Mood Swings, Sundowner’s
The toughest emotion we deal with–so far–is tearfulness. Mom will cry randomly but is unable to tell us why. Usually she will apologize and say she’ll stop, as though she shouldn’t cry. We’ll try to encourage her that it’s okay to cry if she needs to. We so wish we knew why. Is she hurting? Is she remembering Dad, her husband of 70 years? Is she scared?
Our family is blessed with Mom. She was always very sweet, kind and giving. That has remained through her disease. Actually an aide recently told us she is the only resident who has never sworn at them.
It is often different from our experience. Most residents will become short or angry occasionally, or in specific circumstances. Shower time is one example. Many resist a shower, perhaps because of the cold, perhaps modesty, perhaps it simply takes too much energy when they don’t have that much to start.
Sundowners (also called Sundown Syndrome) also affects their moods. It’s quite common in Alzheimer’s and dementia patients. As the name implies, its effects occur late afternoon and evening. It can cause increased anxiety and restlessness which then may affect their sleep and increase wandering.
It’s uncertain what brings it on though many believe it is related to the body’s internal clock or the circadian rhythm. The change in level of light since that affects their vision, and the shorter days in late fall and winter may also contribute. Of course, the tiredness that comes after being active during the day might affect it as well. It seems to occur mostly during the middle stage of Alzheimer’s though. It lessens as the disease progresses.
One of my favorite residents in mom’s home is Dina (name changed). She is such a character, you can’t help but love her. When she first arrived I remember she would only eat peanut butter and jelly sandwiches. Breakfast, lunch, dinner. Not sure when it changed, but she now eats anything. She was also in a lot of pain. Any time one of the aids would move her, you could hear her colorful language all down the hallway. A few minutes later she would be laughing and smiling.
One memorable time occurred when she was seated in the dining room. A table mate was struggling with pain, crying out. Little Dina, who is unable speak clearly often, kept repeating, “it’s okay honey. It’s okay.” Those of us who heard her were so pleased that she was being so kind. About ten minutes later, she pops out with “Oh, shut up.” Hmm, perhaps not quite as comforting. How I wish I knew her before the disease. I think she would have been such fun to know. From my point of view, you have to laugh and smile and enjoy whatever she says. She is so cute and you know it will pass a couple of minutes later.
Anger from Frustration
That isn’t always the case. Residents may get frustrated, not comprehending why they can’t go home or go out. Once in awhile you will find them packing to go home, suitcase and all. This is most common when a resident has first moved into a facility. It often takes a week or two to adjust to their new home–and being out of their old one.
It is hard to imagine the frustration they must feel when they can’t remember something they’ve known all their lives. Think how frustrated we can get when we can’t remember one name.
This often seems more difficult for men to me. They have spent their lives learning, expecting to be the breadwinner, the man of the family, the provider. I think it is harder for them to accept help as much as it is hard for them to accept their need for help. Certainly women too can have trouble settling in. From what I’ve observed though, after a week or two most come to accept living there and start enjoying the activities.
There are Steps You can Take
Any solution will vary from patient to patient, just as the symptoms will vary. The first step once redirected, should probably be to see if they are in pain or hungry. A headache might not be noticeable but could cause them to react. Hunger too, certainly.
A quiet environment, maintaining a routine, a balanced diet, even simply increasing the lighting can alleviate sundowners. Medication may be recommended when depression or insomnia is involved, but some medications can worsen the symptoms. Redirecting the patient is often all it takes.