Episode 132
Understanding Sundowning — Why Late-Day Confusion Spikes and What Helps
Sundowning is a pattern of late-day confusion and changed behavior that can intensify anxiety, pacing, wandering, and agitation for a person living with dementia. In this episode, we unpack what sundowning looks like, why it happens, and practical ways care partners can reduce stress and keep evenings calmer. We also share “The Sundowning Story” of Jack, whose late-day distress eased after the right support and environment were in place.
What You’ll Learn:
- What sundowning is and how it differs from general restlessness
- Common signs: disorientation, suspiciousness, exit-seeking/elopement, and abrupt mood shifts
- Frequent triggers: fatigue, pain, overstimulating environments, complex instructions, being rushed, perceived threats, and more
- Why intent matters: behaviors are signals of unmet needs, not “being difficult”
- Practical de-escalation strategies for smoother late afternoons and evenings
Key Takeaways & Tips:
- Lower stimulation after lunch: dim bright lights, reduce background noise and clutter.
- Keep routines predictable: consistent meal times, toileting, and a calming “wind-down” block (music, hand massage, familiar TV show).
- Offer simple choices: one-step requests; avoid rapid-fire questions.
- Validate and redirect: acknowledge feelings first, then gently guide (“Let’s sit together and look at your photo album while we wait.”).
- Address comfort basics: check for hunger, thirst, pain, temperature, and footwear.
- Plan safe movement: short walks or light tasks before dusk to channel restlessness.
- Prepare for elopement risk: door chimes, ID bracelets, current photos, and a neighbors-aware plan.
Story Spotlight: Jack’s 5 p.m. Calls:
Jack called his son daily to “find the house.” With compassionate placement in a memory-care setting and meaningful evening purpose (sweeping the patio at 5 p.m.), his distress eased and dignity returned. The right support can transform late-day turmoil into calmer connection.
Resources Mentioned:
- Evening routine checklist (create your own from today’s tips)
- Local memory-care consultation (to explore environments that match current needs)
Call To Action:
If evenings are tough, pick two tips above and try them this week. Share what worked (and what didn’t) so we can problem-solve together on a future episode.
Disclaimer - This episode is informational and not medical advice. Always consult your healthcare professional for personalized guidance.
About the Host:
Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.
Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.
So many people today are heavily impacted by Alzheimer's disease and related dementia. The Alzheimer's Association and the World Health Organization have projected that the number of people who will develop Alzheimer's disease by the year 2050 worldwide will triple if a treatment or cure is not found. Society is not prepared to care for the projected increase of people who will develop this devastating disease. In her 30 years of working with family members and caregivers who suffer from dementia, Lisa has recognized how little people really understand the complexities of what living with this disease is really like. For Lisa, it starts with knowledge, education, and training.
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Transcript
Welcome back everybody to another brand new
Lisa Skinner:episode of the truth, lies and Alzheimer's show. I'm Lisa
Lisa Skinner:Skinner, your host today. I'm talking about sundowning. Some
Lisa Skinner:of you are familiar with that term, and know exactly where I'm
Lisa Skinner:going with this, and some of you may not be aware of what the
Lisa Skinner:term sundowning means when it pertains to people living with
Lisa Skinner:Alzheimer's disease and related dementia. So I'm going to
Lisa Skinner:explain it to you. The term sundowning actually refers to a
Lisa Skinner:state of confusion occurring in the late afternoon and spanning
Lisa Skinner:into the night. Sundowning can cause a variety of behaviors
Lisa Skinner:such as confusion, anxiety, aggression, or completely
Lisa Skinner:ignoring instructions or directions. Now, based on
Lisa Skinner:various data, the overall rates of sundowning among people
Lisa Skinner:living with Alzheimer's disease and other types of dementia
Lisa Skinner:ranges from 2.4% to 66% that's a huge range. And this is
Lisa Skinner:according to Gallagher Thompson and Associates, they reported
Lisa Skinner:that the prevalence of sundowning is as high as 66%
Lisa Skinner:among people living at home. So what I'm going to do is I'm
Lisa Skinner:going to illustrate what sundowning actually looks like
Lisa Skinner:by sharing with you a story from my book truth, lies and
Lisa Skinner:Alzheimer's. It's secret faces that depicts a person. This is a
Lisa Skinner:real, true life story of somebody who Sundowns every day,
Lisa Skinner:and what it exactly looks like for him. His name's Jack. Now
Lisa Skinner:the other thing that I want to say is sundown and got its name
Lisa Skinner:because it most commonly shows up when the sun is going down.
Lisa Skinner:But I do want to make sure you're aware that sundowning can
Lisa Skinner:occur any time of the day or night. So every night, at
Lisa Skinner:approximately 5pm Jack telephoned his son Steve to say,
Lisa Skinner:you have to take me to find the house. When he called Jack
Lisa Skinner:always sounded a bit panicky, but Steve had no clue which
Lisa Skinner:house his dad was referring to. When he asked his dad which
Lisa Skinner:house he needed to go to, all Jack would say was, you know, my
Lisa Skinner:house this new behavior alarmed and concerned Jack's daughter,
Lisa Skinner:Alice. But Steve just dismissed it as his dad being a little bit
Lisa Skinner:confused from time to time. But other than that, he thought he
Lisa Skinner:was perfectly okay. Well, Alice, his sister, begged to differ.
Lisa Skinner:She had been researching the symptoms of Alzheimer's disease,
Lisa Skinner:and explained to her brother that the agitation and
Lisa Skinner:confusion, confusion that their dad was exhibiting every single
Lisa Skinner:night at the same time was consistent with what she read on
Lisa Skinner:what is called sundowning. She had also researched local elder
Lisa Skinner:care facilities and told her brother that living in one could
Lisa Skinner:possibly improve their dad's quality of life. Well, Steve
Lisa Skinner:absolutely would not listen. His dad, who had been born during
Lisa Skinner:the Great Depression, had been placed in an orphanage at the
Lisa Skinner:age of eight for men of Jack's era, institutionalization was
Lisa Skinner:synonymous with abandonment. In fact, Jack had once told his
Lisa Skinner:son, I would rather die than have you put me in one of those
Lisa Skinner:homes. That's how strongly opposed he was to going into
Lisa Skinner:one. Well, Steve remained adamant. I know how to take care
Lisa Skinner:of my own father. He insisted to Alice, but the sundowning
Lisa Skinner:behaviors continued to worsen. Steve even started to receive
Lisa Skinner:calls from the. Manager of a local Hooters restaurant,
Lisa Skinner:believe it or not, who complained that his dad was
Lisa Skinner:frequently coming into the restaurant and asking out the
Lisa Skinner:young servers. He told Steve that he was behaving like a
Lisa Skinner:young Romeo and that he must insist that he keep his dad from
Lisa Skinner:coming there. After the fourth call from the Hooters manager,
Lisa Skinner:Alice brought up the subject of looking into moving their dad to
Lisa Skinner:a facility where he could be properly cared for. Well, Steve
Lisa Skinner:remained stubbornly opposed to that idea. He said to Alice, Dad
Lisa Skinner:doesn't need to go into a nursing home. I will just keep
Lisa Skinner:setting him straight. But Alice went ahead and found an opening
Lisa Skinner:at a local memory care facility. However, Steve believed his dad
Lisa Skinner:belonged in a less restrictive assisted living environment,
Lisa Skinner:because he saw him as being much higher functioning than the
Lisa Skinner:residents appeared to be in the memory care unit. So if he was
Lisa Skinner:even going to entertain the idea, he would insist on
Lisa Skinner:assisted living versus memory care, and he said very
Lisa Skinner:emphatically to Alice, I cannot put my dad in there with all
Lisa Skinner:those crazies. He'll die, said Steve. And Alice just rolled her
Lisa Skinner:eyes. He's just not getting this the elder care facilities
Lisa Skinner:administrator insisted that moving him into memory care was
Lisa Skinner:definitely the right placement for their dad. Well, it wasn't
Lisa Skinner:until Jack went missing for two whole days and the police
Lisa Skinner:officers found him sleeping in his car in the Hooters parking
Lisa Skinner:lot that Steve finally conceded to moving his dad there on a
Lisa Skinner:trial basis when they visited him two weeks later, Steve And
Lisa Skinner:Alice were pleasantly surprised to hear how well their dad had
Lisa Skinner:adjusted to life in the memory care neighborhood. In fact,
Lisa Skinner:during their visit, Steve and Alice found that Jack was so
Lisa Skinner:engaged in the facility's arts and crafts activity that he
Lisa Skinner:barely even acknowledged their presence through conversations
Lisa Skinner:with the staff, they also learned that the house that Jack
Lisa Skinner:was trying to find so desperately was actually the
Lisa Skinner:home he lived in with his mother before going to the orphanage.
Lisa Skinner:Jack no longer talked about needing to find this home. He
Lisa Skinner:now bragged about his new position at the facility. He
Lisa Skinner:told his kids that he now had a sweeping job where he swept the
Lisa Skinner:back patio, and he proudly did that every night at 5pm further
Lisa Skinner:thoughts on this story. Sundowning refers to a set of
Lisa Skinner:behaviors in which the person with dementia is disoriented and
Lisa Skinner:confused, typically occurring at the end of the day. But again,
Lisa Skinner:the behaviors can actually occur at any time of the day or night,
Lisa Skinner:the person suffering from sundowning can experience
Lisa Skinner:dramatic changes in personality and behaviors, including pacing,
Lisa Skinner:wandering, suspiciousness, disorientation, confusion and or
Lisa Skinner:agitation, the person may become demanding or combative and yell
Lisa Skinner:out and scream for no apparent reason, the causes and triggers
Lisa Skinner:of sundowning are not clearly understood.
Lisa Skinner:Another common behavior illustrated in the sundowning
Lisa Skinner:story is what we call elopement. Elopement is different from
Lisa Skinner:wandering in that the person has a specific destination in mind
Lisa Skinner:and is determined to find it or to get there, they typically
Lisa Skinner:seek to exit their current environment and have a purpose
Lisa Skinner:or agenda to get to that place. It is very common for a person
Lisa Skinner:with dementia to want to find a deceased spouse who they. They
Lisa Skinner:believe is worried about them. A person exhibiting sundowning
Lisa Skinner:behaviors can be relentless in their pursuit of what they are
Lisa Skinner:looking for. They may even believe that they're being kept
Lisa Skinner:against their will, and become angry, anxious and even
Lisa Skinner:aggressive the most important thing to recognize about
Lisa Skinner:sundowning is that the behaviors and symptoms are a part of the
Lisa Skinner:disease and not the intentional behavior of the person. The
Lisa Skinner:behaviors displayed when a person is sundowning can usually
Lisa Skinner:be effectively managed with assistance from a trained
Lisa Skinner:professional, in a person with a healthy brain, all thinking
Lisa Skinner:powers like memory and reasoning work together to define a world
Lisa Skinner:the person understands, allowing that person to function
Lisa Skinner:effectively in their world, but in people with dementia, those
Lisa Skinner:powers of thought shrink, creating a world that becomes
Lisa Skinner:increasingly overwhelming and they're less able to make sense
Lisa Skinner:of it, the person loses his or her knowledge of how to handle
Lisa Skinner:situations properly and reacts based on how a particular
Lisa Skinner:situation affects them emotionally, there's no reason
Lisa Skinner:or logic anymore. Agitation, anxiety, fear, aggression and
Lisa Skinner:anger are all examples of some of the common behaviors that
Lisa Skinner:will surface as a result, Alzheimer's aggression can flare
Lisa Skinner:up without warning, and there may not be an obvious cause.
Lisa Skinner:However, some of these triggers that are common include, and
Lisa Skinner:there's a huge list of them, but these are some of the common
Lisa Skinner:ones, discomfort from lack of sleep, side effects from
Lisa Skinner:medication or pain that they cannot verbalize to their loved
Lisa Skinner:ones or their caregivers, the environment around them,
Lisa Skinner:including loud noises, too much activity and even clutter,
Lisa Skinner:confusion from being asked too many questions at once, trying
Lisa Skinner:to understand complex instructions, or feeling the
Lisa Skinner:stress of their caregiver being touched, or feeling like their
Lisa Skinner:personal space was invaded, as with bathing or changing
Lisa Skinner:clothes, picking up on your anger, nervousness or
Lisa Skinner:frustration, being criticized or told they were wrong, feeling
Lisa Skinner:rushed, not being allowed to do something or to go somewhere
Lisa Skinner:that they want to get to having to do something that they don't
Lisa Skinner:want to do, like take a shower, feeling threatened, confused
Lisa Skinner:about What's going on, and believing something is happening
Lisa Skinner:that really isn't it's in their mind, they're perceiving it some
Lisa Skinner:way, like you are stealing things from them. So that is the
Lisa Skinner:information that I wanted to share with you today. Hopefully
Lisa Skinner:you will find this helpful and useful and implemented into your
Lisa Skinner:caregiving journey with your loved one or your family member.
Lisa Skinner:And all of these things are intended to relieve some of the
Lisa Skinner:stress and the anxiety in the day to day caregiving
Lisa Skinner:experience, or even the way you communicate with your loved one
Lisa Skinner:and turn your experiences both for both you and your loved one
Lisa Skinner:into positive outcomes. So that's it for today's new
Lisa Skinner:episode of the truth lies and Alzheimer's show. I'm Lisa
Lisa Skinner:Skinner, your host, and I look forward to having you back next
Lisa Skinner:week for another new episode, and in the meantime, please try
Lisa Skinner:to stay happy and healthy, and I'll see you back here next
Lisa Skinner:week. Bye. Bye.
