Home care for the most challenging hours of the day
Dementia affects people differently but late afternoon can cause anxiety and confusion (get more info). At 3pm, your loved one may wander around the house, looking in pockets, or ask why dinner is not ready, although the saucepan has only just reached the hob. They may remain confused and restless throughout this period, which can continue until bedtime.
3pm: Identify the early signs
Curtains appear darker, a clock is ticking in the hallway, and a radio is playing in the other room. After sitting down to have lunch, a loved one may start cleaning their hands, rummaging in cupboards or looking for their bag in the cushion of the armchair.
A caregiver can reduce the stimuli before the confusion worsens: a curtain is drawn to stop the sunlight casting dark shadows on the floor, a well-known lamp is lit and the radio or television switched off. A drink in a blue cup or a biscuit on a flower-patterned plate can bring back familiarity.
4pm: Answer the questions
‘Where is my mum?’ ‘When do we go home?’ Questions may repeat every five minutes. Arguing about dates or showing them the address on the picture frame will lead to more arguments. Providing reassurance with a kind voice, then changing the subject to an activity is often helpful.
Activities like:
- folding laundry which has just come out of the dryer
- sorting out the buttons into an old cookie tin
- wiping down the table
- looking through old photographs
- watering plants
Can all help distract.
A professional from You’re First Home Care can answer questions with the same kindness, even if the kettle has boiled twice and the door chain has been checked multiple times. It gives family caregivers the opportunity to get home from work, collect medication or simply have a few moments to themselves.
5pm: Keep dinner simple
Meals can be stressful. The smell of onions cooking can be unpleasant, it can be hard to see silverware on a printed tablecloth, or a large portion can be difficult to manage. Meal refusals often start with pushing peas around the edge of the plate or placing a piece of toast under the napkin.
Simple meals can be easier: using a plain plate, offering soft foods, reducing the portion size, and setting out cutlery one at a time. A caregiver can sit with them, offer encouragement and keep the atmosphere calm while waiting for the microwave to beep or the door to squeak. Familiar dishes are preferable to elaborate recipes.
6pm: A gentler way to prepare for bed
In the evenings, as daylight fades, they may try to leave. They may put on their shoes and pick up their bag, telling you they need to catch the bus. Locking the front door or trying to explain what time it is will only add to their distress.
It may be easier to persuade them to stay by putting their bag next to a chair, handing them a jumper and suggesting they wait for a cup of tea. Playing some familiar music, as explained at https://cochrane.org/evidence, watching TV together or polishing a wooden object will help pass the time while the light fades.
Bedtime: Maintain a predictable routine
Bedtime can be easier if the routine is predictable: matching pyjamas, lavender soap, bedside lamp and a glass of water can provide reminders. If a caregiver rushes them through a wash or provides too many choices, they could end up wandering in front of an open cupboard.
Professional care can include prompting for medication, helping them use the toilet, getting changed into nightclothes and reassuring them after being called back to the bedroom multiple times. In the meantime, a relative caregiver can have a meal in peace, take a shower or relax on the couch without hearing every footstep.
Behavioural changes can be caused by discomfort and not sundowning. Someone who starts to pace, tugs at their clothes or won’t sit down might need the toilet, be constipated, be too hot or be in pain they can’t articulate. Check that their clothing is comfortable, the temperature of the room is correct and when they were last in the bathroom. Offer one choice at a time.
Any significant deviation from their normal evening routine, particularly if accompanied by fever, weakness, shortness of breath or a fall should be discussed with a medical practitioner, rather than dismissed as sundowning.
Get a supervised walk, or time by a sunny window earlier in the day, to help the body clock know it’s day.
Limit naps and avoid coffee in the late afternoon, both of which interfere with sleep later.
Calming the evening hours
The symptoms of sundowning can fluctuate. Notes of a noisy delivery van at 4pm, skipping lunch or falling asleep in the chair in the afternoon can help to pinpoint causes. With care and a consistent routine, the time between the afternoon and bedtime can be more manageable for the whole household.
