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Tuesday, November 20, 2007

Alzheimer's Sundowning - Things That Can Help

For many years I worked with caregiver agencies, and many of the clients had Alzheimer's Sundowning. I found that the things that helped were unique in each person's case. Below are descriptions of some typical situations and what worked to make things better.

One lady who had sundowning had previously wandered outside, while her husband was napping in the late afternoon. She walked downtown in a tourist area. Passing travelers saw she looked like she needed help and picked her up in their car.

She couldn't remember her name or where she lived, and they drove around for hours trying to see if anything looked familiar to her. Although she had lived in the town for decades, she did not recognize anything. Eventually someone recognized her and was able to guide them to her home.

When her husband became ill and was hospitalized, I arrived as a 24 hour stand-by-assist caregiver for a long row of days. The first afternoon I was there she became more and more agitated. Suddenly she went out the door and walked rapidly toward town, saying she had to catch a train to go home.

I caught up with her and used my cell phone to call someone with a car to come and pick us up. She accepted that I was a friend. She believed she was staying with me for awhile for company. She didn't recognize her own home.

During the next days I got a system going. We spent afternoons playing dominoes, coloring pictures, eating healthy snacks, looking at magazine pictures, doing easy jigsaw puzzles, playing easy card games, doing crossword puzzles and looking at photo albums. I might be doing most of the picture coloring but she picked out the colors. Visual activities worked well, but conversation was difficult because she could not follow it.

For the crosswords I would read the question and we'd make guesses together on the answers. For cards I would lay them out and play both sides but she watched while I explained it. Even if I was doing most of the activity she was still enjoying participating by watching.

When she lost interest I switched to another activity and so on. We put the pictures we colored up with tape. She enjoyed making more pictures with me each day.

If she was participating in an activity it kept her attention busy, so she didn't hop up and start out the door to go wandering when sundowners started in the late afternoon. Watching TV didn't work well because she didn't get involved enough with it.

I also found that having lots of lights on helped. I'm not sure if it made her feel it was earlier in the day, or if she could see better, or if it helped avoid shadows and hallucinations. But, having the house well lit helped.

Being active during the day helped her sleep better at night. We tried going out in the car for scenic drives, going for walks, and going downtown to sit and watch people and activities.

All these things helped pass the time, keep her attention, and provide enough activity, without overdoing it. By night time she was ready to rest.

Too much activity though and exhaustion or stress could make sundowners worse. It had to be a balance that was just right, but since each day is different all I could do was try my best.

Soothing music also helped. Some people liked to listen to soft spiritual music and old favorite hymns, such as "Shall We Gather At the River." Others just seemed more content and calm with any smooth, easy going music that was popular with their age group.

I would try to keep my voice and actions calm and quiet, and just go with the flow. One lady with Alzheimer's Sundowners frequently thought we were in an airport. When I was assisting her as she used her walker to head for the bathroom she would say she hoped we didn't lose her husband in the airport.

She had me tear up pieces of paper and drop them on the floor, so that her husband could follow them to find her. She was so afraid of losing him in the airport. In the morning she knew she was in her own home and recognized us. But by late afternoon Sundowners time she thought she was in an airport.

The people with Alzheimer's Sundowners will not believe you if they don't recognize their own home, but you insist that they are indeed in their home. Just going with the reality they are experiencing instead of arguing is important. Wherever they say they believe they are, that is the location and reality you go along with.

If they don't recognize their home, I've asked them to stay in the house for the night, before returning to their own home tomorrow. Usually in the morning they recognize it as their own, but when late afternoon Sundowners starts then once again they may want "to go home."

At any moment people with Alzheimer's may be completely cognizant. But you cannot make assumptions, because in the next moment that can change. Clear thinking one minute, with good memory recall, can switch to confusion with lack of memory the next minute.

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