Alzheimer's blog

Meaningful activity can relieve sundowning for those with dementia

By Angela Lunde August 2, 2014

All behavior has meaning. When we accept this our relationship with the person living with dementia dramatically changes. We look for meaningful explanations for what they do, rather than judging, labeling or dismissing it just because they have Alzheimer's.

Let's think about this in the context of sundowning. Sundowning is a label commonly applied to people with Alzheimer's when restlessness, agitation, irritability, paranoia or confusion appears as daylight begins to fade.

Because of perceptual, language and memory deficits, people with dementia often have difficulty understanding and talking about the sources of their discomfort and their needs. As a result, some may compensate by expressing themselves through actions.

So, if people living with Alzheimer's were able to express verbally what was causing such restlessness, I wonder what they might say. Perhaps some would communicate that they're uncomfortable, maybe lunch was served several hours ago and late afternoon hunger has set in. Others might say they're feeling confused or insecure due to the reduced lighting and/or shadows caused by the sun's disappearance.

I believe that quite often, late day irritability or restlessness occurs when the natural ebb and flow of energy levels aren't adequately satisfied. We all have a need for periods of higher and then lower levels of activities and stimulation throughout the day. According to sleep experts, the body clock of older adults is extra alert in the morning when they wake up and then peaks again in the late afternoon or early evening.

If we apply this logic to those living with dementia, it could it be that they're restless in late afternoon because they're bored and need of something meaningful to do.

Late afternoon is when many residential living environments offer fewer activities; shifts change, staffs come and go.

Someone living with dementia may see increased staff activity during a time when their energy level is peaking and become agitated if they're restricted from leaving the building.

An important key in reducing late afternoon restlessness, agitation or confusion may lie in promoting a flow of meaningful activities that accommodate the natural periods of high and low energy throughout the day.

Activities to satisfy higher energy levels may be best offered in the morning, as well as before meals to foster alertness, and then late in the afternoon and into the early evening. Calming and more restful activities might be better suited later in the morning and in the hours following lunch.

Those living with dementia sometimes have difficulty planning or beginning an activity on their own. This means that as caregivers, friends and family, we play an incredibly valuable role. If you're wondering what sorts of activities are best, here's a thought.

Research suggests that social interaction involving conversation with family, peers or with a baby or pet is one of the most stimulating and engaging activities to promote a positive mood for those living with dementia. That shouldn't come as a surprise.

Meaningful activity and wanting to engage in life with others is a fundamental human need. Those living with dementia maintain the ability to feel the joy and satisfaction of being connected with others no matter where in the sky the sun may be.

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Aug. 02, 2014