How Care Homes Respond When Dementia Symptoms Increase at Night
For some residents living with dementia, the evening can be a more difficult time.
Care staff often refer to this as sundowning, and while it doesn’t affect everyone, it’s something many care homes are familiar with.
Keep reading as we examine how care teams recognise the signs early and respond in a way that helps residents feel safer, calmer and more supported when symptoms begin to shift after dark.
What Helps Calm Sundowning Behaviour in Dementia Residents?
To help manage sundowning behaviour in dementia residents, care homes use low-stimulation environments, consistent evening routines and gentle, familiar interactions.
Staff members avoid confrontation, offer reassurance and respond to the resident’s individual needs. Soft lighting, reduced noise and calming activities, such as music or quiet conversation, can also help alleviate distress and make residents feel more at ease.
Recognising When Sundowning Symptoms Are Escalating
Not all signs of sundowning are obvious.
In many cases, it begins with something small. A resident who starts pacing more than usual, hesitates when moving through a familiar space or becomes more repetitive in their speech.
Care staff are trained to spot these early cues before they turn into distress. For example, if a resident starts following staff closely, asks the same question repeatedly or is unsettled after dinner, these are usually signs that sundowning symptoms are beginning to develop.
One study suggests that up to 25% of people with Alzheimer’s show increased agitation or confusion during late-day hours. Recognising this pattern early means support can be offered before the situation escalates and the resident becomes overwhelmed.
Why Symptoms Increase at Night
Later in the day, some residents with dementia may find it harder to stay calm or make sense of their surroundings. This is sometimes linked to changes in the body’s internal clock, known as circadian rhythms, which can be disrupted by dementia, resulting in confusion, restlessness and anxiety that seems to intensify as daylight fades.
Fatigue is often a factor. By evening, a resident may be mentally and physically tired, especially if the day has been overstimulating or unpredictable. Reduced lighting can also make shadows more noticeable, which adds to confusion or discomfort.
For some, the environment itself plays a role. A busier shift change, unfamiliar noise or a missed routine can make things feel less certain at a time when a resident needs more stability.
It’s also worth noting that not every resident will experience this pattern, and for those who do, it may not happen every night. However, when symptoms do increase in the evening, understanding the possible triggers helps staff respond more effectively with less urgency.
How Staff Respond in the Moment to Sundowning
Evening distress can look different for each resident. Staff focus on what’s needed in that moment, such as:
Staying calm and present
Staff avoid rushing, raising their voice or correcting a resident, even when the conversation is repetitive or confusing.
Offering quiet reassurance
A familiar phrase, a calm presence or sitting and resting nearby helps a resident feel more secure.
Using gentle redirection
If someone is unsettled, staff will guide them to a quieter area or suggest something that usually makes them feel more comfortable.
They walk with residents who need to move
Instead of asking a resident to sit down, trained care staff will often join them, reducing distress without confrontation.
Keeping instructions simple
Language is always clear, slow and easy to follow, avoiding added confusion or frustration.
They respond to the feeling behind the words
When a resident says something like “I want to go home,” staff focus on the emotion rather than trying to explain, to comfort them as much as possible.
Preventive Steps Taken Earlier in the Day
Care homes don’t wait until evening to support residents who may experience sundowning. Many of the most effective strategies start much earlier in the day.
- Activities are balanced with rest – Overstimulation or fatigue can lead to evening distress. Staff plan the day to ensure residents have sufficient time to participate, while also allowing for necessary pauses when needed.
- Natural light is part of the morning routine – Being outdoors or sitting near a bright window helps support the body’s natural rhythm and can reduce evening confusion.
- Meals and fluids are carefully managed – Regular meals and hydration throughout the day help reduce irritability, discomfort and mood changes that sometimes appear later on.
- The routine stays familiar – A predictable structure helps residents feel more secure. When the day follows a rhythm they recognise, evenings tend to be calmer.
- Staff observe changes throughout the day – Small signs of tiredness, frustration or withdrawal are noted early to allow for adjustments before symptoms escalate.
- Transitions are made gradually – Shifting from one activity to the next is done with care because sudden changes can be unsettling for residents with dementia.
When Extra Sundowning Support Is Needed
There are times when evening routines and calming strategies aren’t quite enough. Sometimes a resident is still distressed or their behaviour shifts in a way that feels out of the ordinary. When that happens, care homes have steps in place to bring in additional support.
The first step is usually to look at what might be behind the change. Senior staff may review the care plan and speak with nurses or the GP to check for any physical issues, such as pain, infection or discomfort. Families are often brought in early too, so they’re kept in the loop and can share anything they’ve noticed as well.
In some cases, a change in medication might be considered, but it’s never rushed. Any medical decisions are made with care, always prioritising the resident’s well-being. The care team focus on finding the least disruptive approach while ensuring the resident’s safety and comfort.
Even when things feel more challenging, the approach remains the same – trying to understand what’s causing the behaviour, rather than trying to stop it. That means thinking about the resident’s health, their routine and whether anything around them has changed that might be making them feel less settled.
Helping Residents Feel Safer in the Evenings
It isn’t always simple, but care teams are trained to notice early signs of sundowning, adapt the routine when needed and respond in a way that helps the resident feel safe. With the right support, even a difficult evening can become more manageable.
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