Many people in the last 3-6 months of their lives experience some difficult behavioral issues that can make this precious time very challenging. There are several terms we use in the medical field to describe this behavior, most commonly “sundowning syndrome”. It includes a variety of things a patient in this stage of life can experience. They can include; visual and auditory hallucinations, communicating with relatives who have already passed, agitation, confusion, pacing or wandering, shadowing a person, or sadness and crying. This is a tough time for anyone caring for them but there are some things we can control to help decrease the anxiety during this time. Sundowning symptoms usually get worse as the day gets later, starting around dusk and continuing for a few hours. Many patients are acting totally normal by bedtime.
Keeping a regular schedule and controlling their environment is helpful. As the daylight ends many patients see shadows and misinterpret them as objects. Having well lit areas and even using a nightlight in their rooms can help decrease shadows and darkness. If they like to watch TV keep any programs they watch light, nothing complex or upsetting. Sometimes people can create delusions out of something they are watching or reading. Plan the bulk of any activities in the morning, keep them busy but allow times for breaks. Overstimulation can cause the sundowning to be worse. Play soothing music or sounds as the afternoon rolls into evening can be helpful. Do not argue with them or try to correct them if they are talking about past relatives, instead try asking them about the person and watch as they relive memories. Just go with it!
It may be beneficial to discuss with their doctor about medications that can be used to help sundowner’s syndrome. Melatonin is a natural supplement, and the doctor can recommend an effective dosage. Mood stabilizers are taken daily and can decrease mood swings. Even a mild sedative given at the proper time can assist in reducing their anxiety. It is worth discussing with your hospice team as they can help you find just the right timing and doses to ease this transition to nighttime that so many end of life patients experience.
As with any complex patient issue you can find what works for your loved ones, it may take some time, trials, and observation of their specific behavior issues, but with the assistance of your medical team there is help available.
