Sunday, January 18, 2009

Sundowner's Syndrome

What is it?

Experts do not really know. It is a syndrome that family members spot in the evening. Common emotional and psychosocial symptoms include
  • rapid mood changes, confusion, frustration, anger, crying, depression, stubbornness, fearfulness, hallucinations, paranoia and agitation.
Behaviours include
  • pacing, restlessness, violence, wandering, rocking, hiding things, phoning adult children, friends or even strangers!
They muse that it might be drug interactions or stress that interferes with circadian rhythms. Others relate it to dementia or Altzeimer's, but I have not seen any reason to make this connection. My husband's late mother had it - she would get morose and depressed and begin to bemoan her state of life. She had not come to terms with being a widow, and living alone. Her life, as she knew it, had changed without a spouse for whom one cooks, cleans, and interacts on a daily basis. It must be such a shock to the system.

I would suggest that those who make a connection between S.S. & dementia are not really in the right ballpark. While plaque build up diminishes the normal brain functioning, and diminishes inhibitions and reduces the normal social nicities, I think it is more a social problem than a biological one. Perhaps it is a chicken vs. egg problem. Does the depression come first, or the aging process, or biology.
Many of our ailing seniors have sleep issues, and this is a time of day when they might worry about getting to sleep.

Behavioural patterms

When I looked back at my life, now that I am retired, I took such pleasure, and gave myself rewards for making it to Friday! This is not true of those who do not work 9 - 5:00, with weekends off, but it is a principle. In my current situation, retired, and writing a book, weekends and weekdays are much the same.

When I think of our seniors, this is the same for them. Every day is now the same. There is no reason, once light levels diminish and the day is over, not to spoil oneself with, perhaps, another glass of wine. There is no reason to stop after a couple. For some adult children they find that their parents have an addiction problem in the evenings. It is a symptom of which to be aware.


Firstly, examine the patterns of behaviour. We kept a sign-in log, since we were not at Dad's retirement home all the time and needed some clues as to the timing of his behaviour and symptoms, as well as the possible triggers. Keeping track of behaviour gives medical practitioners some clues.

In my father's case, he had a brain tumour and dementia, we hired a caregiver to sit with him around 7:30 every night. It helped him.

If you cannot afford this, or your parent lives with you, you simply have to realize that they are
fragile at this time of day. Give yourself permission to relax. Find a volunteer agency, such as a hospice organization, to provide respite.

Our caregiver would give Dad a foot massage, or help him tidy his room, or watch TV with him. It made such a difference to the staff, as they could carry out the normal functioning of their evening routines. This was the time the nurse delivered drugs to the residents, and they could not be juggling Dad's needs. The frantic phone calls ceased, as Dad didn't feel the need to call us every day at this time.

Many recommend drugging these seniors, but this seems so ridiculous. Certainly, a medical check would be the first step, just in case there is an organic cause. Ruling out delirium is crucial, too.

They bear watching, especially if they wander, but the agitation might be a normal part of other physical symptoms. Speak to your doctor.

I hope this helps.

A new study"

Study helps explain 'sundowning,' an anxiety syndrome in elderly dementia patients

COLUMBUS, Ohio – New research provides the best evidence to date that the late-day anxiety and agitation sometimes seen in older institutionalized adults, especially those with dementia, has a biological basis in the brain.

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