Coping strategies for evening agitation

Hello everyone,

“‘Twas the night before Christmas and all through the house, not a creature was stirring, not even a mouse…” But perhaps, some your residents are?

 People with dementia often struggle with restlessness, agitation, irritability or confusion that can begin or worsen in late afternoon and early evening, and can continue into the night. Commonly called “sundowning”, this phenomenon not only affects the person experiencing it, but can leave staff and other residents feeling frustrated and tired, and impact their mood and ability to function the next day.

 According to the National Institute on Aging (NIA), possible causes for sundowning include confused sleep-wake cycles due to disease-related brain changes, being overly tired, hunger, thirst, depression, pain and boredom. Signs of sundowning may include increased confusion or anxiety and behaviors such as pacing, wandering or yelling. The NIA has some helpful suggestions for coping with and preventing sundowning:

Some of their tips include:

  • Try to determine the cause of the resident’s behavior and address it.
  • If person becomes agitated, listen calmly to his/her concerns and frustrations and try to reassure the person that everything is ok.
  • Reduce noise, clutter, or the number of people in a room.
  • Distract the person with a favorite snack, object or activity. For example, offer a drink, suggest a simple task like folding towels, or turn on a familiar and fun TV show (not the news!).
  • Make early evening a quiet time. Play soothing music or encourage a family member or friend to call during this time.
  • Close curtains at dusk to minimize shadows and the confusion they may cause. Turn on lights to help minimize shadows.
  • Go outside (or at least site by a window) since sunlight exposure can help reset a person’s body clock
  • Participate in physical activity every day. This can be a formal exercise class, or simply going for walks and participating in self-care.
  • Keep naps short and not too late in the day.
  • Get enough rest at night.

Sundowning can be exacerbated by serving coffee, cola or other caffeinated drinks late in the day; serving alcoholic drinks, which can add to confusion and anxiety; and too many activities during the day.

Finally, if these approaches don’t help, a medical exam may be needed to rule out pain, a sleep disorder or other illness, or a medication side effect.

We wish you all a happy and healthy holiday, and don’t forget to send us your tidbits for our tidbit contest!!

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