Why Sundowning Gets Worse in Autumn — And What Helps | CarePrints

You noticed it last week and you weren't sure whether to trust it.

She's been harder in the evenings. Not dramatically — a little more restless around five, a little more insistent about going home while already sitting in her own living room, a little quicker to sharpen at whoever's nearest. You went back through the week looking for what changed. Nothing changed. Same routine, same food, same people.

What changed is outside the window.

In late September the daylight starts going earlier and faster than it did in August, and in most households nobody adjusts anything. The routine that worked all summer was built around a five o'clock that used to be bright. It isn't bright anymore. And late-day agitation — the thing most families know as sundowning — tends to track the light more closely than it tracks the clock.

What's actually happening

Nobody can tell you with certainty why late-day agitation happens, and anyone who says otherwise is overselling. But the pieces that seem to matter are fairly well agreed on.

Fatigue is one. By four in the afternoon she has spent the entire day doing something genuinely hard — working out where she is, who people are, what's expected, over and over, without the shortcuts the rest of us use. That effort doesn't show from the outside. It accumulates anyway, and by late afternoon there's nothing left in reserve.

Light is another. Fading light removes detail. A room she could read at two o'clock becomes a room of shapes and shadow at five, and shapes and shadow invite interpretation. A coat on a hook becomes a person. A dark doorway becomes somewhere she shouldn't be. This is not imagination running wild; it's a reasonable reading of poor information.

And the household changes. Late afternoon is when everyone gets busier — dinner, phone calls, people coming home, the noise level rising. The exact hour when she has least capacity to manage complexity is the hour the house delivers the most of it.

Autumn sharpens all three at once. The light goes earlier, so the shadows arrive while the house is still at full volume, and they arrive at the end of a day she's already spent.

The single most effective change

Turn the lights on before you need them.

Not when it gets dim. Before. Around three in the afternoon, put the lamps on — the ones in the room she actually sits in, and the hallway, and wherever she walks between them. Bright, warm, even light with as few pools of shadow as you can manage.

This is the highest-return change available in autumn and it costs nothing but the electricity. Families consistently underestimate it because it feels too simple to matter. The reason it works is that it removes the ambiguity before her brain starts trying to resolve it. You are not calming her down after she gets frightened; you are removing the thing she would otherwise have to interpret.

A few related adjustments worth making this month:

Close the curtains before dusk, not after. The moment when the window turns into a black mirror is a common trigger. Her own reflection in it is a stranger in the house.

Move the demanding parts of the day earlier. Bathing, appointments, anything requiring cooperation — pull them toward mid-morning now that the useful hours have shortened.

Bring dinner forward. If the routine has dinner at seven, autumn is a reasonable moment to make it six. Hunger and fatigue arriving together is a bad combination and both are easy to prevent.

Cut the afternoon noise. Television off, radio down, fewer people in the room. Not silence, which has its own problems. Just less to process.

Start the activity before the trouble

The mistake nearly every family makes is reaching for an activity once the restlessness has already begun. By then it doesn't work. A person who is already agitated cannot be redirected into a task; the task just becomes one more demand arriving at the worst moment.

What works is having something already underway by half past three. Not something you run — you'll be making dinner. Something she can be occupied by, in the same room, without supervision.

And here's the part that matters most at this hour: whatever it is must not be capable of being got wrong.

At four in the afternoon she has no margin. An activity with a right answer — a puzzle with one solution, a quiz, a game with rules, anything where a wrong move is visible — will find the edge of her capacity and produce exactly the distress you were trying to head off. Late afternoon is the worst possible time to accidentally hand someone an examination.

So: things to look at. Things to sort where any arrangement is a fine arrangement. Things to fold. Things to colour where no shade is incorrect. Photographs to hold and talk about, without anybody needing to name who's in them.

That last one is worth dwelling on, because families so often turn it into a test without meaning to. Do you remember who this is? is a question with a right answer, asked at the hour when she is least able to produce it. This one's a good one, isn't it is not a question at all, and it gets you the same afternoon together with none of the risk.

Two weeks, and what to watch for

Give any of this a fortnight before judging it. Changes to routine produce resistance before they produce calm.

And one thing to rule out first. If the evening difficulty arrived suddenly — over days rather than weeks — that's a different pattern and it's worth a call to her doctor. Sudden changes in behaviour are frequently caused by something treatable and entirely unrelated to dementia. A urinary tract infection is the usual suspect, and it is extremely easy to miss in someone who can't report symptoms.

Gradual worsening as the season turns is ordinary. Sudden worsening is information.

The light is going to keep going earlier until December. You have about six weeks of adjusting ahead of you, and the households that do it deliberately have measurably easier winters than the ones that wait to see how bad it gets.

Start with the lamps. Three o'clock. Today, if the sun's already thinking about it.

Our Picture Memory Cards are built for precisely this hour — large, clear images of familiar scenes and objects, made to be looked at and talked about rather than identified. There's no right answer printed on the back, because there's no question being asked. [See the collection →]

This article is for general information and is not medical advice. Sudden changes in behaviour, sleep or alertness should be discussed with the person's physician.