Ask Miriam – November 2022
Dear Miriam,
My sister lives in another state and her husband is her main caregiver. We’ve all been very close, but two years ago she was diagnosed with Alzheimer’s, and it’s been getting hard for him lately. She is fine most of the day; however, around dinnertime, she starts getting very upset. She yells at him that she wants to go home, even going so far as to pull clothes out of her dresser to pack in a suitcase. She sometimes accuses him of kidnapping her and attempts to leave the house. He tries to calm her down, and I even get on the phone to talk to her, but even that doesn’t always work. It can go on for hours. He is exhausted, and we’re at our wits’ end.
—Concerned Brother
Dear Concerned,
This is so hard for all of you. “Sundowning” is when someone with Alzheimer’s or another dementia becomes demanding, suspicious, or upset in the late afternoons or evening. Their confusion seems to increase at this time, but we do not know exactly why this common behavior occurs. It is possible that they are tired towards the end of the day, or alternately, that they are restless because they did not get enough activity. They may also be picking up on other people’s late-in-the-day exhaustion and stress.
Regardless of the reason, there are several ways you can try to reduce this behavior. One is to encourage your brother-in-law to keep the house well-lit. Dark corners can feel scary and your sister may experience confusion if she is not able to see well. In addition, let him know that keeping a routine during the day, with some physical activities including a brisk walk or tossing a beach ball around, have been found to be helpful.
Another good idea is to minimize the distractions in the home. Turn off the television, play music softly, and make sure loud conversations happen in a different room. Sometimes it can help to have an earlier dinner, and your brother-in-law can offer snacks at regular times during the day to make sure she isn’t hungry. Be sure to eliminate caffeine in the afternoon/evening. After dinner, he can ask your sister to help with easy, practical tasks, perhaps folding towels, or sweeping the floor.
It’s important for caregivers to stay as calm as possible. Know that sundowning is part of the disease and that arguing can make things worse. Make sure that your brother-in-law is getting some breaks. Consider bringing in a caregiver for a few hours, or have your sister attend a day program. Continue to offer your brother-in-law emotional support; he may also be interested in a support group for caregivers who are going through a similar experience.
For more information about coping with sundowning, contact our Helpline at 844-435-7259, or watch our video about sundowning.
Best,
Miriam
Questions for Miriam can be sent to askmiriam@alzla.org.