Helping to Manage Sundowner’s Syndrome

Living with Alzheimer’s can be a challenge for the entire family. Whether your family has professional Alzheimer’s care assistance or if you are caring for your loved one alone, it can seem as if each day is full of new challenges and developments. 

One of the things that makes Alzehimer’s care so challenging is that those living with the disease can have different needs at different times of the day. Late afternoon and early evening can be especially hard for those who experience Sundowner’s Syndrome.

What is Sundowner’s Syndrome?

It is a change in behavior, temperament, or personality that occurs in the late afternoon or early evening.  This occurrence is also known as “sundown syndrome” or “sundowners” or “sundowning.”

The experts at WebMD cite that 1 out of 5 people in need of Alzheimer’s care suffer from Sundowner’s Syndrome. Doctors do not know what causes the sundowning behavior. However, the part of the brain that tells you if you are awake or asleep typically breaks down in Alzheimer’s patients. Some scientists think these neurological changes affect the inner body clock. 

Sundowning can manifest in several ways. Your loved one may become:

• Agitated
• Restless
• Irritable
• Confused
• Disoriented
• Demanding
• Suspicious

People with Sundowner’s Syndrome may even yell or pace around the room, sometimes hearing or seeing things that are not there. They may also exhibit mood swings. These behaviors can become progressively worse and can range in duration from a short time to the entire night.

Suggestions for Managing Sundowner’s Syndrome

As a family caregiver, you will need to demonstrate flexibility and empathy to help your loved one feel as peaceful as possible.

1. OBSERVE
   Take careful notice of events that trigger the behavior. Does the evening news instigate agitation? Is the late afternoon a time of significant activity in your home? Anything that disturbs the regular order of the day could prompt a behavioral change. Nutritional triggers can also stimulate behavior. Assess and possibly limit caffeine, sugar, and alcohol intake.
   
   
   
2. DISTRACT
   If this is their new reality, you must endeavor to understand it. Don’t express frustration with your loved one, but use activities, such as music or television shows, they enjoy as a calming tactic. It will divert their attention from troubling thoughts yet soothe them with the familiar things they love. Consider companion care from a professional home care agency to assist your loved one during the most challenging hours of sundowning behavior.
   
   
   
3. ADJUST
   In addition to natural light, the use of bright lights in the room during the day will ward off the evening shadows and maintain the daytime glow until it is time for bed.
   
   
   
4. SIMPLIFY
   Adjust their sleep environment to one that is welcoming and serene. Light-blocking curtains can create a cocoon-like setting that encourages a restful night’s sleep.
   
   
   
5. CONSULT
   Check with your loved one’s doctor* about natural supplements and discuss the possibility of recommending anti-anxiety and even anti-depressant meds. Use caution when purchasing anything over the counter unless the doctor has confirmed there is no interference with already prescribed medications.

Finally, try to have patience. It may take a little time to figure out what combination of solutions works for your loved one. When it comes to Alzheimer’s and dementia care, everyone is different. If you need professional at-home living assistance, we are here to help.

Together with your family, we will give your loved one all the respect and love they deserve with the finest in Alzheimer’s care. To request a free in-home consultation, and find out more about our caregiver services, call us today at 617-795-2727.

About Visiting Angels Newton/Canton:

Visiting Angels Newton/Canton MA is an award-winning local home care agency providing high caliber in-home care services to the elderly and people with disabilities. Countless families have benefited from our dementia and Alzheimer’s care, companion care, respite care, transitional aid, and elder home care services in Brookline, Watertown, Needham, Dedham, Canton, Stoughton, Natick, Wellesley, Newton, Chestnut Hill, Roslindale, Westwood, Norwood and nearby towns. While non-medical in nature, the care provided by Visiting Angels Newton/Canton can make a significant impact on your loved one's happiness and quality of life. If you find yourself or a loved one in need of in-home senior care services, don't hesitate to contact us!

* This article is for information purposes only and should not be considered an endorsement or recommendation for treatment of any kind. If you are concerned about your loved one's health, a diagnosis of dementia or Alzheimer’s, or about their progression after diagnosis, please contact their physician. Visiting Angels does not provide medical care and does not provide recommendations on the type of treatments available for dementia or Alzheimers, nor do we endorse any specific treatments.

Understanding the Stages of Memory Loss

When making care decisions for a family member who is showing signs of memory loss, dementia or Alzheimer’s, it’s vital to understand the stages that they may go through. By having a better understanding of the changes in behavior and abilities, you can choose the most effective course of action for your loved one’s treatment and care with the help of doctors and caregivers.

Alzheimer’s and dementia place a heavy burden on family and friends. The Alzheimer’s Association states that, in 2017, 16.1 million family members and friends provided 18.4 billion hours of unpaid care to people with Alzheimer’s and other dementias, at a value of over $232 billion. Plus, the slow progression through the stages by the patient leads to long-term care duties for the unpaid Alzheimer’s and dementia caregivers. The Alzheimer’s Association says that 86 percent have provided care for at least the past year, and half have been providing care for four or more years. Depending on the severity of the memory loss of the senior, families often seek help from home care services, ranging from a little respite care to 24-hour home care assistance.

The following stages are based on the Reisberg Scale, developed by Dr. Barry Reisberg of New York University. Ultimately, the stage of dementia will be determined by a doctor through the use of tests and examinations. To help make the phases more relatable, we’ll outline some real-world scenarios to go with the more clinical definitions.

Stage 1: Normal/No Impairment

There are no outward signs of memory loss or dementia, and your loved one’s behavior and mood have not changed.

“Laura is still keeping a full calendar, from volunteering at the local hospital to meeting her friends for lunch a few times a week. She’s sharp as a tack, too. She’s started working on digital photography courses and picked it right up.”

Stage 2: Very Mild/Normal Aged Forgetfulness

The second stage of dementia is mostly one that the person subjectively notices happening to themselves. Typical examples would be someone thinking they don’t remember names as well as they used to, or temporarily forgetting where their keys are more often. If someone seems to be in stage 2, some studies have shown that they may progress more rapidly through the following stages.

“Paul feels that he’s more forgetful when it comes to places and names, but that it’s not affecting him at work. He’s getting older, so it’s probably just typical stuff for someone his age.”

Stage 3: Mild Cognitive Impairment

In this stage, changes begin to be noticeable by friends and family. The person can probably get through their daily routine, but a range of symptoms can be observed. There can be higher levels of forgetfulness and memory loss, including more repetitive questions from the person. More complex activities that involve planning and organizations can become challenging, which can be particularly worrisome when it comes to staying on top of medications. There can also be a loss of concentration, higher levels of anxiety, and overall confusion.

Stage 3 is where initial Alzheimer’s testing typically occurs, so be sure to encourage family members to be tested.

“Jackie is starting to worry me because she’s still trying to do everything she’s used to doing, but she has trouble with her memory. I can also tell that she gets frustrated when she notices it happening.”

Stage 4: Moderate Dementia

For people in this stage, tasks like cooking, shopping and cleaning are very hard to accomplish without assistance. Issues with memory loss and forgetfulness intensify and should be very apparent to casual acquaintances. Proper speech and “finding the right words” can be a challenge as well.

There can also be noticeable psychological changes, most often seen in withdrawal from social situations. Usually, this is a state of denial where the subject knows their mental facilities are in decline but don’t want to admit it, even to themselves. Rather than engage in a conversation and forget a name, or try to order from a menu and misspeak, they will avoid the situation.

This stage is also named mild Alzheimer’s disease, and diagnoses in this stage are often very accurate.

“I’m glad Les has his family close by because he’s been in decline the last few months. It has to be hard on them to assist in more and more activities, especially as he seems to be more and more withdrawn.”

Stage 5: Moderately Severe Dementia

When a person enters this stage of dementia, they typically need frequent assistance to make it through their daily activities. There is often an inability to recall necessary, deeply ingrained information, such as phone numbers, home address, or schools attended.

Someone in stage 5 would have great difficulty living an independent life. They may need living assistance in a variety of areas, from picking the proper clothes for the weather to eating regular, healthy meals to handling basic tasks like paying a bill.

“When I saw Mari the other day, she was wearing short sleeves even though it was 40 degrees outside. I’ve also noticed her not being able to recall her home address, which makes me glad she has someone coming to provide in-home care every day.”

Stage 6: Severe Dementia

In stage 6, having full-time care is a must for most patients. They often need help to dress, bathe or use the bathroom. Things that seem as simple as flushing the toilet will be forgotten, leading to cleanliness and sanitary issues within the house.

The memory loss can also manifest itself in the person wandering or getting lost and forgetting the names of family members. A breakdown of speaking ability can often occur later in this stage, making it harder for family members and home caregivers to meet the needs of the person. Emotional and behavioral changes can be quite troubling in this stage as well, as those who have severe dementia can be increasingly paranoid and hostile.

“John’s family seemed very distraught when discussing his current condition with me. They’re so worried about his behavior that they’re cutting back on visits from friends to see him. Plus, he’s at a stage where things that would be very embarrassing are routinely happening, and they want to protect people’s good memories of him.”

Stage 7: Very Severe Dementia

Stage 7 is the final stage of dementia and patients require full-time care. Moving, eating, talking can be nearly impossible for some people, so even trained professional caregivers can find themselves taxed by the needs of the patient.

Symptoms of this stage often include a loss of the ability to speak and communicate, a loss of awareness for people and surroundings, and the failure of motor control, which can lead to an inability to control facial expressions.

“It’s troubling to visit Doris these days as there isn’t much of her personality or even physical state left that you would recognize. Thankfully, she has very patient and caring people looking after her who are trying to make her final days as good as they can be.”

Conclusion

If you can identify symptoms from any of the stages outlined above in your loved ones, please reach out to their primary caregiver to begin the process of testing. Early detection can be instrumental in managing the progression of the disease and also give you time to plan the approach to caregiving that is right for your family, whether it’s assisted living, friends and family, or in-home care by HHAs and CNAs.

About Visiting Angels Newton/Canton

Visiting Angels Newton/Canton MA is an award-winning local home care agency providing high caliber in-home care services to elderly and people with disabilities. Countless families have benefited from our dementia home care, Alzheimer’s care, companion care, respite support, transitional aid, and senior home care services in Needham, Dedham, Brookline, Chestnut Hill, Wellesley, Newton, Canton, Westwood, Watertown, Natick, Stoughton, Roslindale, Norwood, and nearby towns. While non-medical in nature, the care provided by Visiting Angels Newton/Canton can make a significant impact on your loved one’s happiness and quality of life.

Physical vs. Mental Aging

As we grow older, our minds and bodies tend to age at different rates. Some of us slow down physically years before we lose any of our mental quickness. Others stay active well into old age but start to lose their memory earlier. The distinction between physical and cognitive aging can be an issue for friends and family of older adults. Because of this, recognizing and assessing physical and cognitive abilities is crucial in professional home health care.

How we distinguish between physical and mental aging has a significant effect on the way we treat our older loved ones. If we confuse symptoms of physical decline as signs of cognitive aging (or vice versa), we can inflict much unintentional damage. On the one hand, we might underestimate our loved ones’ abilities, treating them as less-than-capable adults. On the other, we might miss symptoms of a serious problem, like early-stage Alzheimer’s.
​
An understanding of this distinction is equally vital for senior home care providers. Caregivers who don’t fully understand the difference between physical and mental decline are liable to provide their clients with substandard care. Meanwhile, caregivers who recognize the difference between aging bodies and aging minds can personalize care according to their clients’ needs.

Knowledgeable caregivers can also serve as a resource for families, providing advice and guidance about age-related concerns and challenges. This way, families are less likely to confuse signs of physical and cognitive decline, making it easier to care for their loved one.

Different Types of Aging Requires Different Types of Senior Care

There’s a significant distinction between physical aging and mental aging. While interrelated, these two types of aging often take place at different speeds. If someone is going through a severe physical decline, it doesn’t mean that they’re also experiencing cognitive decline. Likewise, if someone is declining mentally, they might remain physically healthy.

To illustrate, let’s look at a couple of hypothetical examples.
​
Example 1:
Judy is a 72-year-old woman. Two years ago, her husband passed away, and Judy has been living alone. Recently, joint and back problems have made it impossible for Judy to get around without a walker. What’s more, she’s no longer able to perform simple chores and errands.

Given Judy’s physical state, some may assume that she’s also experiencing cognitive decline. However, thankfully, Judy’s family hired an experienced senior home care agency to provide her with care.

Judy’s caregiver not only offers physical assistance but also recognizes that Judy has complete cognitive function. During visits, Judy’s caregiver provides her with stimulation by playing cards with her, helping her browse the internet, and engaging in thoughtful conversation.

Example 2:
Mark is a 62-year-old man. Recently, Mark has shown signs of early/mid-stage Alzheimer's disease. He has become progressively forgetful, and he’s starting to mix up words and is having a hard time remembering people’s names. Occasionally, he gets confused by time and place.

An avid outdoorsman, Mark has enjoyed long walks outdoors and activities like birdwatching for much of his life. Mark’s family worries that physical activity is increasingly unsafe for him.

Luckily, Mark’s senior home care provider is knowledgeable and skilled in providing Alzheimer’s home care. Mark’s caregiver sees that he’s still physically fit and gets joy from these activities. After discussions with Mark’s family, his caregiver starts accompanying him for outside activities, giving Mark a positive outlet that he would not have if he were utterly homebound.
​​
In both cases, a senior home care provider can spot the difference between physical and mental aging. Having done so, they adapt their care services to the recipient’s needs, significantly improving the quality of care.

Common Mistaken Assumptions 

While you might think that cases like these are rare, inaccurate assumptions about aging are more common than you’d expect.

Compare the way people approach a 30-year-old in a wheelchair to an 80-year-old in the same situation. While most people will engage with the 30-year-old as an equal, a surprising number will talk to the 80-year-old as if they’re speaking to a child, which can be a profoundly humiliating and alienating experience for seniors, especially those who are cognitively functional.
​
For another example, look at the way that many people treat individuals who have dementia. Many people assume that individuals with mid-stage or late-stage dementia are incapable of simple activities. Many of these individuals remain skilled in activities like painting, gardening, or baking, even as they lose some cognitive function. What’s more, these activities can prove sources of great happiness for those with dementia. A well-trained HHA or CNA-certified caregiver can provide appropriate dementia home care services for these seniors.

​Do you have an elderly loved one in need of senior home care in Wellesley, Natick or other cities and towns in the Greater Boston area? Contact Visiting Angels Newton/Canton today to schedule a free senior home care consultation!

Differences between Dementia Care and Regular Home Care

If your elderly loved one is showing signs of dementia, he or she may need more than regular elderly home care services.  A high quality home care agency will do a thorough assessment of individual needs to design a customized home care plan for each client. But still, it is important for you to understand the different types of care available.  Home care needs are different for healthy seniors vs those suffering from Alzheimer’s disease or dementia.

Regular Home Care Services

​Regular in-home care is intended for individuals who require assistance with certain tasks but are able to maintain some independence.  A home caregiver provides help with activities of daily living, such as bathing and dressing, and with household chores like light housecleaning, grocery shopping, and meal preparation. This type of care might also provide medication management and transportation to medical appointments. Regular home care may be appropriate for someone in the early stage of Alzheimer’s disease, but as the disease progresses, more specialized care is needed.

​Dementia Home Care Services

Dementia home care is tailored to the challenges related to the different types of dementia and the changing needs through the progression of the disease. Dementia caregivers are familiar with the stages of the disease, common behaviors, and safety issues related to dementia as well as how to handle erratic moods and behavior. Care plans focus on the specific needs of an individual with dementia, including likes, dislikes, and personality. Dementia care incorporates activities designed to stimulate memory such as looking at family photo albums or listening to music, doing art projects, or reading. Using social media technologies to engage social with friends and family, eating a brain-healthy diet and physical exercise are also ways to help seniors with dementia live at home longer.

In early stage dementia care, the caregiver may need to provide simple memory assistance such as appointment reminders, organization, and money management along with regular home care services.

In middle stage dementia care, it is important for a person with dementia to follow a structured schedule to reduce the stress and anxiety. Individuals may also need increased assistance with dressing and feeding themselves.

In late stage dementia care, individuals typically need 24-hour care to cope with extreme confusion, inability to process information, and difficulty communicating verbally.

Visiting Angels Newton/Canton offers 24-hour home care as well as live-in and live-out homecare for the elderly with dementia. For more homecare information, please call 617-795-2727.