AlzheimersNotes.com

Yesterday I explained Sundowning in Word of the Week. I began thinking about Mother’s sundowning experiences. This wasn’t a big problem with her, but some crisis situations did occur in late afternoon.

I found her sundowning activities usually were connected to something she customarily did in late afternoon in her earlier life.  When I delve deeper into other patients’ sundowning, I’ve realized this often is connected with an afternoon event of former days.

*Feeding chickens - When I was growing up on the dairy farm, we also raised chickens and sold eggs.  We fed the chickens mid-morning and again in later afternoon.  After we discovered Mother regularly feeding invisible chickens in her back yard during her Alzheimer’s days, I finally realized the timing was that of her chicken raising days.

*Catching the bus - One day Mother slipped out of the nursing home and went to a nearby fast food restaurant where they also had a tourist information booth.  She tried to buy a bus ticket (of course, this wasn’t a bus stop) for her hometown.  Upon considering this, I realized that she often caught the bus home from her first teaching job on Friday afternoons after school was out.  She spent the weekend with her family, then returned by bus Sunday afternoons.

*Sneaking out of the nursing home -Another time she stuffed some clothing into her suitcase and eased out the back door of the nursing home.  Again this was late afternoon and she was looking for a bus to go home.  (After that, they hid her suitcase!)

Does your sundowning family member have an agenda that ties in with something they did at that particular time of day in earlier years?

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(c)2008 Mary Emma Allen

AlzheimersNotes.com

SUNDOWNING

Sundowning refers to the agitation and wandering that occurs with Alzheimer’s patients in late afternoon, about the time the sun goes down. For some reason that researchers don’t completely understand, Alzheimer’s patients frequently tend to become agitated about this time of day.

Some have a greater tendency to wander in late afternoon, too.  So they have to be watched more carefully at these times for their safety.

Have you experienced sundowning with your Alzheimer’s patient?

(Here’s an abstract about sundowning from the Journal of Nursing Scholarship, 9/22/07.)

(c)2008 Mary Emma Allen

  With having to set our clocks back one hour to Standard Time in the US, I wondered how time changes affected Alzheimer’s patients.  In the spring we set our clocks ahead to Daylight Savings Time, so I know caregivers may feel a lack of sleep.  Do we get to sleep in that extra hour in the fall?

I didn’t see any real difference in Mother.  Her inner clock always seemed at odds with mine.  She simply got up when she awoke and wandered whether it was light or dark during the night.  I did leave a nightlight on for her because I didn’t want her to bump into things.  The she’d nap during the day if she was tired.

There does seem to be that “sundowners” syndrome in late afternoon with many Alzheimer’s patients when they seem to feel the need to wander and become more agitated.  That’s when Mother wanted to feed her “imaginary” chickens.  I realized that, back in the days when we had chickens on the farm where I grew up, we fed them and gathered eggs around 4 PM.  Mother’s inner clock recognized this time of day.

Changes in routine do often have an affect on those with Alzheimer’s.  So if time changes affected their schedule, you may see additional confusion.

I hope all caregivers did get an extra hour sleep this morning!

A word that comes up when we’re discussing dementia and Alzheimer’s is “sundowning.” 

What is that? I’m asked.

In late afternoon or evening, Alzheimer’s symptoms often seem to become worse.  The person with Alzheimer’s may become more restless, confused, disagreeable, agitated, and paranoid late in the day.  Doctors don’t know exactly why it occurs and what causes it; however, it exists, more pronounced in some people than others, or more intense at one stage of Alzheimer’s than another.

Doctors wonder if the dimmer light has something to do with it. Or is it tiredness, too busy a schdeule, overstimulation and other situations?

My mom’s roommate seemed to associate late afternoon to the time of day her children used to come home from school.  She often said to me, “I’ve got to get home.  The children will be coming back from school.  I’m always there.”  Then she’d want me to take her home.

Some instinct told her this was the time of day her children, when young, arrived home from school.  She was back living in that era, so became agitated if she thought she wouldn’t be at home when they got there.

My mom wanted to go outside in late afternoon to “feed her chickens.”  I finally realized that years ago, when I was a child on the farm, this was the time of day Mother fed the chickens for the night and gathered eggs.  As the sun went down and the day grew darker, Mother knew it was time to see to the chickens.

More information about sundowning is available at the Alzheimer’s Association web site: www.alz.org and the Mayo Clinic site: www.mayoclinic.com/health/sundowning/HQ01463  as well as other web sites related to dementia and Alzheimer’s disease.