Sundowning Made Me Question the Way I Care

It was in 2022 that i realised I had a pull towards caring for older people. Since then, working in adult social care has introduced me to a world I knew very little about. New experiences, challenging behaviours, medical conditions I had never heard of, new terminology, different personalities, and I could go on.

Every shift teaches me something. One of those lessons has been sundowning.

The Alzheimer's Association describes sundowning as the increased confusion that people living with Alzheimer's disease or other forms of dementia may experience from late afternoon into the evening.

I've seen it in different residents. I have known residents who are gentle, calm and full of smiles throughout the day. Then, as evening approaches, everything changes. The confusion sets in. Sometimes anger, sometimes tears, sometimes accusations. I've also cared for residents who spend most of the day happily sitting down but, towards the end of the shift, begin walking around with no obvious destination. They seem restless, anxious or determined to go somewhere that only makes sense to them.

When I first started working in care, I used to wonder whether there was a medication that could simply make it stop. Looking back, I think I was asking the wrong question. One thing this journey has taught me is to question the way I think about care. Not because I have the answers but because better questions often lead to better care.

So now I find myself asking something different. What if sundowning is not simply a behaviour to manage? What if it is a form of communication not yet fully understood?

Maybe the resident is not "being difficult". Maybe they are frightened or trying to get home or searching for something familiar, or maybe they are trying to tell us something that words can no longer express, I don't know. But I think it matters that questions are asked because when sundowning happens, everyone is affected. The resident experiences the confusion, the family may worry, and the care worker carries the responsibility.

That responsibility is not always straightforward. It can be difficult trying to support someone who is determined to keep walking when you know they are at high risk of falling. Most care workers don't mind residents walking around. The challenge is keeping them safe while also supporting everyone else in our care. Sometimes there simply are not enough hands to spend an hour walking alongside one resident while still meeting the needs of others. These are the realities care workers navigate every day.

That's why I think conversations about dementia should not only focus on residents. They should also ask: "How are we preparing care workers to respond to these moments with confidence, understanding and compassion?"

Supporting someone through sundowning is not just about knowing what dementia is. It is about understanding the person in front of you. Maybe it will not solve every difficult evening but I believe it is a better place to begin. When we support carers and care workers, we improve care.