Sundowning

  Today I had the awesome chance to revisit a friend I hadn't seen in several months. It was such a joy for both of us to reconnect and I felt that sense of comfort that comes from feeling like we picked up right where we left off.  She is a wise and wonderful 92 year old and every moment spent with her is delightful. 
  As I drove home, I reflected on the precious gift people are to us in our lives. Family, friends, co-workers and even aquaintances have something to teach us if we just receive them as gifts.  Even the not so good moments can teach us so much about ourselves, our attitudes, or the way we respond to any given situation. 
  That is so true when dealing with dementia too. The person living with dementia is very much a gift to us as we are to them. Their way of interacting and communicating may have changed because of changes in the brain, but their personhood is something to continue to treasure.
  I guess that is uppermost in my mind because my travels and presentations this week led to discussions on challenging behaviors. I know from firsthand experience that challenging behaviors can teach us much about ourselves and when in the moment, it often does not seem like a gift!
  I thought we could explore various behaviors for the next several posts and I could offer some activity solutions that might be worth a try.
  We'll start with sundowning.  That is the behavior wherein the person living with dementia may start to become more confused, restless, anxious, irritated and/or insecure as the sun goes down and evening begins. For many, it can last throughout the night and can be very hard on everyone. Lack of sleep leading to exhaustion, can increase the frustrations and make everything more difficult to handle. 
  There are many theories on sundowning although the actual reason is not known.  One theory is that early evening in most homes is a transitioning time of day when many activities are happening and that is "built into" the internal clock of a person.  It is a time when family comes home from school and work, homework gets done, dinner is prepared and a household is bustling with activity. The person's behavior may be their way to communicate stress.  Another thought is that it is the time of day when the person becomes overly tired.  Like seasonal affectiveness disorder, it might be a vitamin D deficiency.
  Whatever the reason, some of the things that might help are as follows:
1. Think lower voice and slower, calmer and quieter. That means a less active atmosphere if at all possible.
2. See if there is an activity the person can help with during that time - folding towels or napkins, polishing the utensils, tearing lettuce or setting the table using templates. (draw the outline of the plate and utensils on plain placemats). If the utensils get super-polished then know you found something that gave a sense of purpose. I worked with a woman who's family was concerned because she wasn't eating well. When she helped tear the lettuce she ate part of what she tore and I could push other vegetables her way to put into the salad and some of those pieces found their way into her mouth too.
3. Turn off/decrease "noise" and play some favorite calming music and  maybe sing together.
4.  Use the time to reassure, even if it is just discussing what you are making for dinner.
5.  Give them an activity on a tray to occupy their time. In our Brainy Day Program we have pentominoes, butterflies and flowers, word rummy, and shut the box that could keep them occupied.
http://www.hippocampus-hq.com/
  Most importantly, find ways to take some deep breaths together and relax. Look for the precious gift of each moment -  it's there for the taking.    Mary Ann