Caregiver Blog: A Caregiver’s Guide to Recognizing Wandering and Sundowning in a Dementia Patient

Article Categories: Caregiver Corner & Diseases and Conditions

Caregivers may find themselves caring for a patient with dementia or Alzheimer's disease in the length of their career, and it is important to understand certain information about signs of a worsening condition such as wandering and sundowning.

Wandering is a behavior seen in advancing dementia where the patient’s confusion and disorientation causes them to walk aimlessly from place to place. Wandering patients cannot recall their names, and they may not remember where they have been or where they are going
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Did you know that 6 out of 10 people with dementia will wander? This is the reason why caregivers must recognize the signs of wandering to keep their patients safe. Here are some warning signs to watch out for:

- their walk or drive takes longer than usual

- they ask how to get to a familiar place

- they talk about going to a place where they usually go to when they were younger

- they say they want to ‘go home’ even if they are home

- they have trouble looking for the bedroom or the bathroom

- they ask where a relative or a friend lives

- they show signs of restlessness such as pacing

- they could not finish a familiar task such as putting away the dishes

- they are looking lost when they are in crowded places such as malls or shops

Caregivers must observe these signs and closely supervise the patient at all times to prevent the patient from being harmed if they wander.

Another challenge that a caregiver may face in caring for a patient with advancing dementia is sundowning. People usually love sunsets. But for caregivers of patients with advancing dementia, it is a time they fear because as the sun disappears on the horizon, their patient’s behavior changes for the worse.

Just as the name suggests, sundowning is a term used to describe a patient’s worsening dementia signs and symptoms. The changes begin at dusk and last throughout the night. At the start of the evening, the patient will appear more confused, disoriented, and forgetful. They might even be having hallucinations, verbal outbursts, and mood changes. As if these challenges are not yet enough, the patient will also have trouble sleeping at night. One in every five patients with dementia will experience it, so caregivers must be aware that this can likely happen to their patient if they have Alzheimer’s disease.

Here are some triggers of sundowning to watch out for:

- the patient is tired from either a physical or mental exertion, especially toward the end of the day

- the patient’s normal 24-hour body rhythm (Circadian rhythm) is disrupted causing their body to react with confusion as they mix up night and day

- the environment is dark, which creates shadows that sundowning patients usually misinterpret

- the patient sees that their caregiver is frustrated or irritable while caring for them

- a change of workers at the end of the shift if the patient is in a facility or a hospital

- winter, a time when daytime is shorter

Caregivers who provide assistance to people with dementia such as Alzheimer’s disease are faced with many challenges. Wandering and sundowning are just two of the many aspects of providing care to these patients. Knowing what to expect will make you understand that these signs are just a part of the patient’s illness and that you need to prepare yourself and act in the patient’s best interest when dealing with such situations. More importantly, being aware will help you keep your cool during these challenging times.


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