During the more advanced stages of Alzheimer’s, a person may develop Sundowner’s Syndrome. As the sun goes down and night begins to appear, a person with Alzheimer’s become fearful, confused, agitated, and more unfamiliar with their surroundings.

This stimulates the primal fight or flight response even though there is no new environment or circumstance to justify this reaction. Patients can become intensely agitated to the point of raging usually at the closest target, the caretaker. Or they literally try to run away, becoming skilled escape artists. This is also known as the Elopement Phase.

Trying to manage this state is very difficult. In no way, is the patient’s behavior a characteristic of whom they are, rather, as the brain deteriorates, so does their personality. What is left is a shadow of their former self. Here are some tips for dealing with Sundowner’s.

  1. Don’t reason. While the patient may seem lucid at the time, their ability to logically reason is lost. This is a purely instinctive, emotional response and must be answered as such. Simple statements directed towards the fear are best, “You are safe,” “I’m just as confused as you,” or “I’m angry too,” eases the situation.
  2. Stay calm. The last thing that is needed during Sundowner’s is for the caretaker or others to also react emotionally. It is difficult to disconnect and detach from a loved one at this moment but it necessary. Try to remember that this is the disorder talking, not the person.
  3. Don’t personalize. Even though the comments a patient makes are bitting and hurtful, internalizing them as reality is not helpful. Usually at this stage the executive functioning of the brain is no longer operating at full capacity so they are unaware of how their words or actions impact others.
  4. Get help. Once this pattern of Sundowner’s has begun, it will not reverse itself. This is a good time for a caretaker to hire some assistance because it is so difficult to manage. When the patient becomes a threat to themselves or threatens the caretaker, then a facility that specializes in Sundowner’s might be necessary.
  5. Remove guilt. Guilt tripping is a common tactic of the patient. As the disorder progresses, they become more childlike. Think of it as an adult two year old throwing a temper tantrum if they don’t get their way. The patient frequently uses guilt as a way to get what they want. Don’t take on the guilt or the responsibility of the deterioration of the brain. This is solely the result of Alzheimer’s.
  6. Don’t replay. It is hard to listen to hurtful, threatening, and abusive comments made by a loved one. But replaying the statements verbally or mentally only reinforces the inaccurate perception. Instead, counteract the false statements with the truth, “I have cared for them,” “I am loving.” A strong support system that provides encouragement is also a necessity.
  7. Forgive frequently. The patient is so unaware of how damaging they are behaving in the moment that any form of an apology is an unrealistic expectation. Forgiveness is not for the wrong doer; rather it is for the one who has been wronged. Releasing the pain often restores energy and keeps things in their proper perspective. Remember, it is not the person talking, it is the disorder.
  8. Discount delusions. Part of Sundowner’s is delusional where the patient may even believe they physically are somewhere else. For instance, if they are watching a TV show about the wilderness, they may believe they are actually there in the moment. Don’t try to counteract the delusion, rather enter into their world and agree with their perception. This helps to minimize the confusion and anger restoring them back to reality sooner.
  9. Set boundaries. Everyone has their own personal limitations. Sundowner’s has a way of pushing the best of boundaries way beyond their breaking point. The patient will not understand the concept of boundaries but those caring for them will. Don’t be afraid to set boundaries and inform others of personal limitations.

This is perhaps the most difficult stage of Alzheimer’s as the patient is still able to communicate however what they are saying and doing is extremely damaging. This is the best time to reach out to a support group of people who are also experience in this stage. Don’t try to go at it alone.