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Dear Jenny: How do I combat Sundowning? Jenny Wallis | Fri, Sep 03 2010 12:00 PM

Dear Jenny,

My aunt has been diagnosed with early stages of Alzheimer's disease by her doctor. She seems fine to me like she has always, but lately in the afternoon or evening she gets very agitated. The doctor didn't mention this and this isn't like her. What's happening?

Your aunt is experiencing a condition known as Sundowner's Syndrome. Sundowner's is fairly common for someone recently diagnosed in the early stages of dementia (like Alzheimer's), but not everyone experiences it.

There are many different theories as to what triggers Sundowner's Syndrome, often called Sundowning. Some theories include hormonal imbalances, fatigue, or even a response to limited visibility as it gets darker. The symptoms of Sundowning differ in each person; some have rapid mood swings with anger or fearfulness, while others experience random crying, excessive pacing or general restlessness. In many cases the individual tends to become stubborn, or more so than usual and sometimes will refuse the caregiver's direction, even from their spouse. In extreme cases, a person with Sundowning may wander away from familiar surroundings or even become violent. Whatever the cause of Sundowner's Syndrome, once the sun comes back up these symptoms usually go away.

Sundowner's Syndrome can place a tremendous strain on family members, both physically and emotionally. Often in the morning, the individual with dementia will not have any recollection of whatever behaviors they exhibited the previous evening, so patience is one of the most critical traits for caregivers.

The good news is there are different things that can help reduce the effects of Sundowning. Routine is crucial to those suffering from dementia, so establishing a consistent nightly routine while getting ready for bed is important. Exercise during the day may help reduce some excessive energy that comes out in the evening. Changes to the environment can also help, such as ensuring there is sufficient lighting for visibility, reducing unnecessary clutter, and reducing the volume on the television or radio. If the TV is on, minimize shows that have scenes of violence, including the news with stories of kidnapping, murders, bank robberies, war, bleak economic news, or any other negative messages. Ideally keeping the person engaged in activities that are not over-stimulating, but still exercise the mind and body help distract from some of the effects of Sundowning.

Lastly, if one thing doesn't work, try something else to get a better response or create a calming presence. It may be a trial-and-error approach, but since everyone is different, this is sometimes necessary. Lastly, consider attending a local dementia support group since you can share ideas and techniques that work, and it helps to know that you aren't alone out there.

If you have questions about senior care or helping an elderly loved one, contact Jenny Wallis, Community Marketing Director at Villa Bonita Senior Living at (619) 739-4400 or by e-mail at villabonitamkg2@islllc.com.

Villa Bonita Senior Living is an Assisted Living Community licensed by the California Department of Social Services, located at 3434 Bonita Road, Chula Vista, 91910. You can also visit Villa Bonita online at www.villabonitaseniorliving.com.

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