Eight ways to help with sundowning behaviours

Those with Alzheimer’s disease or another dementia sometimes become confused, anxious, aggressive, agitated or restless. These are so-called sundowning behaviours.

If you’re caring for an aging parent with Alzheimer’s disease or another dementia, you may have noticed your loved one becoming confused, anxious, aggressive, agitated or restless. The Alzheimer Society estimates that so-called sundowning behaviours, which may arise in the late afternoon or early evening, can be challenging for up to two-thirds of people with dementia. In some cases, frustrated caregivers may use medication to try and deal with the behaviours.

Image for Conversations Article Help with sundowning behaviours. Senior living at Amica. 

Dr. Heather Palmer takes an entirely different approach. As National Director of Cognitive Well-Being and an expert in brain-behaviour relationships, she developed Amica's memory care programs and oversees the staff who support Amica residents living with dementia. “I have an aversion to labels like sundowning because it runs contrary to our philosophy of supporting the individual,” says Palmer. “Disease processes and symptoms may manifest differently in different people based on who they are and what they’re feeling. It’s more beneficial to seniors if their family or caregivers can ask themselves, ‘What is this person experiencing right now and what can I do to support that person regardless of their diagnosis, whether it’s a stroke or Alzheimer’s?’”

Palmer says quite often these behaviours come at a time when seniors may be fatigued, hungry or not engaged, or when frustration has mounted over the day. “Someone with dementia may not have the ability to process experiences and address them as they are experienced, so there’s a greater likelihood that frustrations will linger and build.” Sometimes even cognitively healthy people fall short on the ability to manage this “build up,” such as when parents yell at their kids when they normally wouldn’t. “If the senior is unable to recognize and communicate their experiences—whether they’re feeling hungry or bored or need to use the washroom—they are likely to communicate through behaviours.”

Our objective at Amica is to get to know every resident and their habits, and to balance activity so they don’t reach a point of fatigue, frustration or escalating anxiety. Here are Palmer’s tips for supporting your loved one to minimize sundowning:

Know your loved one

It may sound obvious, but if you know your dad’s comfort zone around sleeping, waking, eating, exercise, socializing and leisure time, it helps to track those preferences during the day. It will help you recognize how to make his day go more smoothly or be proactive when he may face challenges.

Tailor engagement opportunities to your parent

If you know your mom loves music, you can use it to engage her in a positive way to diffuse confusion, anxiety, etc. The flip-side is also true: if your dad hates music, then turning on the radio may escalate his behaviours. Instead, find an activity that feeds his interests.

Make an inventory of activities your loved one enjoys

In one column, list ideas that are physically engaging or energetic, such as going for a walk; in the second column, include activities that can be done in solitude, such as painting; finally, think of activities that are cognitively engaging, such as having a conversation or playing a game. “If you do this in advance, you’re not trying to think on the spot when things are escalating,” says Palmer.

Match activities to energy at a given time

Try to recognize your loved one’s abilities, skills and emotional state at any given point in her day. If your mom’s had a sleepless night or an exhausting day, she may not respond to an afternoon activity that takes more energy than she has to give. In other words, taking your mom to her favourite swimming class might be soothing on one day but frustrating on a different day when her coping skills have been compromised.

Create a book or box about your loved one

At Amica, every resident has a box or scrapbook highlighting their past through pictures, clippings and other meaningful objects, such as ticket stubs, recipe cards, a tennis ball or calculator. “The boxes and books allow residents to engage alone or one-on-one to reminisce, reflect and talk about things we know are important to them,” says Palmer.

Create activity kits. Depending on your loved one’s interests, you might keep handy a box of beads to be strung, buttons to be sorted or miscellaneous laundry in a basket that could be folded.
Give choices. It helps your loved one if you use visual prompts (showing, pointing) instead of just talking. You might ask, “Would you like to look through this box about your life or would you like to listen to this classical music CD?”

Don’t be afraid to keep activities quiet

Palmer says some families assume that to cognitively enhance their loved one with dementia, they must always engage them in cognitive activities. Doing something alone, such as folding napkins to help set the table, can be just as pleasurable and meaningful.

Dr. Heather Palmer is a cognitive aging and dementia specialist with more than 30 years of clinical and scientific experience. She focuses on helping individuals improve the way they think, feel and function. As Amica’s National Director of Cognitive Well-Being, she develops cognitive well-being programs for Amica with a heightened focus on memory care and assisted living.

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