Understanding Sundowning — Why Late-Day Confusion Spikes and What Helps

Sundowning is a pattern of late-day confusion and changed behavior that can intensify anxiety, pacing, wandering, and agitation for a person living with dementia. In this episode, we unpack what sundowning looks like, why it happens, and practical ways care partners can reduce stress and keep evenings calmer. We also share “The Sundowning Story” of Jack, whose late-day distress eased after the right support and environment were in place.

What You’ll Learn:

• What sundowning is and how it differs from general restlessness
• Common signs: disorientation, suspiciousness, exit-seeking/elopement, and abrupt mood shifts
• Frequent triggers: fatigue, pain, overstimulating environments, complex instructions, being rushed, perceived threats, and more
• Why intent matters: behaviors are signals of unmet needs, not “being difficult”
• Practical de-escalation strategies for smoother late afternoons and evenings

Key Takeaways & Tips:

• Lower stimulation after lunch: dim bright lights, reduce background noise and clutter.
• Keep routines predictable: consistent meal times, toileting, and a calming “wind-down” block (music, hand massage, familiar TV show).
• Offer simple choices: one-step requests; avoid rapid-fire questions.
• Validate and redirect: acknowledge feelings first, then gently guide (“Let’s sit together and look at your photo album while we wait.”).
• Address comfort basics: check for hunger, thirst, pain, temperature, and footwear.
• Plan safe movement: short walks or light tasks before dusk to channel restlessness.
• Prepare for elopement risk: door chimes, ID bracelets, current photos, and a neighbors-aware plan.

Story Spotlight: Jack’s 5 p.m. Calls:

Jack called his son daily to “find the house.” With compassionate placement in a memory-care setting and meaningful evening purpose (sweeping the patio at 5 p.m.), his distress eased and dignity returned. The right support can transform late-day turmoil into calmer connection.

Resources Mentioned:

• Evening routine checklist (create your own from today’s tips)
• Local memory-care consultation (to explore environments that match current needs)

Call To Action:

If evenings are tough, pick two tips above and try them this week. Share what worked (and what didn’t) so we can problem-solve together on a future episode.

Disclaimer - This episode is informational and not medical advice. Always consult your healthcare professional for personalized guidance.

About the Host:

Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.

Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people

Episode Transcript

Lisa Skinner (00:00):
Welcome back everybody to another brand new

(00:03):
episode of the truth, lies andAlzheimer's show. I'm Lisa
Skinner, your host today. I'mtalking about sundowning. Some
of you are familiar with thatterm, and know exactly where I'm
going with this, and some of youmay not be aware of what the

(00:24):
term sundowning means when itpertains to people living with
Alzheimer's disease and relateddementia. So I'm going to
explain it to you. The termsundowning actually refers to a
state of confusion occurring inthe late afternoon and spanning

(00:46):
into the night. Sundowning cancause a variety of behaviors
such as confusion, anxiety,aggression, or completely
ignoring instructions ordirections. Now, based on
various data, the overall ratesof sundowning among people

(01:10):
living with Alzheimer's diseaseand other types of dementia
ranges from 2.4% to 66% that's ahuge range. And this is
according to Gallagher Thompsonand Associates, they reported
that the prevalence ofsundowning is as high as 66%

(01:34):
among people living at home. Sowhat I'm going to do is I'm
going to illustrate whatsundowning actually looks like
by sharing with you a story frommy book truth, lies and
Alzheimer's. It's secret facesthat depicts a person. This is a

(01:57):
real, true life story ofsomebody who Sundowns every day,
and what it exactly looks likefor him. His name's Jack. Now
the other thing that I want tosay is sundown and got its name
because it most commonly showsup when the sun is going down.

(02:19):
But I do want to make sureyou're aware that sundowning can
occur any time of the day ornight. So every night, at
approximately 5pm Jacktelephoned his son Steve to say,

(02:40):
you have to take me to find thehouse. When he called Jack
always sounded a bit panicky,but Steve had no clue which
house his dad was referring to.When he asked his dad which
house he needed to go to, allJack would say was, you know, my

(03:01):
house this new behavior alarmedand concerned Jack's daughter,
Alice. But Steve just dismissedit as his dad being a little bit
confused from time to time. Butother than that, he thought he
was perfectly okay. Well, Alice,his sister, begged to differ.

(03:24):
She had been researching thesymptoms of Alzheimer's disease,
and explained to her brotherthat the agitation and
confusion, confusion that theirdad was exhibiting every single
night at the same time wasconsistent with what she read on

(03:46):
what is called sundowning. Shehad also researched local elder
care facilities and told herbrother that living in one could
possibly improve their dad'squality of life. Well, Steve
absolutely would not listen. Hisdad, who had been born during

(04:10):
the Great Depression, had beenplaced in an orphanage at the
age of eight for men of Jack'sera, institutionalization was
synonymous with abandonment. Infact, Jack had once told his
son, I would rather die thanhave you put me in one of those

(04:34):
homes. That's how stronglyopposed he was to going into
one. Well, Steve remainedadamant. I know how to take care
of my own father. He insisted toAlice, but the sundowning
behaviors continued to worsen.Steve even started to receive

(04:59):
calls from the. Manager of alocal Hooters restaurant,
believe it or not, whocomplained that his dad was
frequently coming into therestaurant and asking out the
young servers. He told Stevethat he was behaving like a
young Romeo and that he mustinsist that he keep his dad from

(05:24):
coming there. After the fourthcall from the Hooters manager,
Alice brought up the subject oflooking into moving their dad to
a facility where he could beproperly cared for. Well, Steve
remained stubbornly opposed tothat idea. He said to Alice, Dad

(05:46):
doesn't need to go into anursing home. I will just keep
setting him straight. But Alicewent ahead and found an opening
at a local memory care facility.However, Steve believed his dad
belonged in a less restrictiveassisted living environment,

(06:07):
because he saw him as being muchhigher functioning than the
residents appeared to be in thememory care unit. So if he was
even going to entertain theidea, he would insist on
assisted living versus memorycare, and he said very

(06:27):
emphatically to Alice, I cannotput my dad in there with all
those crazies. He'll die, saidSteve. And Alice just rolled her
eyes. He's just not getting thisthe elder care facilities
administrator insisted thatmoving him into memory care was

(06:50):
definitely the right placementfor their dad. Well, it wasn't
until Jack went missing for twowhole days and the police
officers found him sleeping inhis car in the Hooters parking
lot that Steve finally concededto moving his dad there on a

(07:13):
trial basis when they visitedhim two weeks later, Steve And
Alice were pleasantly surprisedto hear how well their dad had
adjusted to life in the memorycare neighborhood. In fact,
during their visit, Steve andAlice found that Jack was so

(07:33):
engaged in the facility's artsand crafts activity that he
barely even acknowledged theirpresence through conversations
with the staff, they alsolearned that the house that Jack
was trying to find sodesperately was actually the
home he lived in with his motherbefore going to the orphanage.

(07:58):
Jack no longer talked aboutneeding to find this home. He
now bragged about his newposition at the facility. He
told his kids that he now had asweeping job where he swept the
back patio, and he proudly didthat every night at 5pm further

(08:22):
thoughts on this story.Sundowning refers to a set of
behaviors in which the personwith dementia is disoriented and
confused, typically occurring atthe end of the day. But again,
the behaviors can actually occurat any time of the day or night,

(08:44):
the person suffering fromsundowning can experience
dramatic changes in personalityand behaviors, including pacing,
wandering, suspiciousness,disorientation, confusion and or
agitation, the person may becomedemanding or combative and yell

(09:09):
out and scream for no apparentreason, the causes and triggers
of sundowning are not clearlyunderstood.
Another common behaviorillustrated in the sundowning
story is what we call elopement.Elopement is different from

(09:29):
wandering in that the person hasa specific destination in mind
and is determined to find it orto get there, they typically
seek to exit their currentenvironment and have a purpose

(09:50):
or agenda to get to that place.It is very common for a person
with dementia to want to find adeceased spouse who they. They
believe is worried about them. Aperson exhibiting sundowning
behaviors can be relentless intheir pursuit of what they are

(10:10):
looking for. They may evenbelieve that they're being kept
against their will, and becomeangry, anxious and even
aggressive the most importantthing to recognize about
sundowning is that the behaviorsand symptoms are a part of the
disease and not the intentionalbehavior of the person. The

(10:35):
behaviors displayed when aperson is sundowning can usually
be effectively managed withassistance from a trained
professional, in a person with ahealthy brain, all thinking
powers like memory and reasoningwork together to define a world
the person understands, allowingthat person to function

(10:58):
effectively in their world, butin people with dementia, those
powers of thought shrink,creating a world that becomes
increasingly overwhelming andthey're less able to make sense
of it, the person loses his orher knowledge of how to handle

(11:18):
situations properly and reactsbased on how a particular
situation affects thememotionally, there's no reason
or logic anymore. Agitation,anxiety, fear, aggression and
anger are all examples of someof the common behaviors that

(11:42):
will surface as a result,Alzheimer's aggression can flare
up without warning, and theremay not be an obvious cause.
However, some of these triggersthat are common include, and
there's a huge list of them, butthese are some of the common

(12:04):
ones, discomfort from lack ofsleep, side effects from
medication or pain that theycannot verbalize to their loved
ones or their caregivers, theenvironment around them,
including loud noises, too muchactivity and even clutter,

(12:25):
confusion from being asked toomany questions at once, trying
to understand complexinstructions, or feeling the
stress of their caregiver beingtouched, or feeling like their
personal space was invaded, aswith bathing or changing

(12:46):
clothes, picking up on youranger, nervousness or
frustration, being criticized ortold they were wrong, feeling
rushed, not being allowed to dosomething or to go somewhere
that they want to get to havingto do something that they don't

(13:07):
want to do, like take a shower,feeling threatened, confused
about What's going on, andbelieving something is happening
that really isn't it's in theirmind, they're perceiving it some
way, like you are stealingthings from them. So that is the

(13:35):
information that I wanted toshare with you today. Hopefully
you will find this helpful anduseful and implemented into your
caregiving journey with yourloved one or your family member.
And all of these things areintended to relieve some of the

(13:56):
stress and the anxiety in theday to day caregiving
experience, or even the way youcommunicate with your loved one
and turn your experiences bothfor both you and your loved one
into positive outcomes. Sothat's it for today's new

(14:17):
episode of the truth lies andAlzheimer's show. I'm Lisa
Skinner, your host, and I lookforward to having you back next
week for another new episode,and in the meantime, please try
to stay happy and healthy, andI'll see you back here next
week. Bye. Bye.