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Sundowning and Shadowing
 
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Sundowning and shadowing are the names given to certain behavioral problems that sometimes affect people with Alzheimer's in the late afternoons and evening. Beginning at dusk and continuing throughout the night, as many as 20 percent of Alzheimer's patients will at some point experience periods of increased confusion, disorientation, anxiety, agitation, restlessness, insecurity, suspicion, delusions, and hallucinations — a syndrome clinically known as "sundowning." 

Shadowing is when the person with Alzheimer's follows or mimics the caregiver, or talks, interrupts and asks questions repeatedly.  At times, the person may become upset if the caregiver wants to be alone or doesn't engage with them.


Sundowning

While no one is certain how or why this late-day behavior occurs, many experts attribute it to the following factors:

  • End-of-day exhaustion (both mental and physical)
  • Upset in the internal body clock, causing biological mix-up between day and night
  • Reduced lighting and increased shadows
  • Disorientation due to the inability to separate dreams from reality while sleeping
  • Less need for sleep (a common trait among older adults)

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Tips for Handling Sundown Syndrome

Plan activities of the day so that there is less to do in the late afternoon

Always keep in mind that fatigue plays a major role in sundowning. Alzheimer's is often characterized by a downhill daily course from morning competence and cooperation to evening confusion and irascibility.

Schedule appointments and trips for the earlier part of the day

Plan the person's day so that less is expected at night. Consider controlling the number of people who visit in the evening hours or confining noisier family activities to another area of the house.

Control the person's diet

Reduce foods and beverages with caffeine (chocolate, coffee, tea and soda) or restrict them to the morning hours.

Help the person to use up extra energy through exercise

For the person who tends to pace or wander in the evening, you may want to arrange at least one or two brisk walks during the day.

Play quiet music in the late afternoon instead of loud television

Be sensitive to environmental factors that might confuse the person more at night.

Try to make the person feel secure and well protected

Keep orienting people confused by sundowning to where they are and what is happening. Do not ask what is bothering them; they probably don't know and can't tell you. Never restrain them unless absolutely necessary.

Do not argue with the person

This rule of thumb becomes more crucial with sundowning's intensifying behavioral problems.

Try quelling restlessness by interesting the person in some quiet activity.

Try whatever works to calm the person, from a favorite pastime to simply folding towels.

It's important to always keep in mind that people with Alzheimer's do not have control over their behavior, and that their annoying behavior stems from the inability of the brain to sort out a confusing environment.

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Shadowing

Analyzing Shadowing

It is helpful to analyze the factors that contribute to shadowing, to help lesson and prevent it. Consider these questions:

  • Do certain people or surroundings trigger the behavior?
  • At what time of day does it occur?
  • What seems to calm the impaired person?

Once you have answers to these questions, you can devise a strategy to help deal with the behavior. For example, if the person gets most upset while you are preparing supper, try to plan meals that are quick and easy, that are left over from lunch or that you can prepare in advance. Consider eating the larger meal at midday.

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Tips on Managing Shadowing

Try to keep the person occupied

Find simple, repetitious activities to occupy the person even if you could do them better on your own. Possibilities include folding the wash, dusting, stacking pap

Provide the person with headphones for listening to calming music

Try "gum therapy" or "cereal therapy"

If the person with Alzheimer's is able to chew and swallow easily, you may want to give him sugarless gum. Consider providing him with a non-breakable bowl of high-fiber, low-sugar cereal. By having something to snack on, the person may be less inclined to talk or ask questions.

Protect your privacy

You may want to install a childproof doorknob on the bathroom door or use a timer and reassure the person by saying, "I'll be back when the timer goes off.

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