Many families notice a puzzling pattern. A parent who seems relatively calm and oriented during the day becomes restless, confused or agitated as evening approaches. This phenomenon, commonly referred to as sundowning, can be distressing for both the older adult and their caregivers.
Sundowning is most often associated with dementia, particularly Alzheimer’s disease, but it can also appear in seniors experiencing cognitive impairment or medical stress. According to the NHS, behavioural and psychological symptoms of dementia frequently intensify in the late afternoon and evening.
Understanding why behaviour changes at night helps families respond effectively rather than react emotionally.
What Is Sundowning?
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Sundowning describes a pattern of increased confusion, anxiety or agitation that typically occurs in the late afternoon or early evening. Symptoms may include pacing, irritability, repeated questioning, suspiciousness or difficulty recognising familiar surroundings.
While the precise cause is not fully understood, sundowning reflects the interaction between neurological changes, fatigue and environmental factors.
It is not deliberate behaviour. It is a symptom of underlying cognitive vulnerability.
Why Behaviour Worsens in the Evening
Several factors contribute to evening behavioural changes.
Fatigue plays a central role. As the day progresses, mental energy decreases. For seniors with cognitive impairment, reduced cognitive reserves make it harder to process information and maintain orientation.
Changes in lighting also affect perception. Shadows and dim environments can increase visual misinterpretation, especially in individuals with dementia. Reduced daylight may heighten confusion and anxiety.
Circadian rhythm disruption is another contributing factor. Ageing and neurological conditions can alter sleep-wake cycles, making late afternoon a vulnerable period for disorientation.
Common Symptoms of Sundowning
Evening behavioural changes vary in intensity. Some seniors become mildly restless, while others experience pronounced agitation.
Families may notice repetitive questioning, increased wandering, paranoia or emotional distress. In some cases, a previously cooperative individual becomes resistant to assistance or suspicious of caregivers.
Sleep disruption frequently follows. Night-time wakefulness can worsen daytime fatigue, creating a cycle that intensifies symptoms.
The following table summarises typical sundowning behaviours and their implications.
| Evening Behaviour | Possible Trigger | Level of Concern |
|---|---|---|
| Increased confusion | Fatigue or cognitive overload | Moderate to High |
| Pacing or wandering | Anxiety or disorientation | High |
| Irritability or aggression | Overstimulation or fear | High |
| Suspiciousness | Perceptual changes | High |
| Sleep disturbance | Circadian rhythm disruption | Moderate to High |
Is Sundowning a Sign of Dementia Progression?
Sundowning often appears in moderate to advanced stages of dementia, but it can also occur earlier. Increased frequency or severity of evening agitation may indicate progression.
However, sudden worsening should prompt medical evaluation. Infections, dehydration, pain or medication changes can intensify confusion and mimic behavioural decline.
Distinguishing between gradual progression and acute medical issues is essential.
How Families Can Manage Evening Behaviour Changes
Consistency is one of the most effective strategies. Maintaining a predictable daily routine reduces cognitive strain. Gradually transitioning from daylight to well-lit indoor environments can minimise visual confusion.
Reducing noise and stimulation in the late afternoon may prevent overload. Gentle reassurance and calm communication are more effective than confrontation.
Ensuring adequate hydration and nutrition during the day may also reduce evening irritability.
When symptoms become severe or unsafe, professional guidance should be sought.
When Sundowning Becomes a Safety Concern
Sundowning becomes serious when behaviour compromises safety. Wandering, nighttime falls or aggressive reactions increase risk significantly.
If supervision is required every evening, families may need to evaluate whether the current living environment provides sufficient support. The goal is not to eliminate independence but to prevent harm during vulnerable hours.
Early discussion often prevents crisis-driven decisions later.
FAQ – Sundowning in Seniors
What causes sundowning in elderly people?
Sundowning is linked to fatigue, circadian rhythm disruption and cognitive impairment, particularly in dementia.
Is sundowning the same as dementia?
No. Sundowning is a symptom often associated with dementia, not a diagnosis itself.
Can sundowning be treated?
While it cannot always be eliminated, structured routines, proper lighting and medical evaluation can reduce severity.
When should medical advice be sought?
If behavioural changes appear suddenly or worsen rapidly, medical assessment is necessary to rule out infection or other causes.
Does sundowning increase fall risk?
Yes. Evening confusion and restlessness significantly increase the likelihood of falls.
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