Sundowning and Appropriate Intervention Techniques
A Helpful Scenario for Family Members and Caregivers…
Its 4:00pm and our residents with Dementia living in our Memory Care neighborhood are sundowning – a period of increased confusion and restlessness in late afternoon or early evening. This is prime time when residents exit seek, demand to go home, argue with others, pace and even become aggressive. Our residents have just finished having some refreshments, strategically planned to occur between lunch and dinner when they may get hungry and during shift change making the transition less evident.
As they all get ready for Tai Chi, everyone is energized from changing settings. Jan is following her friend, Bea, too closely as they walk to the living room and she almost hits her feet. Jan yells at Bea “Move it??!!” Bea in return chastises Jan for her impatience. George is shouting in his general’s voice “Darn it! Where is my car? I have to go home! Get me out of here!!” Tom is laughing at this whole scene. Other residents are agitated by the commotion and the scene is beginning to resemble utter chaos.
Next, a care manager engages Jan by complimenting her for how well she is walking these days. Jan beams with pride and the two continue talking about her progress while the care manager unassumingly leads her to another direction. This allows Bea time to get to her chair. While praising Jan for her walking, the care manager brings her to the bathroom and asks her if she would like to use it while they are there. Jan says, “Oh I was looking for the bathroom.”
George is demanding his car and his agitation is escalating when the dining server intervenes with “Tell me what your car looks like again” and they trail off together walking and talking.
Bea is now sitting but is looking for Jan “Where is my friend? She doesn’t know what to do. What are we doing?” The Tai Chi instructor responds “We are going to do some breathing and relaxing…” Bea tells him this is stupid. Jan joins Bea in the living room. Bea is telling the instructor “No one wants to learn how to breathe. This is moronic.” Jan and Tom are now laughing together and Jan pats Bea’s hand and tells her “I like this exercise. It’s wonderful. Just try it.”
George returns with the dining server. They are laughing and talking about cars. George is relaxed from his walk and happy to join Tai Chi. Bea is still complaining when Tai Chi starts but the other residents are now encouraging her to join. Within 5 minutes everyone is fully participating in Tai Chi, breathing, stretching, smiling and engaging together as one family.
Thoughtful, Quick Intervention Will Satisfy Underlying Needs
In the preceding scenario, the sundowning situation was about to escalate to pandemonium. Residents were fighting with one another, arguing with staff and exit seeking. Team members are trained to intervene quickly. First they listen carefully to what the resident is saying. They understand that “behaviors” are really just communications.
Rather than direct the resident to comply with the agenda of the staff, they meet the resident in the moment and satisfy the underlying need.
At The Kensington, we promise to love and care for your family as if they are our own. Other professionals often ask how The Kensington is able to create successes for residents that have had extensive challenges elsewhere. They notice the “feel” in the environment, as one of camaraderie and mutual respect. Successes are a direct result of carefully selected loving and skilled individuals to care for and engage our residents, knowing and honoring the whole person and planning strategically and systematically to create successful experiences. This intentional structure enables residents, family and team members to feel comfortable in their environment.
Jan’s agitation was resolved when the care manager appealed to her sense of pride and then met her need by bringing her to the bathroom.
George’s need was to go home. At the end of his work day for over 4o years, George drove home in his blue Cadillac and joined his family. George’s demand to go home was rectified with the dining server engaging him in talking about his car (familiar part of his routine at night fall and source of happiness). Once they chatted about the car and George felt camaraderie with the dining server, George’s need for his familiar sense of home was provided.
Bea was initially a target for Jan’s aggression and quickly became the instigator in the group, at first feeling bad for being yelled at by her friend, then chastising Jan in return then overall ornery behavior towards instructor while advocating for Jan and others and finally engaging in the activity fully when encouraged by her friends. Bea’s need was to have her peers’ friendship. In the end, the other residents were the essential people redirecting Bea and giving her a sense of comfort in the environment just like a real family.
Sundowning can be very challenging because the demand is usually something that cannot be met. People often become anxious and try to reason with the person with Dementia. A person with Dementia is not capable of reasoning in the midst of sundowning. The key is to find out what the demand represents as the team members did above. When we appropriately anticipate their needs we help people with Dementia make sense of the world around them. When people navigate through life successfully they are able to pursue meaningful endeavors and gain a sense of comfort and purpose.
Isn’t that what loving and caring for people as our own family is all about?