What does the term Sundowning mean?

Why do I hear people referring to ‘Sundowning’ and what does it mean?

The term ‘sundowning’ is often used to refer to the fact that some people living with dementia can experience a worsening of their confusion or restlessness towards the end of the day.

At Randolph Hill nursing homes, we try to avoid applying labels such as ‘sundowning’ to people, preferring instead to see each of our residents as individuals, and to try to understand what affects their day-to-day life. Every person’s experience of dementia is unique to them, and understanding the person, their experience of life, what is important to them and what challenges them can all help us to tailor their care in a way designed to alleviate symptoms and improve their quality of their life.

How do changes in behaviour come about?

There are many reasons why someone living with dementia may experience a worsening of their symptoms later in the day.

Increased tiredness

For the person living with dementia, everyday tasks can require much more concentration and energy to achieve, and so for someone who may already be physically frailer, or dealing with chronic ill-health, they may hit a barrier of tiredness as the day progresses, making it harder for them to deal with the world around them.

Disrupted sleep

It may be that changes in the brain have affected the person’s normal daily rhythms and cycles of sleeping and waking, resulting in disrupted sleep at night, or a need to sleep during the day. All of this adds to feelings of confusion and tiredness as the day progresses. The person may feel disorientated as they see the light changing as we transition into evening, but their body feels unready for night-time, so they may think that they are in the wrong place at the wrong time.

Influence of light

Changing light levels can also have a more direct effect on people living with dementia, as many will have a degree of age-related visual difficulty or, depending on the type of dementia, may have an altered perception of what they are seeing. All of this can add to a sense of anxiety and confusion.

Evening seen as a time of transition
Most of us lead busy lives, and the early evening is often a time of transition from working day to home life – with meals to be prepared, housework to be done, and children to collect from school, and then later settle to bed. In the mind of someone living with dementia, there may still be that sense of ‘things that need done’ at this stage of the afternoon or evening that stirs up feelings of restlessness without direction, of frustration or worry that they should be attending to family.

Physical influences

Hunger, thirst or pain may also drain someone’s resources, and make the end of the day harder to deal with as they become increasingly tired.

Knowing the individual can ease the symptoms

Using a label such as ‘sundowning’ can create an excuse to do nothing; take away the need to enquire and understand; make us see the illness and not the person.

By getting to know our residents well, understanding the rhythms and priorities of their past lives, as well as providing care in a way that meets their needs in the present, the staff teams in our Randolph Hill Nursing Homes aim to alleviate the symptoms that each of our residents living with dementia experience, and to improve their quality of life – no matter what time of day or night.