'Sundowning' can be reduced by simple measures

Q: My husband and I are in our early 80s. Sometimes in the evening he is agitated, confused, and just quite a handful to deal with. The doctor says he has "sundowning." What is it, and is there anything I can do?

A: Some older people have trouble concentrating, grow agitated or even confused, and become especially fatigued at the end of the day. This phenomenon is known as "sundowning" because its effects tend to coincide with sunset - usually occurring in the late afternoon into the evening, then settling down late at night.

Sundowning behavior is quite common in people with dementia. However, it can also occur in older people without dementia.

Sundowning is more likely to occur in an unfamiliar environment in a dark place. In a previous column about sundowning, I described a patient who never experienced it at home. However, sometimes when she and her husband traveled, it would happen in a hotel room at night. Sundowning occurs quite often in hospitalized patients.

Sundowning needs to be taken seriously, because it can lead to falls and fractured bones as people get out of bed in their confusion and trip over something.

Sundowning isn't an illness; it's a temporary condition, and we don't entirely understand what causes it. But we do know some ways you and your husband can alleviate its effects:

• Keep a daily log and jot down events that seem to trigger symptoms. For instance, too much noise or the act of preparing dinner could be a trigger. Once you and your husband recognize these triggers, you can work on ways to avoid them.

• Stick to a regular schedule. Take walks or exercise at the same time each day, preferably early in the day. Eat an early dinner and go to sleep at the same time each night.

• Schedule appointments, trips and activities in the morning. Limit obligations in the late afternoon hours.

• Take a late afternoon rest. Just putting his feet up and closing his eyes for a short respite can help preserve your husband's energy and prevent end-of-day fatigue.

• Prevent overstimulation by reducing noise from televisions or stereos.

• Reduce food and beverages that contain caffeine, or restrict them to early morning hours. Caffeine can stay in his system for as long as 16 hours and interrupt his sleep. Poor quality sleep may also contribute to sundowning.

• When he begins to feel symptoms, he should either rest or do something familiar that relaxes him, such as reading the newspaper.

Fortunately, sundowning is not usually a sign of a serious underlying problem. But because it can lead to falls and fractures, try some of the things that you and your husband can do yourselves. If they don't help, ask his doctor if testing of his intellectual function might be required. But I'll bet that won't prove necessary.

• Dr. Komaroff is a physician and professor at Harvard Medical School. For questions, go to AskDoctorK.com.