DEMENTIA SUNDOWNING CARE PLAN

So, your Mom has dementia. And, every evening starting at 5.30, she begins sundowning. She cries. She wants her mother. She wants to go home. She wants anything but you, apparently. She’s inconsolable. She weeps. She wails. She paces. She wrings her hands.
Or maybe it’s your Dad. He wants to go home too. But he gets mad about it. He rants. He rages. He wants to go to work. To school. To war. He berates you. Harangues you. Sundowning is transitional for people with dementia but wrenching for their caregivers. Caregivers feel wrung out long after it’s over for the person with dementia. That’s why it’s so important to have a care plan.
Sundowning is a universal phenomenon, not confined to those with dementia. At close of day, emotional feelings intensify. Babies get fretful, people feel their loneliness most, even birds go flying around energetically. It’s a very intensified time throughout the whole of nature. So, keep a sense of proportion.
Each person has sundowning his or her own way, but normal sundowning does not become violent, crazed or last all night. That would be a sign expert psychiatric intervention might be needed, for possible PTSD, undiagnosed schizophrenia or some other serious mental illness or neurological issues.
Normal sundowning typically lasts about two hours. It involves intense feelings of loss, anger, longing, unhappiness, with agitated or anxious behaviors, often repeating the same thing over and over.
Typical might be:
“I have to go home now.”
“Is my mother coming?”
“It’s time for work.”
“Nobody knows where I am.”
Pay close attention to these, because they express real emotional issues. Your support helps genuine emotional issues, but your planning is needed for sundowning. Before you plan, observe.
When does it start? When does it finish? What helps? Since we don’t truly know what sundowning is, we take a multi-tasking approach. Assume hunger and hydration are issues. Assume redirection could help. Assume emotional support, not suppression, is needed. Don’t be afraid. Sundowning doesn’t harm anyone — it’s just distressing. Don’t take on the agitation. This will pass in a given period of time.
The Care Plan:
1. About an hour before sundowning usually starts, give a nutritious snack and both juice and water;
2. When it starts, be supportive, don’t argue, do console. Don’t say, “Your mother died forty years ago,” but “I know you miss your Mom,” and then act motherly;
3. Have your distraction activity ready — a drive in the car, a favorite movie, a cd of waltzes and you two waltzing, an old family photo album, consolation and Kleenex;
4. Relax and breathe deep, don’t get swept up into agitation and do not think it’s all failed brain cells. That’s abandonment of the worst kind.
5. Pay attention to the emotional issues and resolve to work with them. For example, if Dad wants to work, give him daily chores or gardening or something to do, so he can feel less useless. If Mom misses her mother so much, be more motherly to your Mom. That way, you may heal a wound she’s always had until now.
It takes planning, yes, but you’ll be glad you did it. I have found, in 20 years of working with people with dementia, it’s entirely possible to eliminate sundowning with a good all-round care plan.
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