Assisted living communities are designed to offer residents quick access to caregiver assistance, easy socialization with peers, and amenities that make meeting their wellness goals more convenient. For residents with Alzheimer’s disease and other types of dementia, assisted living communities, especially those with memory care programs, further enhance safety and comfort. Common dementia behaviors, including a phenomenon called sundowning, can make life more challenging and even dangerous for older adults with the disease. Fortunately, communities can alleviate some of that danger and provide more comfort and peace to residents with dementia. Here, we explain sundowning and describe several ways assisted living facilities help individuals who exhibit this common behavior.

What is sundowning?

Sundowning is a term used to describe a set of behavioral changes that come with the increased confusion caused by dementia. These symptoms typically arrive in the late afternoon and persist throughout the evening (when the sun goes down). They can include:

• Restlessness.
• Confusion.
• Anxiety.
• Aggression.
• Pacing or wandering.
• High levels of distress.
• Repetitive questions or statements.

Sundowning can occur in any stage of dementia but is most commonly observed in the middle stage. It’s important to note that while sundowning usually occurs in the late afternoon and evening, it can also happen during the morning or early afternoon.

How assisted living facilities help with sundowning

Assisted living communities, specifically ones with memory care programs, aim to decrease the agitation and anxiety that come with sundowning for their residents. Here are a few ways they accomplish it.

Secured exits

Pacing and wandering are hallmarks of sundowning that can be dangerous. People who pace and wander as part of their sundowning are not always easily redirected and are often so restless that they cannot simply “sit down and relax.” 

Communities with memory care wings feature secured exits to ensure the safety of those who pace and wander. These secured exits prevent residents from walking out of the community in a confused and agitated state, keeping them in a safe environment.

Routines

Establishing a predictable routine can benefit individuals experiencing sundowning. Sticking to a familiar routine can reduce feelings of agitation and anxiety by giving the older adult a sense of security and control in knowing what to expect and when. Assisted living facilities provide a daily routine, allowing residents to feel comfortable while receiving the care they need in a predictable manner.

Daytime activities

One way to combat sundowning is to encourage activity throughout the daytime hours, including spending time outdoors, if possible. The Alzheimer’s Association advises that caregivers make time for outdoor activities, like a walk or time in the garden, and discourage daytime napping as much as possible. Daylight, physical activity, and limited napping can ensure they get more restful sleep at night.

Communities have a calendar that provides ample opportunity for activities, often with time outdoors, but is not overstimulating. While rest is important, many communities try to limit napping during the day by scheduling restful activities in the afternoon, such as meditation groups or discussion circles.

Ample lighting

Low lighting can increase confusion and agitation during sundowning, as darkness can make it difficult for seniors with dementia to see and interpret the world around them. This can cause feelings of fear and unrest.

The Mayo Clinic suggests offsetting this confusion and fear by using nightlights. Some communities have motion-sensor lighting in private bathrooms or incorporate lighting in shared community spaces that dims but still illuminates during the nighttime.

Lighting plays an important role in the daytime as well. Communities often have large windows in shared spaces, allowing residents and staff to enjoy plenty of natural light. This access to natural light supports the body in maintaining its circadian rhythm, which can help with sleep issues and alleviate symptoms of sundowning.

Rummage bins and sorting stations

Sundowning causes restlessness in seniors with dementia. While pacing can be the answer for some, it is not always safe. Sorting and sifting are other ways for seniors to work out their restlessness.

Communities often feature bins, dressers, and drawers for rummaging and sorting. Residents can sit with a box of scarves or sift through a drawer of knickknacks as a safer alternative to wandering or pacing. These interventions are often customized with sorting items personalized to the resident’s preferences and history.

Mealtime interventions

Sundowning can make dinnertime challenging for seniors with dementia. Fortunately, communities are staffed with experienced and creative dining staff who find ways to ensure residents are eating well. Assisted living facilities provide nutritious, balanced meals with foods that support cognitive health.

Breakfast and lunch are commonly the larger meals of the day for memory care residents at assisted living, as they are often less restless or anxious during these mealtimes. During dinner, when some might be pacing or feeling anxious, dining team members might find unique ways to meet residents’ needs and enhance their dining experience. For example, a pacing resident might take a sandwich “to go” if sitting down for a meal isn’t possible. Another resident may be more likely to sit down for dinner when they have smaller portions so that they are not overstimulated.

Trained staff members

Perhaps the best way that assisted living communities help residents cope with sundowning is through the staff that lovingly supports them. Team members who work in memory care are trained on the disease progression as well as best practices for care. They attend ongoing education about dementia-specific topics and share what’s working (and what isn’t) with their teammates in order to find interventions that are customized to each resident’s abilities and history.

Getting help managing your loved one’s sundowning symptoms

Sundowning can be stressful for seniors and their loved ones. Fortunately, assisted living communities can help lessen some of that stress and anxiety. If you find that your loved one’s dementia symptoms are worsening and have been thinking about looking into a senior living community, consider talking with a local advisor with expertise in senior care. Learning your options is the first step toward making a choice that will allow your loved one to get the care they need.