What is Sundowning?

The speaker, Amanda Bulgarelli, introduces the topic of sundowning, a phenomenon often observed in individuals with dementia. She outlines the six key questions that will be addressed in the webinar: defining sundowning, identifying the key puzzle pieces to understand, those that can be influenced, the role of the care partner, handling moments of confusion, and exploring different manifestations of sundowning. The webinar aims to provide insights and strategies for care partners dealing with the challenges of sundowning.

The term 'sundowning' originates from the observation that individuals with dementia often exhibit changes in behavior, language, and symptoms as the day progresses towards evening. The explanation provided involves the stress threshold theory, suggesting that as the day wears on, individuals' abilities diminish, leading to a tipping point where the brain can no longer manage stress effectively, resulting in sundowning symptoms. The session also discusses the role of hormonal imbalances and delirium in sundowning phenomena.

The speaker discusses the impact of sundowning on care partners, highlighting that they too experience stress, hormonal imbalances, and mood swings. Care partners may unintentionally contribute to an unwelcoming environment due to their own stress and exhaustion. The speaker emphasizes the importance of understanding the person with dementia's history and preferences to better handle sundowning episodes and suggests looking for clues from their past to make sense of their current behavior.

The speaker introduces the 'six pieces of the puzzle' model for understanding sundowning, which includes personal history and preferences, abilities and brain states, type of dementia, other health conditions, environmental factors, and daily routines and activities. Understanding these aspects can help care partners recognize triggers and patterns, and provide appropriate interventions. The speaker stresses the importance of data gathering and observation to predict and manage sundowning events.

The speaker continues to explore the 'six pieces of the puzzle' by discussing the significance of understanding the person's abilities, the type of dementia they have, and any other health conditions that might be influencing their behavior. The speaker emphasizes the need to consider all possible factors, including physiological and psychological aspects, to gain a comprehensive understanding of sundowning and how to address it effectively.

The speaker discusses how the environment and social interactions can impact sundowning. Environmental conditions can either trigger stress or mimic familiar settings, leading to confusion. Social interactions, including the behavior of care partners and others in the environment, can also significantly affect the individual's state. The speaker suggests being curious and observant to understand the role of these factors in sundowning and to make necessary adjustments to create a more supportive environment.

The speaker explores how the passage of time and daily routines can influence sundowning. She discusses the importance of recognizing patterns and rhythms in the individual's behavior, such as monthly or seasonal changes, and how these can be linked to hormonal fluctuations and circadian rhythms. The speaker also considers the impact of artificial light and the lack of natural sunlight, especially in winter, on sleep patterns and overall well-being, which can contribute to sundowning symptoms.

The speaker encourages care partners to reflect on their approach when dealing with sundowning. She suggests that understanding the individual's abilities, the type of dementia, and other health conditions can help in managing sundowning symptoms. The speaker also emphasizes the importance of considering the care partner's own well-being and how their stress and reactions can affect the person with dementia. The goal is to move away from quick fixes and towards a more detective-like approach to understanding and addressing sundowning.

The speaker engages in a role play with a participant named Carolyn to demonstrate how to respond to sundowning. The role play shows how interactions can escalate and become distressing for the individual with dementia if the care partner pushes too hard or fails to adapt to the person's changing abilities. The speaker highlights the importance of stepping back, observing, and adapting to the person's needs in the moment, rather than insisting on certain behaviors or tasks.

The speaker discusses the concept of 'gem states' to understand the varying abilities and responses of individuals with dementia. She explains how a person's abilities can shift throughout the day, affecting their behavior and interaction. The speaker emphasizes the importance of recognizing these shifts and adjusting the approach accordingly, to prevent escalation and provide support that matches the individual's current state.

The speaker concludes the webinar by reinforcing the importance of becoming curious and observant when dealing with sundowning. Instead of viewing sundowning as illogical, care partners should try to understand the underlying needs and triggers for the individual. The speaker encourages asking questions, reflecting on the person's behavior, and validating their feelings to better manage and address sundowning episodes.