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My Parent is Experiencing Late-Day Confusion: What Does it Mean?

“One minute, my mother is looking at pictures of her grandkids and talking about how one wants to become a dancer. The next minute, she becomes very confused and accuses me of trying to steal her money or trying to poison her when I give her medicine. She becomes very agitated and unreasonable; she also paces around, like she has somewhere to be. I’ve even found her wandering around the neighborhood and asking for directions home, even though she has lived in her home for more than 50 years.“Her confusion seems to start at about the same time of day – in the late afternoon or early evening. She also gets very moody and angry, even though she normally has a sunny disposition. The confusion, moodiness and wandering lasts for a few hours, sometimes late into the night. She seems fine by morning.“What does my parent’s late-day confusion mean? Should I be worried?”~Susan B.

Does this sound all-too familiar? If your mother or father has Alzheimer’s disease or other form of dementia, your parent may be experiencing late-day confusion. Late-day confusion, also known as sundowning or sundown syndrome, is a group of symptoms or behaviors that people with Alzheimer’s disease and other types of dementia may experience or exhibit.

While researchers have not yet determined the exact physiological processes that trigger late-day confusion, they have expanded our understanding of sundown syndrome, its symptoms and its triggers. They know that sundowning is relatively common among people with dementia, for example, and that it is only temporary. Research suggests that about 20 percent of people with Alzheimer’s disease will exhibit sundowning behaviors, according to the Alzheimer’s Association. Sundowning typically peaks in the middle stages of Alzheimer’s disease and then tapers off as the condition progresses.

What are the Symptoms of Sundowning?

Sundowning can cause your parent to exhibit a variety of behaviors that occur later in the day. These behaviors may include:

  • Restlessness
  • Agitation
  • Irritability
  • Confusion

The names “late-day confusion” and “sundown syndrome” reflect the time of day that the behaviors typically occur – in the afternoon and evening, often just when tired caretakers need a break. Sundowning behaviors can continue into the night. The restlessness and agitation associated with late-day confusion can make it hard to fall asleep and stay asleep. Sleep deprivation associated with sundowning can leave your parent (and you) exhausted the next day. The disruption in the normal sleep-wake cycle can also lead to more behavioral problems throughout the day.

Causes of Sundowning

Researchers have not yet discovered the underlying physiological causes of late-day confusion, but it is likely due to the way Alzheimer’s disease and other forms of dementia make changes to a person’s brain. This includes the widespread death of nerve cells, known as neurons, which communicate messages between the brain and the rest of the body. Devastation of these neurons interrupts the normal communication pathways in the brain; this prevents the brain from correctly communicating  with the rest of the body.

The National Institute on Aging says these brain changes may possibly affect a person’s “biological clock” in ways that confuses his or her sleep-wake cycles. In other words, your parent’s brain may be waking up when everyone else’s brains are just falling asleep.

Certain factors can trigger or aggravate the behaviors associated with late-day confusion. These factors include:

  • End-of-day fatigue, both physical and mental
  • Having unmet needs, such as hunger or thirst
  • Pain
  • Depression
  • Boredom
  • Loss of a routine, especially loss of routine at the normally busy hours of the afternoon and evening
  • Too little or too much light, especially during the extremely short days of winter and long days of summer, which can cause an older adult to misinterpret what they see
  • Medications that cause or worsen confusion
  • Wearing-off of medications that control confusion
  • An excessively noisy or busy environment
  • Less need for sleep, which is common in older adults
  • Caffeine late in the day
  • Alcohol
  • The presence of certain health conditions, such as poor vision or hearing loss

When is sundowning not really sundowning?

Not every adult with dementia who experiences confusion or agitation during the afternoon or evening are experiencing sundowning, according to the Alzheimer’s Society. In some cases, someone who exhibits the behaviors of sundowning may be trying to communicate a need to a caregiver but is unable to come up with the right words or behaviors. This is because of the way the brain changes associated with dementia interfere with communications. He or she might be tired, for example, and simply being tired can make it hard for them to convey the fact that they are tired.

Preventing and Managing Sundowning Behaviors

Helping your parent avoid fatigue that leads to late-afternoon/early-evening restlessness can help reduce sundowning behaviors. To reduce tiredness and restlessness, encourage your parent to:

  • Maintain a schedule
  • Make a comfortable sleep environment
  • Sit by a sunny window or go for a short stroll in the afternoon – exposure to sunlight can help reset your parent’s body clock
  • Get exercise or perform some physical activity each day
  • Avoid an overly full schedule, as engaging in too many activities during the day can lead to excessive tiredness at night
  • Get enough rest at night
  • Keep the home well-lit
  • Take a late morning or early afternoon nap as needed, keeping naps short and early in the day
  • Avoid caffeine late in the day
  • Avoid alcohol, as it can increase confusion and anxiety

If you live with your parent, it is important that you follow these suggestions, too. Your reaction to sundowning and other dementia symptoms plays an important role in how your parent responds, so you will need to feel well-rested and alert when dealing with the symptoms of late-day confusion.

Even with the best of care, you may not be able to prevent sundowning, but you can take steps to manage any symptoms that do arise. The earlier you detect sundowning symptoms, the better you can cope with them, so start looking for late-day confusion near dusk. Other management tips include:

  • Approaching your parent in a calm manner, especially when he or she seems anxious
  • Asking if there is something he or she needs, such as a snack or a trip to the bathroom
  • Gently reminding your parent of the time to help him or her judge day from night
  • Avoid arguing
  • Offer assurances that everything will be okay
  • Never using physical restraints – allow your parent to pace or walk, as needed and under supervision

For more information on late-day confusion, consult with a doctor or memory care professional at Spring Creek. A doctor can help determine whether the symptoms are the result of sundowning or a different cause. The memory care professionals at Spring Creek can offer more tips and strategies for dealing with sundown syndrome and reduce the behavioral symptoms of late-day confusion. Contact us today.

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