Distressing to the resident and difficult for caregivers to manage, sundowning typically occurs between 4:30 and 11:00p.m. This statue of increased agitation and restlessness has been observed in up to 20% of persons with moderate to moderately severe dementia. It resembles delirium because there is a rapid change in behavior. Sundowning, like delirium, may contribute to falls, injury to others, attempted elopement and removal of medical devices. It is important to distinguish between sundowning and delirium because treatment differs. Interventions for delirium are supported by strong evidence. General interventions include meeting physical and psychological needs, structuring the environment, using effective communication techniques and providing behavioral cues and appropriate social activities. Scheduled eating, toileting, pain medication, mobility, activity an rest all assist in meeting physical needs. Effective interaction focuses on words and actions that create pleasant emotions and experiences for the resident enhancing self-esteem, enjoyment, happiness, sense of belonging and positive memories.
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