Sundowning is a pattern of late-day confusion and changed behavior that can intensify anxiety, pacing, wandering, and agitation for a person living with dementia. In this episode, we unpack what sundowning looks like, why it happens, and practical ways care partners can reduce stress and keep evenings calmer. We also share “The Sundowning Story” of Jack, whose late-day distress eased after the right support and environment were in place.

What You’ll Learn:

• What sundowning is and how it differs from general restlessness
• Common signs: disorientation, suspiciousness, exit-seeking/elopement, and abrupt mood shifts
• Frequent triggers: fatigue, pain, overstimulating environments, complex instructions, being rushed, perceived threats, and more
• Why intent matters: behaviors are signals of unmet needs, not “being difficult”
• Practical de-escalation strategies for smoother late afternoons and evenings

Key Takeaways & Tips:

• Lower stimulation after lunch: dim bright lights, reduce background noise and clutter.
• Keep routines predictable: consistent meal times, toileting, and a calming “wind-down” block (music, hand massage, familiar TV show).
• Offer simple choices: one-step requests; avoid rapid-fire questions.
• Validate and redirect: acknowledge feelings first, then gently guide (“Let’s sit together and look at your photo album while we wait.”).
• Address comfort basics: check for hunger, thirst, pain, temperature, and footwear.
• Plan safe movement: short walks or light tasks before dusk to channel restlessness.
• Prepare for elopement risk: door chimes, ID bracelets, current photos, and a neighbors-aware plan.

Story Spotlight: Jack’s 5 p.m. Calls:

Jack called his son daily to “find the house.” With compassionate placement in a memory-care setting and meaningful evening purpose (sweeping the patio at 5 p.m.), his distress eased and dignity returned. The right support can transform late-day turmoil into calmer connection.

Resources Mentioned:

• Evening routine checklist (create your own from today’s tips)
• Local memory-care consultation (to explore environments that match current needs)

Call To Action:

If evenings are tough, pick two tips above and try them this week. Share what worked (and what didn’t) so we can problem-solve together on a future episode.

Disclaimer - This episode is informational and not medical advice. Always consult your healthcare professional for personalized guidance.

About the Host:

Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.

Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.

So many people today are heavily impacted by Alzheimer's disease and related dementia. The Alzheimer's Association and the World Health Organization have projected that the number of people who will develop Alzheimer's disease by the year 2050 worldwide will triple if a treatment or cure is not found. Society is not prepared to care for the projected increase of people who will develop this devastating disease. In her 30 years of working with family members and caregivers who suffer from dementia, Lisa has recognized how little people really understand the complexities of what living with this disease is really like. For Lisa, it starts with knowledge, education, and training.

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Welcome back everybody to another brand new

episode of the truth, lies and Alzheimer's show. I'm Lisa

Skinner, your host today. I'm talking about sundowning. Some

of you are familiar with that term, and know exactly where I'm

going with this, and some of you may not be aware of what the

term sundowning means when it pertains to people living with

Alzheimer's disease and related dementia. So I'm going to

explain it to you. The term sundowning actually refers to a

state of confusion occurring in the late afternoon and spanning

into the night. Sundowning can cause a variety of behaviors

such as confusion, anxiety, aggression, or completely

ignoring instructions or directions. Now, based on

various data, the overall rates of sundowning among people

living with Alzheimer's disease and other types of dementia

ranges from 2.4% to 66% that's a huge range. And this is

according to Gallagher Thompson and Associates, they reported

that the prevalence of sundowning is as high as 66%

among people living at home. So what I'm going to do is I'm

going to illustrate what sundowning actually looks like

by sharing with you a story from my book truth, lies and

Alzheimer's. It's secret faces that depicts a person. This is a

real, true life story of somebody who Sundowns every day,

and what it exactly looks like for him. His name's Jack. Now

the other thing that I want to say is sundown and got its name

because it most commonly shows up when the sun is going down.

But I do want to make sure you're aware that sundowning can

occur any time of the day or night. So every night, at

approximately 5pm Jack telephoned his son Steve to say,

you have to take me to find the house. When he called Jack

always sounded a bit panicky, but Steve had no clue which

house his dad was referring to. When he asked his dad which

house he needed to go to, all Jack would say was, you know, my

house this new behavior alarmed and concerned Jack's daughter,

Alice. But Steve just dismissed it as his dad being a little bit

confused from time to time. But other than that, he thought he

was perfectly okay. Well, Alice, his sister, begged to differ.

She had been researching the symptoms of Alzheimer's disease,

and explained to her brother that the agitation and

confusion, confusion that their dad was exhibiting every single

night at the same time was consistent with what she read on

what is called sundowning. She had also researched local elder

care facilities and told her brother that living in one could

possibly improve their dad's quality of life. Well, Steve

absolutely would not listen. His dad, who had been born during

the Great Depression, had been placed in an orphanage at the

age of eight for men of Jack's era, institutionalization was

synonymous with abandonment. In fact, Jack had once told his

son, I would rather die than have you put me in one of those

homes. That's how strongly opposed he was to going into

one. Well, Steve remained adamant. I know how to take care

of my own father. He insisted to Alice, but the sundowning

behaviors continued to worsen. Steve even started to receive

calls from the. Manager of a local Hooters restaurant,

believe it or not, who complained that his dad was

frequently coming into the restaurant and asking out the

young servers. He told Steve that he was behaving like a

young Romeo and that he must insist that he keep his dad from

coming there. After the fourth call from the Hooters manager,

Alice brought up the subject of looking into moving their dad to

a facility where he could be properly cared for. Well, Steve

remained stubbornly opposed to that idea. He said to Alice, Dad

doesn't need to go into a nursing home. I will just keep

setting him straight. But Alice went ahead and found an opening

at a local memory care facility. However, Steve believed his dad

belonged in a less restrictive assisted living environment,

because he saw him as being much higher functioning than the

residents appeared to be in the memory care unit. So if he was

even going to entertain the idea, he would insist on

assisted living versus memory care, and he said very

emphatically to Alice, I cannot put my dad in there with all

those crazies. He'll die, said Steve. And Alice just rolled her

eyes. He's just not getting this the elder care facilities

administrator insisted that moving him into memory care was

definitely the right placement for their dad. Well, it wasn't

until Jack went missing for two whole days and the police

officers found him sleeping in his car in the Hooters parking

lot that Steve finally conceded to moving his dad there on a

trial basis when they visited him two weeks later, Steve And

Alice were pleasantly surprised to hear how well their dad had

adjusted to life in the memory care neighborhood. In fact,

during their visit, Steve and Alice found that Jack was so

engaged in the facility's arts and crafts activity that he

barely even acknowledged their presence through conversations

with the staff, they also learned that the house that Jack

was trying to find so desperately was actually the

home he lived in with his mother before going to the orphanage.

Jack no longer talked about needing to find this home. He

now bragged about his new position at the facility. He

told his kids that he now had a sweeping job where he swept the

back patio, and he proudly did that every night at 5pm further

thoughts on this story. Sundowning refers to a set of

behaviors in which the person with dementia is disoriented and

confused, typically occurring at the end of the day. But again,

the behaviors can actually occur at any time of the day or night,

the person suffering from sundowning can experience

dramatic changes in personality and behaviors, including pacing,

wandering, suspiciousness, disorientation, confusion and or

agitation, the person may become demanding or combative and yell

out and scream for no apparent reason, the causes and triggers

of sundowning are not clearly understood.

Another common behavior illustrated in the sundowning

story is what we call elopement. Elopement is different from

wandering in that the person has a specific destination in mind

and is determined to find it or to get there, they typically

seek to exit their current environment and have a purpose

or agenda to get to that place. It is very common for a person

with dementia to want to find a deceased spouse who they. They

believe is worried about them. A person exhibiting sundowning

behaviors can be relentless in their pursuit of what they are

looking for. They may even believe that they're being kept

against their will, and become angry, anxious and even

aggressive the most important thing to recognize about

sundowning is that the behaviors and symptoms are a part of the

disease and not the intentional behavior of the person. The

behaviors displayed when a person is sundowning can usually

be effectively managed with assistance from a trained

professional, in a person with a healthy brain, all thinking

powers like memory and reasoning work together to define a world

the person understands, allowing that person to function

effectively in their world, but in people with dementia, those

powers of thought shrink, creating a world that becomes

increasingly overwhelming and they're less able to make sense

of it, the person loses his or her knowledge of how to handle

situations properly and reacts based on how a particular

situation affects them emotionally, there's no reason

or logic anymore. Agitation, anxiety, fear, aggression and

anger are all examples of some of the common behaviors that

will surface as a result, Alzheimer's aggression can flare

up without warning, and there may not be an obvious cause.

However, some of these triggers that are common include, and

there's a huge list of them, but these are some of the common

ones, discomfort from lack of sleep, side effects from

medication or pain that they cannot verbalize to their loved

ones or their caregivers, the environment around them,

including loud noises, too much activity and even clutter,

confusion from being asked too many questions at once, trying

to understand complex instructions, or feeling the

stress of their caregiver being touched, or feeling like their

personal space was invaded, as with bathing or changing

clothes, picking up on your anger, nervousness or

frustration, being criticized or told they were wrong, feeling

rushed, not being allowed to do something or to go somewhere

that they want to get to having to do something that they don't

want to do, like take a shower, feeling threatened, confused

about What's going on, and believing something is happening

that really isn't it's in their mind, they're perceiving it some

way, like you are stealing things from them. So that is the

information that I wanted to share with you today. Hopefully

you will find this helpful and useful and implemented into your

caregiving journey with your loved one or your family member.

And all of these things are intended to relieve some of the

stress and the anxiety in the day to day caregiving

experience, or even the way you communicate with your loved one

and turn your experiences both for both you and your loved one

into positive outcomes. So that's it for today's new

episode of the truth lies and Alzheimer's show. I'm Lisa

Skinner, your host, and I look forward to having you back next

week for another new episode, and in the meantime, please try

to stay happy and healthy, and I'll see you back here next

week. Bye. Bye.