Sundowning

Confusion, or delirium, at the end of the day and into the evening is called ‘sundowning.’ This isn’t a disease but a symptom that happens in people with dementia such as Alzheimer’s disease. The cause of sundowning isn’t known, but things such as fatigue, low lighting, and increased shadows contribute to it. Especially for people with Alzheimer’s disease, sundowning puts them at greater risk of falling. Fortunately, there are ways to reduce the risk of sundowning. These include encouraging a mid-afternoon nap or quiet time, keeping a night light on to reduce agitation, and – in a strange setting such as a hospital – bringing familiar items such as photographs or a radio from home. Family members also can help by scheduling visits for later afternoon/early evening shift changes to make sure that someone is with their loved one when the risk of sundowning is higher and the flurry of activity can worsen agitation or confusion. They also can help by keeping activities earlier in the day – for example, take mom to lunch instead of dinner. Another way to reduce the risk of sundowning – and falls that can result – is to keep late afternoon/early evening noise (such as the television, loud talk, or noises from a videogame) to a minimum.

AMDA physicians in regions throughout the country have information and guidance on this topic. You can listen to these practitioners offer insights about sundowning and how to prevent it and the falls that may happen when someone experiences this confusion/delirium.*

Daniel Haimowitz, MD, FACP, CMD	Pennsylvania
Jay S. Luxenberg, MD	California
John E. Morley, MB BCh	Missouri
*Requires a program that plays MP3 audio files

For information on reducing the risk of falling, refer to the [Falls/Fall Risk Consumer Corner].