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Caregiver Tips to Manage Sundowning in Parkinson's Dementia

As a certified speech pathologist, I counsel patients with Parkinson's dementia and their families on the symptoms of sundowning.

Sundowning is a neuropsychiatric symptom that begins at the time of sunset. This syndrome may occur in persons that have the start of Lewy body dementia, Alzheimer's, or Parkinson's dementia.1,2

Sundowners may present with anxiety, agitation, aggression, pacing, wandering, trying to escape, fighting, and not being able to follow directions.1,2

Create a calming routine

When the sun goes down, sundowning starts to elevate. I suggest that caregivers cover the windows and put the house lights on. This begins the wind-down of daily activities.

Play soft music in the background to create a calming influence. Loud noises should be eliminated. Discourage visitors at this time and avoid watching aggressive television shows or the news. In other words, establishing calming daily routines will reduce agitation.

How to communicate

I also advise caregivers on how to communicate optimally with a person who is sundowning. In my practice, I recommend that caretakers speak in a calm voice with loved ones when giving instructions.

Say one direction at a time. Speak in concrete terms. Avoid similes and metaphors. If the person with sundowning starts to communicate with untrue thoughts, instead of trying to correct the conversation, just go with the flow, change the subject, and continue on speaking. Usually, they will forget the former upsetting conversation and their demeanor will improve.3

Tracking the triggers

An effective way to deal with sundowning is to learn from each experience. Journalling of all signs of distress is important. Consider these questions:

  • What may have triggered them?
  • How was this day different from others?
  • What physical signs did they show?
  • How long did the episode last?
  • What worked to calm them this time?

By using what you’ve learned from each occurrence, it will make it easier to deal with the next one.

Taking care of yourself

During my discussions with caregivers, I stress the need for their own downtime to maintain their health. Caregivers need to recharge their batteries.

I encourage them to join a caregiver support group where they can get emotional support from others. In the long run, members may have tips and techniques that could help us all. 

Caregivers should take several short breaks daily to focus on themselves. Some suggestions I recommend in my counseling sessions for caregivers are:

  • Giving yourself a manicure or pedicure
  • Joining a caregiver support group
  • Coloring with an adult coloring kit
  • Doing a needlepoint or knitting project
  • Taking time to meditate or pray
  • Relaxing exercises such as yoga, tai chi, or stretching
  • Progressive relaxation exercises
  • Breathing exercises
  • A phone or video chat with a friend

Keeping loved ones safe

Sundowners can become confused, aggressive, wander around, fight, or start to yell.  Incidentally, lock your doors - with the lock being up high and out of reach to discourage wandering.

Place stop signs (like the red ones in the street) on your doors. Speak to your doctor about sundowning and follow the tips outlined above to reduce the effects of sundowning and keep your loved ones safe.

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