Green House Blog

Rhythms of the Day, Evening Time

Sometimes it’s not as complicated as it seems.  Sometimes it just takes a closer look at a situation and the solution might not be as challenging or impossible as we may believe.  “Sundowning” has long been a complicated issue for those who care for the elderly.  It is the term used to describe agitation, irritability, disorientation that some people with dementia experience during the late afternoon or evening.  But is it the dementia that causes the “sundowning”?  Eden Mentor, Dr. G. Allen Power, from St. John’s Home in Rochester, New York says “No” and offers a different perspective on the issue:

“Dementia simply “fans the flames” by making people (1) more sensitive to their environment, (2) more easily fatigued, and (3) less able to cope with having their biorhythms shifted into artificial schedules that better suit our nursing home operations.

This is a small distinction, but a very important one. Here’s why: We cannot cure dementia, but we can cure almost all cases of “sundowning” without medication, by shifting operational patterns and staff behavior.”

You may wonder if it could be that simple.  Dr. Power suggests that we take a look at the latest issue of the NYC Alzheimer’s Association newsletter which tells a compelling story about how a care home in Phoenix made just those changes and have been virtually “sundown-free” for over a decade.  Jane Verity, Founder and CEO for Dementia Care Australia, fully agrees with Dr. Power.  

“Sundowning is not a symptom of dementia. To me it is a symptom of an environment that does not feel like home. Our job is to make the place where people with dementia live – one of genuine kindness, love and compassion, where each and everyone has opportunity and is encouraged to contribute, feel needed and useful, have opportunity to care, self esteem boosted and the power to choose (which is different from having the ability to choose). As you write, the challenge for us is to shift focus from our routines and hurry to their emotional and spiritual needs. However the end result is so rewarding for everyone.”

Judy Berry, Founder of the Lakeview Ranch specializing in dementia care in Minnesota echoes the same message. 

Many times, in an effort to change a specific behavior, care partners try to distract or redirect the person without first validating the feeling or emotion they are trying to communicate. This devalues their feelings and often they become more agitated.  By making the effort to learn each individual’s lifestyle, developing a trusting relationship, respecting and validating their feelings and meeting their needs, most so called behavior is eliminated.”

Dr. Power encourages all of us to take a look at our teams and challenges us to create a more natural experience that honors the individual rhythms of our elders.  A great way to show that culture change not only improves the quality of life, but clinical care as well.  What better way for all of us to start out 2012!