My StepDad said that he's noticed that my 83 year old Mom is becoming confused in the later afternoon.
She's had a few neurologist appointments and at least 3 MRI's of her brain over the past 4 years. No definitive diagnosis. The doc's are just calling it the normal aging process.
I think the recent time change back to standard might have contributed to this presenting earlier in the day.
Does anyone have any methods for dealing with confusion? Maybe ways to reduce the elderly person's stress that results from the confusion?
Does anyone find music, audible books, word puzzles or anything similar to be helpful as calming aids?
Any suggestions or words of advice are welcome!
Tips for Coping with Sundowning
Late afternoon and early evening can be difficult for some people with Alzheimer’s and dementia disease. They may experience sundowning—restlessness, agitation, irritability, or confusion that can begin or worsen as daylight begins to fade—often just when tired caregivers need a break.
Sundowning can continue into the night, making it hard for people with Alzheimer’s to fall asleep and stay in bed. As a result, they and their caregivers may have trouble getting enough sleep and functioning well during the day.
Possible Causes
The causes of sundowning are not well understood. One possibility is that Alzheimer’s-related brain changes can affect a person’s “biological clock,” leading to confused sleep-wake cycles. This may result in agitation and other sundowning behaviors.
Other possible causes of sundowning include:
Being overly tired
Unmet needs such as hunger or thirst
Depression
Pain
Boredom
Coping with Sundowning
Look for signs of sundowning in the late afternoon and early evening. These signs may include increased confusion or anxiety and behaviors such as pacing, wandering, or yelling. If you can, try to find the cause of the person’s behavior.
If the person with Alzheimer’s becomes agitated, listen calmly to his or her concerns and frustrations. Try to reassure the person that everything is OK and distract him or her from stressful or upsetting events.
You can also try these tips:
Reduce noise, clutter, or the number of people in the room.
Try to distract the person with a favorite snack, object, or activity. For example, offer a drink, suggest a simple task like folding towels, or turn on a familiar TV show (but not the news or other shows that might be upsetting).
Make early evening a quiet time of day. You might play soothing music, read, or go for a walk. You could also have a family member or friend call during this time.
Close the curtains or blinds at dusk to minimize shadows and the confusion they may cause. Turn on lights to help minimize shadows.
Preventing Sundowning
Being too tired can increase late-afternoon and early-evening restlessness. Try to avoid this situation by helping the person:
Go outside or at least sit by the window—exposure to bright light can help reset the person’s body clock
Get physical activity or exercise each day
Get daytime rest if needed, but keep naps short and not too late in the day
Get enough rest at night
Avoid things that seem to make sundowning worse:
Do not serve coffee, cola, or other drinks with caffeine late in the day.
Do not serve alcoholic drinks. They may add to confusion and anxiety.
Do not plan too many activities during the day. A full schedule can be tiring.
If Problems Persist
If sundowning continues to be a problem, seek medical advice. A medical exam may identify the cause of sundowning, such as pain, a sleep disorder or other illness, or a medication side effect.
If medication is prescribed to help the person relax and sleep better at night, be sure to find out about possible side effects. Some medications can increase the chances of dizziness, falls, and confusion. Doctors recommend using them only for short periods of time.
I'll share this with my Stepdad and Brother when I'm home.
I appreciate you taking the time to send this! It's really a great picture of the entire situation.
Confusion in the late afternoon is Sundowner's. It's where loved ones become more confused at a certain time of day, mainly in the mid-late afternoon. You can try various methods of alleviating her confusion such as a light treat with protein. Maybe some cheese and crackers or a sandwich. Don't wait until she's confused, offer her a treat prior to her becoming confused.
Around this time every day cut back on distractions such as the TV, radio, people coming in and out, etc. If your mom favors a certain kind of music you can try having that on low in the background. Don't overstimulate her. Don't ask her what kind of snack she'd like or otherwise try to distract her from the confusion. Do what you can and if it doesn't work try again the next day.
I gave my Dad Previgin for awhile and it really helped.
Hopefully stepdad will be willing to take the advice here for cutting down on her confusion at this time of day.
I have to give my Stepdad credit. He's really been a great caregiver. He has always enjoyed cooking, so they eat well and he's good about making sure that she exercises.
He could really use some respite but it's hard to get him to leave home for more than 1 night.
When I go up to visit he'll usually run up to Lake Tahoe for a 24 hr stay. Just enough to unwind a bit I guess.
Thanks again.
Routine is going to be one of my focal points on my next trip home.
1- Turn on lights in the afternoon/evenings to increase light in the area - shadows can be confusing or scary.
2 - Make sure everybody is getting a good night's sleep - at least 7 hours every night. Being tired makes it harder to cope.
3 - Exercise outdoors - a walk in the sunshine helps the body stay on course with circadian rhythms.
4 - Develop routines and consistent environments. If folks know what to expect, fear diminishes.
5 - If none of the above help, it may be time to enlist your health care provider for medications.
Great suggestions! The house doesn't have very good lighting. It's always on the dark side once the sun goes down. I'll try using a couple of those bright camping lanterns to see if that helps. I never thought about things like the intensity of the lighting and the possibility of shadows.
She does sleep good, so we're lucky there:)!
She fell in Nov 2017 and fractured her pelvis in 5 places. It was a painful healing process and the fear of falling could easily provoke an anxiety attack but she was a fighter and made a beautiful recovery!
Then, in Sept 2018 she tripped on something in the driveway when she stepped back and she broke her right wrist and hip:(. That was a big set back and an even more painful recovery.
She underwent surgery the next morning to repair the hip but to do the wrist correctly would have taken a long time. Given her age we opted just to have them manipulate it as much as possible and splint it because we didn't want to risk any issues with the anesthesia.
So when the weather is nice we do get her out for a walk with her walker.
She also does strength training with elastic bands, she has some light weights for her arms and a peddling machine for her legs and hips. My Stepdad makes sure that she exercises every day.
So it sounds like our bases are covered but maybe we just need a more consistent routine and schedule with a focus on lighting in the late afternoon and evening.
Thank you so much! I'll let you know how it goes.
Vitamin B complex supplement might also help.
I would look at problems with hygiene, such as a yeast infection.
She does have ongoing issues with urinary tract infections and I know that confusion is common in elderly people with urosepsis. She's good about starting antibiotics right away but they're fairly frequent so a yeast infection is definitely also something to consider. Good thought.
Thank You
1. Routine, routine, routine - because she was such a creature of habit, she was able to live on her own for years before we realized how far she had declined. I guess it's kind of like muscle memory or something, so we kept her on a schedule when she moved in with us.
2. Music - she loved listening to old hymns so I had numerous CDs that played in a continuous loop.
3. Distraction - this didn't always work, but sometimes I could get her talking about old photos or family members, weather, or whatever and it would get her focused on something else.
Bottom line is that sometimes NOTHING works! You just have to keep trying different things until one of them makes somewhat of a difference. Best wishes
I appreciate knowing that we'll probably have to try different things until something "works".
My Mom loves music, so I'll make some CD's for her of the music she likes.
She is also very much a creature of habit. Three meals a day at specific times, bedtime between 9:00-9:30, etc. We do try to maintain her schedule as much as possible.
When my Grandmother used to get confused about who we were or where she was I'd always just follow her lead. If she thought I was a cousin then I took on the role of cousin. My Mom was with me on a few of my visits and she could help to explain what my Grandmother was talking about. So I learned more about her early life as a result. I think it also helped to ease my Mom's stress.
I live 500 miles away so I only get there every 6 to 8 weeks to visit.
I'm going up again the first week in December so wanted to have some ideas as to what to try.
Thank you for your reply.