Claire Dawson
Sundowning is a state of confusion and panic that older people often experience as daylight fades during the late afternoon and evening. It is a form of delirium that can cause elderly patients to become agitated, restless, worried, and even hallucinate. Hospitals have protocols in place to prevent sundowning, such as light therapy, where rooms are bright during the day and darkened at night, and the use of reminders of the time and day. Understanding the triggers of sundowning is key to prevention, and treatment should involve multiple approaches as there are various potential causes.
How to prevent sundowning in the hospital
| Characteristics | Values |
|---|---|
| Lighting | Rooms should be kept bright during the day with curtains open, and darkened at night |
| Time reminders | Clocks and whiteboards can help patients stay oriented to the time and day |
| Personal items | Ensure patients have their hearing aids, eyeglasses, and dentures to help them stay involved in their surroundings |
| Routine | Stick to a schedule, including regular times for bathing, dressing, and eating |
| Physical activity | Encourage daily physical activity, but don't plan too many activities |
| Diet | Avoid alcoholic and caffeinated drinks late in the day; keep patients well-hydrated and fed |
| Sleep | Discourage long naps during the day |
| Noise | Reduce noise to allow patients to sleep |
| Medication | Avoid sedatives and medications that may cause confusion |
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What You'll Learn
Avoid sedatives and medications that cause confusion
Sedatives and medications that cause confusion should be avoided to prevent sundowning in hospitals. Sundowning is a state of confusion and panic that older people often experience as daylight fades during the late afternoon and evening. It can be unsettling for both caregivers and their loved ones. Sundowning affects up to two-thirds of people with dementia but can happen to any older person.
Hospitals can implement protocols to prevent sundowning, such as GRACE (Global Risk Assessment and Care plan for Elders) and NICHE (Nurses Improving Care for Healthsystem Elders). These protocols help keep patients oriented and include measures such as keeping hearing aids and glasses within reach, getting patients out of bed, ensuring they stay hydrated and well-fed, and reducing noise to allow patients to sleep.
Additionally, avoiding medications that cause confusion is crucial to preventing sundowning. Drug-to-drug interactions and the use of multiple medications at once can exacerbate delirium and cause agitation, disinhibition, and confusion in elderly patients. Sedatives, for example, can contribute to a snowball effect, exacerbating and prolonging delirium. In particular, benzodiazepines have been found to lower the threshold at which patients develop delirium.
Instead of relying on sedatives, hospitals can explore non-pharmacologic treatments for sundowning. This may include light therapy, in which rooms are kept bright during the day and darkened at night, and providing reminders of the time and day, such as clocks and whiteboards. Creating a calming environment, reducing noise, and maintaining a familiar routine can also help prevent sundowning.
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Establish a routine and stick to a schedule
Establishing a routine and sticking to a schedule are crucial for preventing sundowning in a hospital setting. Sundowning, a state of confusion and panic, commonly affects older individuals as daylight fades during the late afternoon and evening. It can manifest as agitation, irritability, restlessness, and even hallucinations. Here are some detailed steps to establish a routine and schedule to mitigate sundowning:
Firstly, ensure that the patient has a consistent daily routine. This includes maintaining regular times for essential activities such as bathing, dressing, and eating. Encourage daily physical activity, but be mindful not to overload them with too many tasks. Create a calming and familiar environment by reducing noise and clutter, as hospitals can be noisy and disorienting places.
Additionally, maintain a healthy sleep schedule by discouraging long naps during the day. This will help ensure the patient is tired in the evening and can maintain a regular bedtime. Encourage sunlight exposure during the day by sitting near a window or going outside. However, as the day transitions to evening, create a soothing atmosphere by dimming the lights or closing the curtains to signal the end of the day.
Furthermore, be mindful of the patient's diet. Avoid alcoholic and caffeinated beverages late in the day, as these can disrupt sleep and exacerbate agitation. Also, ensure the patient stays hydrated and well-fed throughout the day, as dehydration and hunger can negatively impact their mood and energy levels.
By establishing and adhering to a consistent routine, you can help prevent sundowning in the hospital and improve the patient's overall well-being.
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Reduce noise and clutter
Reducing noise and clutter is an important strategy to prevent sundowning in hospitals. Sundowning is a set of neuropsychiatric symptoms that occur in elderly persons with or without dementia at sunset, in the evening, or at night. It is characterised by behaviours such as confusion, disorientation, anxiety, agitation, aggression, pacing, wandering, and resistance to redirection.
Hospitals, with their bright fluorescent lights, loud noises, and unfamiliar surroundings, can contribute to sundowning. To reduce noise and clutter in hospitals, the following strategies can be implemented:
- Keep the hospital room quiet, particularly in the early evening. Minimize loud background noises, such as banging pots or sudden loud noises. If needed, create some white noise, which can help lessen the impact of sudden noises.
- Turn down the volume on televisions, radios, and other electronic devices, especially in the afternoon and evening.
- Play quiet, soothing, and gentle music in the background.
- Avoid stimulating activities, such as large group gatherings or television, late in the day. Instead, encourage quiet activities like reading or puzzles.
- Keep the hospital room free of clutter.
- Implement a structured routine for patients, as individuals with dementia thrive on routine and can feel safer with a predictable schedule. This includes consistent times for waking, meals, activities, and bedtime.
- Ensure patients have access to natural light during the day by encouraging them to sit near bright windows or go for walks outdoors.
- Use soft lighting in the evening to reduce glare and create a calm atmosphere.
By reducing noise and clutter, hospitals can help prevent sundowning and improve the well-being of elderly patients.
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Encourage physical activity and sunlight exposure
Encouraging physical activity and sunlight exposure is a key component of preventing sundowning in hospitals. Sundowning, a state of confusion and panic that older people often experience as daylight fades, can be unsettling for both caregivers and patients. It is important to note that sundowning affects up to two-thirds of people with dementia but can occur in any older person.
To prevent sundowning, it is recommended to encourage physical activity and sunlight exposure daily. This can be achieved by assisting patients in getting out of bed and arranging a time for them to go outside or sit by a window to receive sunlight. It is crucial to stick to a schedule and ensure that patients are physically active each day, but it is important not to plan too many activities.
Additionally, creating a calm and comfortable environment can help reduce agitation associated with sundowning. This includes reducing noise and clutter, keeping hearing aids and glasses within reach, and ensuring patients stay hydrated and well-fed. Maintaining a consistent routine, such as bathing, dressing, and eating at the same times each day, can also be beneficial.
By encouraging physical activity and sunlight exposure while maintaining a calm and consistent environment, hospitals can help prevent sundowning and improve the well-being of elderly patients. These proactive measures can make a significant difference in the overall patient experience and reduce the occurrence of sundowning-related delirium.
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Keep patients oriented with time and day reminders
Keeping patients oriented with time and day reminders is an effective way to prevent sundowning in hospitals. Sundowning is a state of confusion and panic that older people often experience as daylight fades in the late afternoon and evening. It can be unsettling for both caregivers and patients and affects up to two-thirds of people with dementia, but it can also happen to any older person.
To help patients stay oriented, hospitals can provide time and day reminders. For example, a clock and whiteboard in front of each patient's bed can display the time of day and the name of the nurse on duty for various shifts. Additionally, keeping patients involved in their surroundings by providing them with their hearing aids, eyeglasses, and dentures can help them stay oriented.
Maintaining a consistent routine is also essential for preventing sundowning. This includes sticking to a schedule, getting sunlight and physical activity each day, and avoiding long naps and caffeine late in the day. By following these strategies, hospitals can help patients stay oriented and reduce the risk of sundowning.
Furthermore, hospitals can implement protocols such as GRACE (Global Risk Assessment and Care plan for Elders) and NICHE (Nurses Improving Care for Healthsystem Elders) to prevent sundowning. These protocols focus on keeping patients oriented and well-cared for by ensuring they have access to their hearing and visual aids, are well-hydrated and fed, and are not overmedicated. By following these comprehensive protocols, hospitals can effectively prevent sundowning and improve patient care.
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Frequently asked questions
Sundowning is a state of confusion and panic that older people often experience as daylight fades during the late afternoon and evening. It can cause elderly people to become agitated, restless, irritable, and confused. Sundowning affects up to two-thirds of people with dementia but can happen to any older person.
People experiencing sundowning may become extremely confused, agitated, and restless. They may not know where they are, begin to hallucinate, or act aggressively towards others.
Many hospitals have protocols in place to prevent sundowning, such as light therapy, where rooms are kept bright during the day and darkened at night. Other methods include providing patients with reminders of the time and day, keeping hearing aids and glasses within reach, getting patients out of bed, making sure they stay hydrated and well-fed, and reducing noise to allow patients to sleep.
