Dementia, Alzheimer’s and Sundowner’s Syndrome

Did you know that nearly seven million adults in the U.S. over the age of 65 are living with dementia? By 2060, that number is projected to be almost 14 million. One in three seniors dies with dementia, that’s more people than breast cancer and prostate cancer combined. More than 11 million people in the United States serve as unpaid caregivers for people with Alzheimer's and other forms of dementia, providing an estimated 18 billion hours of care each year. 

What is dementia? 

Dementia is a general term for cognitive decline that can be caused by several different neurodegenerative disorders affecting the brain and causing damage to brain cells. A person with dementia has difficulties with cognitive function, including reasoning, judgment and memory. While some cognitive decline is common in aging, dementia is not a normal part of aging. 

People who have dementia typically have some memory loss and difficulty in at least one other area, such speaking and writing coherently, understanding what is said or written, recognizing familiar surroundings, and accomplishing multi-step tasks. Early signs of dementia include mild changes in the ability to think and learn, but because a person in early stage dementia can still participate in daily activities and dialogue, it may appear to others that the person does not have dementia. 

What triggers anger in dementia patients? 

Sometimes, a person with dementia will become suddenly verbally or physically aggressive. This can happen for no apparent reason or as the result of a frustrating situation. Physical discomfort, environmental factors and lack of communication can cause a person with dementia to become agitated, but remembering that it’s not the person’s fault can help you cope more effectively. When dealing with dementia and anger, try to identify the immediate source of the anger or aggression and make sure it is not pain. Focus on the person’s feelings and stay calm. Try transitioning to a relaxing activity, like music, massage or exercise, and limit distractions.  If you need to walk away and take a moment for yourself, do so, but only after making sure your loved one is safe. 

Alzheimer's vs. Dementia

Irreversible dementia is chronic and progressive, and the most common type of irreversible dementia is Alzheimer’s disease, accounting for 60 to 80 percent of all cases. However, while Alzheimer’s is a form of dementia, all dementia is not Alzheimer's disease. Alzheimer’s disease is a degenerative brain disease that comes on slowly and worsens over time. The most common early sign of Alzheimer's is trouble with memory, because that is the part of brain affected first. The early stages of Alzheimer's can last for years, but as the condition advances, symptoms get more advanced. Disorientation, confusion and behaviour changes are common symptoms, and as Alzheimer's progresses to the end stages, speaking, swallowing and walking become difficult. 

What is Sundowning?

Also called Sundowner’s Syndrome, sundowning is agitation and restlessness that typically occurs late in the day. The reasons behind sundowning are not well understood, but certain factors can trigger it. These may include unmet physical needs like tiredness, hunger, or pain, lack of sunlight exposure during the day, overstimulation or disturbance to the person’s body clock from damage occurring in the brain. Disturbed levels of hormones, sensory impairment, or depression, or side effects of prescribed drugs can also cause sundowning. 

Pay attention to signs of sundowning, like increased confusion or anxiety, pacing, wandering, yelling, rocking in a chair or crying. Try to determine the cause of the behaviour and listen calmly to your loved one’s concerns, offering reassurance. Reduce noise and clutter, try distractions and strive to make early evening a quiet time of day, playing soothing music, softening the lights, reading or going for a walk. You can also reduce the risk of sundowning by helping the person get some sun exposure and regular exercise and sleep enough at night. Avoid serving caffeine and alcoholic drinks, and do not plan too many activities in one day. 

Tips for Caring for a Senior with Dementia 

Caring for a loved one with dementia can be stressful. At times, the challenges faced by a family caring for someone living with dementia can be heart-breaking. Expert caregiving tips can be very helpful, like the following.

• Make sure the home is safe. Depending on your loved one’s condition and stage of disease, there are different levels of safety measures you will need to put into place. Remove trip hazards like throw tugs, as dementia patients face fall risks. Provide mobility assistance, using walkers and grab bars. Hide the car keys because most people with dementia should not drive. Only allow outdoor access in protected, enclosed areas, and install a sturdy shower chair, to support unsteadiness. Talk to your loved one’s care provider about additional safety measures you should take. 
• Put a routine in place. It is important for a person with dementia to have a routine, with a planned day that allows more time for activities that provide meaning and enjoyment. Bathing, dressing, meals and sleep times should be consistent every day. 
• Make mealtime simple. People with dementia experience changes in spatial awareness, vision, attention and sometimes temperature tolerance. This can make mealtime overwhelming, but you can make it easier by following a few guidelines. Reduce distractions and choose plates that contrast with the food and table setting. Don’t use patterned tablecloths and placemats because it can be confusing and make it difficult for the person to distinguish the food from the setting. When served multiple foods they can find it hard to decide on which food to eat first. Offering one or two foods at a time can help alleviate confusion. 
• Anticipate sundowning. A phenomenon known as sundowning is associated with day turning to night, and this can cause a person with dementia to experience increased confusion, memory loss and irritability. Symptoms of sundowning include crying, agitation, restlessness, depression and pacing. By understanding and anticipating this, you can reduce the risk by sticking to a routine and providing an activity, like a puzzle or board game, to occupy the person’s attention. 
• Give your loved one reasonable independence. It is important to involve someone living with dementia as much as possible in daily activities, allowing the person to perform as many tasks as he or she can. This serves the dual purpose of keeping the person occupied while also providing tactile and mental stimulation to promote a sense of calm. 
• Avoid arguing. Because a person with dementia does not have the ability to reason and think the same way other people do, arguing will only cause upset. Rather than arguing, divert your loved one’s attention to a task. 
• Keep naps to a minimum. Avoiding long or multiple naps during the day can minimize the risk of creating abnormal sleep patterns and sundowning. 
• Make the most of music. Make your loved one a playlist of favorite songs from when he or she was young. Music from their youth can help people with dementia regain some of their old personality. Further, a recent study determined that listening to meaningful music can actually make small changes in the brain’s neural pathways, which could improve memory for dementia patients. Provide comfortable headphones to avoid sensory overload and eliminate any competing noises.
• Practice self-care. While you are caring for others, make sure you also take care of yourself. If you don’t give yourself time to rest and recharge, you may be too exhausted to provide the best care for your loved one. If you are having trouble finding time for self-care, respite care can be a great option to give you a break from caregiving to focus on other things for a little while. 
• Try not to take it personally. As dementia progresses, your loved one will get more confused and forgetful, and they may even forget who you are. It doesn’t mean that the person loves you any less, or even that all the memories you have shared are gone. Older memories tend to last the longest.  
• Asking for help. Partnering with a home care agency can help alleviate the pressure on family members. Professional caregivers trained to understand and manage dementia-specific behaviours can ease the burden on the family and provide care and support to the person with dementia.

BrightStar Care^_® Provides Expert Alzheimer's and Dementia Care

At BrightStar Care, we keep up with evolving research so that we can give our clients the very best care. We are committed to providing home care services for all stages of Alzheimer’s disease and other forms of dementia, assisting clients and their families when they need our care. When you need help meeting the physical, mental and emotional needs of an older relative, trust BrightStar Care for excellence in home health care. 

Find a BrightStar Care^® Location Near You 

Looking for in-home care services or assisted living for your loved one or a reliable medical staffing partner for your organization? Our experienced local care team members are ready to help. Find a location near you, contact us online, or call 866.618.7827 to speak with a local care expert and learn more about how BrightStar Care offers A Higher Standard^®.