is at a comfortable level.
5) Identify and treat medical ailments: Many ailments can contribute to sundowning and agitation. Arthritis can be one of the most common causes. An over-the-counter painkiller as recommended by your Loved One’s physician before the time of sundowning might be of great benefit. Urinary Tract Infections(UTI), flus/colds, asthma, allergies and other conditions are all medical ailments that can contribute to sundowning. It is always a good idea that when your Loved One first begins to exhibit sundowning or when sundowning becomes common, to take them to the doctor to make sure that there is nothing ailing them.
6) Be observant to possible causes: Many times there are triggers to agitation leading to sundowning. Noise and stress can be a factor. Be aware of having too many things going on at one time. Mirrors also can become a trigger, as well as certain pictures around the house. Watching to see what is going on, what events are happening and who is present prior to sundowning can help reveal some causes (and solutions). Sometimes no matter what you do sundowning will happen. Understanding it allows you to have more patience and empathy in dealing with this sometimes confusing symptom.
7) Provide a private “time out” space for your Loved One: Create a place where your loved one can go if things became too much so it becomes their natural private area. Sometimes there are times when they just need to get away and be alone. We all need this, and someone with dementia is no exception.
8) Check with the doctor: If sundowning is particularly troublesome, you may need some extra help with prescription medication. Talk with the doctor to let him know of the behaviors, time of day and how your Loved One is behaving before sundowning. He may be able to help you by prescribing a medication to help ease the symptoms. Medication is a last resort and may take several attempts with different drugs and doses to find the right one that will work for your Loved One. If the medication does not help, do not become discouraged, relay the information to the doctor and he may either adjust the dosing or change the medication. Always ask the doctor to start with the smallest dose possible. Medication is only meant to take the “edge” off the behavior, it is not meant to make your Loved One dopey or groggy, although some medications may make your Loved One sleepy the first few days.
10) Keep things simple: Keep the surroundings as simple as possible. Be sure your Loved One’s walking paths are clear from clutter and obstacles. Low furniture such as coffee tables and foot stools can make it difficult and become a source of frustration. Keep knickknacks to a minimum and the tops of tables, television shelves and other surfaces as clear as possible. Mirrors and pictures can often become unfriendly visitors that the individual with Alzheimer’s disease cannot understand. Complicated, noisy appliances are also frustrating to them. Avoid changing things once you have things simplified. Changes of any kind are extremely frustrating.
And most importantly, as a caregiver of someone with dementia, remember to take care of yourself! It is often the caregiver that becomes ill from stress, worry and being overextended. Take the time to mark caretime events that nurture and support you,
no matter how heavy the demands are that you are facing. It is crucial for your own health and well being and to be able to maintain the caregiving role.
Please send along any other tips you have found useful for sundowning to firstname.lastname@example.org and we will share them on our website.