Sundown syndrome in the elderly: how can it be treated?

Seniors with senile dementia or Alzheimer’s are more likely to suffer from sundown syndrome in the elderly. The intensity of the episodes depends on the cognitive impairment.

Last update: October 22, 2021

The sunset begins and with it, desperate symptoms for the elderly diagnosed with the sunset syndrome in the elderly. This is how the geriatric condition of patients with dementia, depression or Alzheimer’s disease is known.

People with the disorder experience anxiety, despair, agitation, irritability, and pessimism. The condition is also identified by the name in English sundowning, e impacts between 4:30 p.m. and 11:00 p.m.. As the sunlight disappears, behavioral alterations occur that worsen depending on the cognitive state.

Sundown syndrome symptoms

Although some people have several signs of the syndrome, others have just one. In general, they show screaming, nervousness, sadness, crying, whispering, stubbornness, frustration, and a sense of danger. There are those who repeat phrases, hide, act violently, hallucinate, hide objects or wander too much.

An investigation published in the Argentine Journal of Neuropsychiatric Clinic correlates the mood states of the elderly with the incidence of sunset. The study specifies that confusion and disorientation are expressed through anxiety, fear, irritability, apathy and depression.

The episodes start at the same time every day and last as long as sundown.

What can cause it?

A potential biological trigger for sundowning It is the alteration of the circadian rhythm. This refers to mismatch of daily cycles that correspond to light and dark, causing physical, mental and behavioral changes.

In addition, pattern tracking has made it possible to specify the following factors:

  • Little or a lot of light, which leads to bewilderment and fear, especially in people with vision problems.
  • Exhaustion at the end of the day, especially when there are things to do.
  • Social isolation, triggered by limited mobility.
  • Lack of knowledge of the environment, as well as unexpected changes in environments.
  • Unmet physical needs, such as hunger, thirst, sleep, or hygiene.
  • Hormonal imbalances and interruptions of the internal biological clock.
The last hours of the day accumulate the stresses of the day and a reduction in sunlight that alters the biological clock.


How to act in case of sunset syndrome?

You need to know who has the syndrome to help you. For example, establishing behaviors at a specific time allows us to act appropriately.

Implementing environmental measures, such as changing the patient’s room or adjusting the light, are also helpful. You can plan activities that involve little effort so that the old man occupy himself during the day and improve night sleep.

Similarly, it is essential to apply a routine to eat. The Fundación Alzheimer España explains that patients tend to eat less and as the disease progresses they wander for long periods, which leads to agitation.

Regarding drug treatment, it is considered useful when there are symptoms of depression, sleep disorders or very high levels of anxiety. A doctor must approve the remedies and the caregiver has to pay attention to possible side effects.

When is it necessary to see a doctor?

As soon as the signs of restlessness or despair appear with the sunset, it is necessary to seek medical assistance. During the first few episodes, the sundowning often confused with delusional pictures.

The difference is that delusions happen at any time of the day. With the help of the specialist, in addition to distinguishing the conditions, it will be known which medications serve to relax the patient.



Lifestyle and recommendations

Those in charge of monitoring the elderly with sundown syndrome should collaborate to minimize the alterations with the guidelines that we will mention below:

  • Avoid daytime naps: the less they sleep during the day, the better the rest at night. However, if such naps are found to be beneficial, then they should not be discouraged.
  • Follow the diet: take note of changes or patterns linked to certain foods. Balance the food, avoiding large proportions of sugars and caffeine. They harm alcohol, soft drinks and substances that disturb sleep.
  • Plan activities: schedule walks or excursions when the patient is most active, but try not to have so many activities per day so as not to overwhelm him.
  • To exercise: moderate sports that increase muscle strength promote control of aggressive behavior, whet the appetite, relieve tension, and reduce stress.
  • Minimize noise: replace the sound of radios, telephones and televisions with relaxing music. Anything that involves noise has to move away as sunset approaches.
  • Work lighting: lighting the rooms lessens the effects of the night. At dawn, the patient must be exposed to artificial or natural light, so that they do not wake up surrounded by darkness. Light therapy is an alternative for the treatment of insomnia in old age.
  • Anticipate surprises: If you create a routine in which you anticipate what will happen, the impact may be less.
  • Comply with medication: the sundowning it is more bearable without skipping the medication.
The role of home caregiver is essential to reduce the effects of sundown syndrome.

The Role of the Caregiver in Sundown Syndrome

The caregiver requires patience and knowing how to react to an episode. It is essential to remain calm and not argue, since the older adult does not have control of the syndrome and their attitudes are not intentional.

It is advisable to validate the patient’s feelings, explain that you are listening to him, transmit calmness to him and lead him to some activity that restores his calm. It is necessary that the family or those who live in the house adhere to the measures to improve comfort.

And the most important, if the caregiver needs help, they have to ask for it. Institutions such as the Spanish Alzheimer’s Confederation or the Alzheimer’s Foundation of America provide guidance in these cases.

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