What is sundowning and how can it be managed and prevented?

Sundowning is a term that is used concerning older people with dementia who experience changes in behaviour and mood in the evening, usually around dusk (hence the name ‘sundowning’). As the day transitions to the evening, people with dementia can sometimes experience a growing sense of agitation and anxiety, and this period of ‘sundowning’ often makes the person with dementia feel like there is something wrong, like they have forgotten something, or they are in the wrong place. 

Sundowning also increases the chances of people with dementia experiencing hallucinations or delusions, two examples given by Dementia UK are that they might insist that they need to go home even if they are in their own home, or that they need to pick up their children from school, even though their children are now adults.  

What causes sundowning? 

Sundowning is more common during the middle and latter stages of dementia, and while it isn’t very well understood why sundowning happens, a range of different issues are likely to heighten its effects or make it more likely to occur. For example, dementia symptoms tend to get worse over the course of the day anyway as the person becomes more tired, while hunger, thirst and physical pain are also thought to play a part. 

Other causes can include: 

• Unmet physical needs generally 

• A lack of exposure to sunlight during the day 

• Damage to the brain causing a disruption in the person’s internal body clock, meaning they may sleep during the day but feel more awake at night 

• Sensory issues (e.g. hearing or sight loss) 

• Feelings of anxiety or depression 

• Side-effects of prescribed medications 

• Overstimulation during the day in a busy care home 

How to prevent sundowning 

Though it is not fully understood why sundowning happens, there are measures you can take to pre-empt sundowning from happening in your care home. For example: 

• People with dementia respond better to established routines, so follow a daytime routine that contains activities the person enjoys, and be sure to organise any appointments, like GP visits for example, as early as possible when the person is more alert. 

• Because overstimulation could be a cause, try where possible to limit their intake of caffeinated drinks, especially later on in the day. 

• Those with dementia often find their body clock is disrupted, so try to make sure daytime naps are limited to encourage them to sleep well at night. 

• Manage the transition into evening by, if possible, closing the curtains and turning lights on before dusk has come so the change is less noticeable. 

• Lower light often produces shadows in the room, which can be confusing to people with dementia, so try where possible to arrange the lighting so as to minimise shadows. The same goes for reflections caused by light reflecting from switched-off TVs or windows, so try covering these things with a sheet or towel. 

• Another way to manage the transition is to keep the person busy with things they enjoy, so introduce an evening routine with activities that engage them, such as watching a favourite programme, listening to their favourite radio station, listening to music or others. Be sure, however, that these are quiet, soothing activities that do not cause undue stress or confusion. An enjoyable and reliable routine like this might help to introduce positive and reassuring associations with this time of day.  

• Keep notes of everything that happens leading up to sundowning events so that you can try to identify triggers next time. 

Tips to manage sundowning if it happens 

Despite best efforts to manage and avoid sundowning events, sometimes they are unavoidable. So, if a sundowning episode does take place with one of your residents who has dementia, try these tips to manage the situation: 

• Sometimes people with dementia experiencing sundowning might be trying to communicate a need or that something is wrong, so take the time to listen to them and give them the time and space to explain the problem. 

• If there doesn’t seem to be a tangible issue that needs to be resolved, try taking their mind off things by making them a drink, having a snack or putting on some gentle music or their favourite TV show. 

• Sometimes just sitting and talking with them can be the best thing to do. Remember to talk in a calming, slow way, and give them time to respond.  

• Hold the person’s hand and sit close with them, making sure that they know you are there to reassure them.  

Finding the right balance with the right activities 

Navigating a sundowning event can be difficult for care staff, and one of the best ways to prevent the situation from happening or to manage it when it does is to engage the person in meaningful activities that are designed to keep their mind occupied whilst simultaneously promoting a calming, positive and engaging experience. 

The Oomph! On-Demand Wellbeing & Activities Platform has a wide range of activities that are specially designed to be enjoyed by people with dementia. These include sensory activities, reminiscence activities, puzzles, crafts and many more.