Diagnosis and Management of Sundowner’s Syndrome

Sundowner syndrome, known as sundowning, or night-time dementia, is a condition that increases confusion and disorientation during sunset or sunrise. It is most common in elderly residents who have established dementia, Alzheimer disease, delirium, or those who have had surgeries. Not all people who have these ailments will experience sundowning, but as each person reacts in different ways when under the effects, diagnosis can be difficult.

Associated sundowner syndrome symptoms include rocking, rapid mood changes, restlessness, anger, stubbornness, agitation, depression, pacing, and fear. While common in elderly patients, these are not exclusive to sundowning and need to be discussed with facility members during the admission process, and on routine health checks.

More complex symptoms include hallucinations, hiding things, lying, cussing, wandering, violence, and paranoia. Most senior health care facilities have trained their staff in many techniques to help calm patients who have these symptoms, but should be made aware prior to admittance if the family member is exhibiting any of these signs.

Finding the cause of the symptoms is the key to the diagnosis of Sundowner’s syndrome, thus copious notes by staff about the residents mental status during routine visits is vital. Knowing the routines of the patient is necessary to isolating how the symptoms build up, and how best to treat them. While the resident may become more agitated as the day goes on, if they experience increased rocking, paranoia, or anger during shift changes, then sundowning is a distinct possibility and should be seriously considered as the cause.

Once an associated cause is found, management can begin. Such therapies can include music and other soothing sounds like bird chirping or waves crashing on the beach. The progression of sound or the repetitive nature of the sounds tends to calm down recurrent agitation and soothes over increased anger bouts.

Another type of therapy used is soothing touch therapy. Hand-holding and hand massage are the most common techniques used. Soothing touch gives comfort for those who cry, are depressed, and show signs of fear or anxiety. Having a warm touch to the hand or shoulder gives the family member a sense of being safe and that someone is there who cares for them.

Some facilities also bring animals to interact with patients. This therapy gives the resident a sense of normality and bonding. Animals are great listeners, give unconditional love, and are stress relievers. For many with recurrent agitation and wandering tendencies, having animals in the facility allows them to focus their attention and stay in control, without staff having to worry about them wandering off.

Common triggers for Sundowner’s syndrome are end-of-day activities, fatigue, a routine change, low lighting, and the on-set of winter or fall. Anything that can be considered out of the normal realm of daily life to a resident can also trigger sundowning and should be avoided at most times. Increased stress, anxiety, banging, flailing, and increased tendency to get up and walk around aimlessly are all common symptoms for elderly patients who trigger in such situations. Facilities which stagger shift changes, and who ask family members and visiting guests to register at the desk first, and stagger their comings and goings often boast the best success with dealing with this syndrome.

In all, sundowning syndrome is a very difficult condition to diagnose, but it is one of the more common and more manageable syndromes for elderly patients in senior care facilities. As most patients learn to cope with their surroundings, and the routines that take place, the effects begin to become manageable, and they become more comfortable.

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