Confusion, Agitation, Anxiety in Seniors - Is it Sundowners Syndrome?

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posted by Ryan Whittington on February 17, 2011

Sundowning is a term used with Alzheimer's and dementia in order to describe behavior difficulties that can occur in the early morning, late afternoon, evening or night hours.  Sundowning is commonly associated with early stages of Alzheimer's and can be found in senior citizens who are in an unfamiliar setting such as a rehabilitation facility, hospital or have recently moved to assisted living.

How do I know if my loved one is experiencing Sundowning?


Sundowning usually results in a noticeable change in a persons body language and/or mood.

Specific changes can include:

  • Increased confusion and anxiety
  • Increases irritability
  • Decreased ability to process information
  • Overall being less cooperative and/or more argumentative

It is important to note that just because you are observing these behaviors, your loved one might not be experiencing sundowning.  There may be a level of discomfort due to medications, living conditions, continence and other outside influences.  Be careful to do what you can to minimize these contributing factors.  Do your best to make sure you are not being  demanding or setting unrealistic expectations.

What can I do to help deal with Sundowning?


First make sure the agitation is not caused by physical pain or discomfort.  Look for "triggers" that may be leading to sundowning.  If you see a pattern developing that is contributing to the confusion or agitation, do your best to limit the trigger.

Consider these possible triggers:

  • End-of-day activity (at a care facility). Some researchers believe the flurry of activity toward the end of the day as the facility’s staff changes shifts may lead to anxiety and confusion.
  • Fatigue. End-of-day exhaustion or suddenly the lack of activity after the dinner hour may also be a contributor.  Seniors may loose their desire to clean up the dishes or put leftover food away following a meal.  Assistance with meal preparation is important.
  • Low light. As the sun goes down the quality of available light may diminish, and shadows may increase, making already challenged vision even more challenging.  If a person is living at home alone with little interaction, they can become easily confused.  Regular, frequent home care visits can help a person stay on a schedule.
  • Winter. In some cases, the onset of winter’s shorter days exacerbates sundowning. This effect indicates sundowning may have a correlation with Seasonal Affective Disorder, a common depression caused be less exposure to natural light.

Sundowning is Exhausting for Caregivers and People with Dementia


Towards the end of the day, both the person with Alzheimer’s, and his or her caregiver, may be tired and not at their best. Understanding the dynamics of sundowning, and the fact that it is a result of dementia, will prepare caregivers and family members for properly handling the situation in which sundowning occurs.

To work towards limiting the amount of sundowning a person experiences, you may:

  • Set a routine.  A routine is a good way to make things feel more familiar to a person with dementia or confusion.  You should experience less resistance due to the fact that the person feels like they should be doing what is routine.
  • Limit outside distractions.  If your loved one is living in a facility, do your best to reduce the amount of noise and unpleasant odors.  Individual rooms or moving to another floor can make an enormous difference in a person’s outlook on life.
  • Diet.  Large fluctuations in sugar and caffeine can be a bad thing.  Try to do your best to limit the amount of caffeine or sugar that your loved one is eating.  Even though a piece of cake or pie at the end of the day is what many seniors look forward to, limiting the number of pieces they eat may be helpful. 

Remembering that your loved one is not choosing to be the way they are acting can help the caregiver or family member cope with the behavior easily and more appropriately. When caring for a person with Alzheimer’s or dementia it is important to take care of yourself through adequate rest, respite care, and knowledge about the disease. If your health is failing or you are not emotionally stable, this will have a negative effect on both you and your loved one.

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