My LO seems to extend her questions and sundowner behavior longer every day. It starts about 8pm and lasts at least 4 hrs. But it's the same questions over and over. Then she wants to change from her night gown and robe to street clothes, and wants to go "home". How can I answer her questions and how much longer will this go on?
1. Distraction is worth a try, but the repetitive questions may simply continue.
2. In expressing the desire to "go home" your LO is trying to say they want to know where they are, how they can regain their sense of location and purpose. You can try to reassure them with talking about their present environment, both in the house and outside. You can ask questions about what they are missing or trying to find out what they are thinking and feeling.
3. Try to be as calm and relaxed as possible. If you become stressed your LO will become even more stressed.
4. Set boundaries--difficult to say what boundaries: times when you are in bed with door locked? times when you are out?
5. Get help from agency caregivers at certain times, perhaps in the evening when the sundowning is usually happening.
6. Try to find a rhythm of life that your loved one accepts with a set routine each day about when to get up, eat, rest, etc. For example, does it work better for your loved one to get up early or later? How much sleep do they need? Keep a notebook of sleep patterns (day and night) and what impact this has on the sundowning. As dementia progresses, sleep patterns may change.
7. Look after yourself. If you try to do this on your own, you will at some time burn out. When others around you are unsupportive, this has consequences both for you and for them. Perhaps outside counselling for the two of you would help. Involve friends and neighbors.
8. You might find it worth reading Chapter 4 about repetition in Judith London's "Connecting the Dots: Breakthrough in Communication as Alzheimer's Advances" (New Haringer Publications, 2009). She urges you try to find out what lies beneath the repetition--what is the person trying to say? Ask questions and see if you can uncover the hidden meaning.
I hope this is helpful.
Best wishes and prayers.
There is a chef there. They are given five good meals and 2 nutritious snacks. I have provided her with her favorite snacks. They are in her room.
I know that she is not hungry. But, she cannot say what is really going on.
Anyone have any strategies. Distraction doesn't work. She is back on the same loop within 3 minutes.
I found cutting out caffeine and cutting down on sugars has been a big help, for him to be calmer. In order to keep things calm I do not try to teach him/give him instructions. They can not learn or understand and it causes anger and frustration.
Less words from me is a big help for both of us.
As usual, the first question is has she been tested for UTI? A culture is better than the dip stick test. Blood work is important too, as it can identify other infections that may be impacting her, or imbalances in her system.
I was a skeptic about the UTIs when I first joined the forum. Mom never had the traditional sun-downing. She lived alone until we had to move her to MC (we tried aides, but she refused to let them in.) Months before the move, she DID develop an odd OCD behavior at night, just before bed, where she would check the door lock, side-lights, dishwasher and LR. We had a camera at the front door, so this became obvious as it progressed. It started out with a couple of rounds checking these things a few nights/week and eventually became a nightly marathon, lasting 1 - 1.5 HOURS! Once in MC, this seemed to stop. The only time she had "normal" sun-downing was when she got her first UTI at MC. Oh boy! She was out of control every evening and it was a weekend, so there was nothing we could do! I became a believer in UTIs and odd behavior (subsequent UTIs showed up as night time bed wetting - soaking!)
Along with the antibiotic, she got an Rx for an anti-anxiety. While these do have a fall risk, the mildest dose was sufficient and she NEVER fell while on it. It worked first time, every time, took effect in about 10-15 m and doesn't need to be weaned off when no longer needed. It was just enough to take the "edge" off and keep her calm. She was NOT doped up with it.
It may take some trial with medications. What works great for some doesn't work for others. Explain this to her PCP when you have the blood and urine tests done, and see if they have any suggestions for something that might help.
(While setting boundaries may work for some things, it isn't likely to help here. Even trying to distract or redirect doesn't always work. These techniques work for some dementia behaviors, but sun-downing is in a class all by itself!)
What I tell my Dad to do now is to keep the house during the day as bright as possible. Leave lights on in the living room, theirs's is usually dark during the day because of the side of the street they are on. When she starts with her confusion, try not to yell (ha), stay calm and just play along but try to divert her attention to something else. Watch a favorite show, try to suggest she do a puzzle, something. I don't know if that works, I just think he's exhausted and sad and doesn't know what to do. Neither do I.
I really feel that getting good rest and good nutrition would be key for her but she gets neither. She refuses to sleep upstairs in the bedroom. She HAS to stay downstairs so she can keep an eye on things. So, all night she snoozes but has to check the boiler, the outside lights, the doors....all night long. My Dad told me she doesn't even change her clothes to put on a nightgown "just in case". The doctors are really no help either.
I'm afraid it will not go away, you can check on sites to try to get suggestions as to how to help, but it's really trial and error. She's also on Lorazepam, I don't think that it's helping much. Sometimes I think a little bit of a tranquilizer would help get her some rest, but I'm more afraid of her falling so that is not an option. I just feel so bad for their brains, how awful this must be.
I wish you much good luck and prayers to you and your LO during these difficult times.