Sundowners Syndrome, Dementia and Wandering

Sundowners syndrome and dementia graphicIf you care for a loved one with dementia, whether Alzheimer’s disease or any other form of dementia, you may encounter some challenging behaviors over time.  Dementia affects complex thinking and memory in ways that may cause the person with the disease to suffer from confusion, anxiety, agitation and paranoia.  Wandering and sundowners syndrome behaviors are also common among sufferers of dementia.

First, here are some basics on terminology and the “what” and “why” of these behaviors:

What is Sundowners Syndrome?

As described by Aging Wisely in their article on Sundowners Syndrome, the term describes “a pattern of increased behavior problems in the late afternoon and early evening”. When sundowning, “persons may exhibit increased confusion, agitation, wandering, hallucinations and general disorientation”. 

Why does Sundowners Syndrome occur?

There are a variety of possibilities/factors that may cause this phenomena, from light patterns and the person’s related circadian rhythms to established patterns (i.e. the time of day we often associate with transition such as coming home from work), being tired or medication timing.  Some work with light therapy has had a positive impact on symptoms, in addition to traditional behavioral therapies, redirection and pharmacological solutions.

What is wandering and when/why does it occur?

About 60% of people with dementia will wander, according to the Alzheimer’s Association. 

The confusion associated with Alzheimer’s disease can lead to wandering off for many “reasons” such as the need to fulfill an obligation (“I need to get to the airport to pick up my mother”, “I need to get back to work”) or return home (home often being a concept or some long-ago home due to lack of familiarity with current setting and poor short-term memory).  General agitation and a feeling that something is not right or fear and discomfort about a current environment can also be part of wandering.  Medication side effects, infection or illness can exacerbate agitation and instigate wandering.  Unfortunately, many of the medications used to treat behavioral symptoms of dementia can also exacerbate effects.

You should assume your loved one with dementia will wander at some point.  We often hear from families who say that their elder parent with Alzheimer’s has never wandered or they have always been able to keep a close watch on him/her, but we warn that even in these cases you should take precautions.  In a progressive disease such as Alzheimer’s, different symptoms will occur over time.  If the person still has some degree of mobility, he or she could begin to wander at some point and a different level of supervision and caution might become necessary.

Some quick tips for preparing for behaviors such as sundowning and wandering:

  1. Watch for changes in your loved one’s behavior as both an indication that things may be changing which require caregiving adaptations (i.e. not being able to leave the caree alone or taking safety precautions) and a signal of other concerns (sudden behavior changes may mean there is an underlying infection, for example).
  2. Take precautions proactively.  Sign up for the Alzheimer’s Association Safe Return program, consider monitoring or tracking systems (such as Safety Net by LoJack), take simple steps in the environment (lighting and activity changes to help with sundowners, door locks and “distractors” at doorways for wandering reduction).
  3. Look towards activities to distract and calm. Does music help to calm the person?  Can you plan activities for engagement during restless periods?  Does exercise help?  What activities help to redirect the person’s energies?
  4. Closely monitor changes that may be related to medications, especially when changes are made.  A geriatric specialist such as a neurologist who works primarily with memory disorders or a geriatric psychiatrist may be most helpful in finding the appropriate balance of medications.  Unfortunately, some of the medications most often used to reduce agitation and other behavioral symptoms can be particularly problematic for elders and those with dementia.  The solution may be worse than the original problem.

Every caregiver will find different techniques to deal with some of the behavioral issues that accompany Alzheimer’s disease.  Every path will be different for both caregiver and caree.  One thing our home health caregivers find most helpful in dementia caregiving is creativity.  The caregiver must adapt to the changes of this progressive disease.  We understand this can be an exhausting job for family caregivers.

We have brought together a number of tips and resources from our many years of dementia care experience to help caregivers with ideas and solutions.  We invite you to grab your free copy and share it with others who you think might benefit.






Our EasyLiving home health caregivers are specially selected, trained and supported to assist your loved ones with dementia.  We provide Alzheimer's Specialty Care in the home, extra one-on-one care for persons in Assisted Living Facilities, hospital sitters and respite care for Alzheimer's family caregivers.  We can set up personalized care plans to manage wandering and other behavioral concerns associated with Alzheimer's in a dignified and caring manner. 

Contact us today at 727-448-0900 to learn more about how we can help--and how we set up our team members for success so that they can provide the best in home care services to our community--and YOU!