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VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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I'd be careful with Melatonin which sometimes CAUSES bad dreams for elders and did nothing for my mother with advanced dementia to help with Sundowning. The only thing that did work was Ativan every 8 hours, which was increased to every 6 hours towards the end of her life when things got very bad.
Your profile says worrisome things; that your mother lives in her own home and refuses help? With advanced dementia, that's a very dangerous situation! You may need to get guardianship for her so you can have her placed in a Memory Care Assisted Living Facility for safety purposes. If you have POA, you can do that now w/o her agreement if she's been formally diagnosed with dementia by her doctor.
Here's a great 33 page article to read on the subject of dementia in general:
Understanding the Dementia Experience, by Jennifer Ghent-Fuller https://www.smashwords.com/books/view/210580
Here is a list of useful tips from her e-book I found to be excellent:
The “Dont's” · Do not reason and argue · Do not demand that they reason or problem-solve · Do not demand that they remember · Do not demand that they get their facts straight · Do not correct their ideas or scold them · Do not reorient them · Do not think that they are being uncooperative on purpose · Do not think that they really do remember, but are pretending not to · Do not use a “bossy” dictatorial attitude in care · Do not act with impatience
The "Do's" · Enter into their frame of reality, or their 'world' · Be aware of their mood or state of mind · Use few words and simple phrases · OR use no words, just friendly gestures and simple motions · Do everything slowly · Approach from the front · Wait for a slow response · Constantly reassure them that everything is 'OK' · Keep people with dementia comfortable 'in the moment' - every moment · Maximize use of remaining abilities · Limit TV or radio programs which they may feel are frighteningly real · Maintain privacy · Provide a safe physical environment
Language Needs · Use short words · Use clear and simple sentences · Speak slowly and calmly · Questions should ask for a “yes” or “no” answer · Talk about one thing at a time · Talk about concrete things; not abstract ideas · Use common phrases · Always say what you are doing · If they repeat their question, repeat your answer as you did the first time · Give them a longer time to process information · Wait patiently for a response · Be accepting of inappropriate answers and nonsense words · Speak softly, soothingly and gently
Care Needs · Recognize that receiving personal care feels intrusive · Reassure with your tone and manner · Do one thing at a time · Talk through the care “play-by- play” · Be aware of your body language and use it to communicate relaxation and reassurance · Be sincere · Use a soft, soothing touch · Be aware of the individual’s unique triggers · Be aware that a person with dementia may not accurately judge whether a situation is threatening to them · They may respond to fear, pain or anxiety by defending themselves with what we call “aggression” · If they become distressed, stop immediately and allow them time to calm down – don’t try to restart the activity right away You need to change your behaviour to adapt to the dementia because the person with the disease cannot.
Wishing you the best of luck with all you have on your plate.
Turn bright lights on earlier than necessary and keep them on longer. Engage your LO in an activity before or around the time the sundowning usually occurs.
BioMom41, my Dad had sundowning. For him, at night he was transported back in time to the 1940's. He would call me and tell me that his meeting ran late and he missed the last bus home, so he will be stilling at the hotel [which was his apartment at senior living]. I would tell him that was a good idea. There wasn't any treatment for dementia.
Now, your Mom was much like my own Mom as per your profile. My Mom refused caregivers, refused to downsize, refused to use a walker as it would make her look old [she was in her 90's], and was under the impression that my Dad could catch her if she started to fall. No sundowning, but refused to believe everyone had aged around her. I was also a senior citizen.
It took a really bad fall in home in order for me to have my Mom placed in a nursing home, as she needed a village to help her. This is not uncommon, many of us here had to wait for such an event. Not long after that, Dad moved to senior living.
I feel like it's waiting for the other shoe to drop, waiting for that inevitable event that will forever change their future. Like a bad fall. Or a serious acute medical issue. I'm not anxiety ridden over it, but it is a little bit on my mind. In a way, it will be a relief if/when it happens. But mostly, it will be a tragedy.
My mom does get agitated at night sometimes. Can sundowners come and go from day to day?
Some research suggests that a low dose of melatonin — a naturally occurring hormone that induces sleepiness — alone or in combination with exposure to bright light during the day may help ease sundowning.
Respectfully, it makes no sense to use melatonin for sundowning. You don't want someone to feel sleepy that early in the day. It will throw off their circadian rhythm. If you choose to use it at all, give it at night, at bedtime. It doesn't cause sleep or sleepiness, it just chemically associates darkness with sleep.
"Melatonin is a hormone in your body that plays a role in sleep. The production and release of melatonin in the brain is connected to time of day, increasing when it's dark and decreasing when it's light. Melatonin production declines with age."
This Mayo Clinic page also includes a long list of possible prescription drug interactions with melatonin. Never give it without first consulting your doctor.
My mom has it. The symptoms are odd behavior around the evening hours. Hallucinations can also be part of it. My mom thinks people are moving the furniture to make her feel crazy. She's lucid during the day and this only happens when there are certain triggers.
The first think I would do is talk to the person while they are lucid and explain the behavior they are showing and how it's not representative of who they are. They need to understand something is happening because most of the time they won't remember it or it will seems they feel their behavior is ok.
I would even put a camera in the room and record the next episode. It helps them understand more, when they are lucid that you are there to help them.
Part of it is helping them recognize when it's happening. And that's what you need to do...what triggers it, because sometimes there are triggers. With my mom it's loud noises and sounds at night.
Make sure at the end of the day, you turn DOWN the lights, turn off loud tv or music. Get their mind into a calm state.
I wonder if recording their sundowning behavior will help them understand what's happening. If they're in the sundowning stage, I doubt it's likely that they will remember the talk about what might happen, etc. Good idea to turn down lights and noise when it's getting to be time for bed.
It's quite common that Alzheimer's patients aren't aware that they have dementia. It's not denial, it's called "Anosognosia". It's one of the symptoms of dementia and some mental illnesses. This is the challenge that many families face when an elder member develops dementia. Unless they become dangerous to themselves or to others, they can't be admitted involuntarily to a psychiatric facility for diagnosis or for treatment. Sundowning is quite common in early dementia. When the day light begins to fade, the confusion increases because they can't see the points of reference they use during the day.
For my mom sundowner begins in afternoon and lasts through dinner, so from about 3pm til 6pm or so. She becomes visibly agitated and begins pacing, checking/rechecking things around the house, patting the seat where she'll sit later, looking for her comb, looking for her pets that have gone missing....kind of like the rug has just been pulled from under her and she's trying desperately to get herself back on top of things. I've found that filling this time up is the best strategy for us. So at 3pm I serve her a piece of pumpkin pie (all year round), then a drink of water or orange juice then if she's real agitated we'll take a short walk outside, maybe just to the mail box and back. Sometimes she will just pace back and forth through the house which is just fine. She'll usually ask repetitive questions which I try my darnedest to answer exactly the same each time, and this seems to calm her. For example she'll ask "Where are all my cats? I haven't seen them for three days!" I just reply each time that all the cats are in the house safe and sound. During sundowners this will play out several times. Then dinner is served and afterwards the sundowner subsides. This is every day without fail. It helps if I don't plan to do anything important during this time because she is very needy. Plus during her pacing she'll usually make a trip or two to use the toilet and she cannot manage that by herself anymore so I need to be aware of where she is at all times, especially during the pacing episodes. So for us there is no treatment for sundowners as such, just managing the behavior as best we can to minimize the stress on both of us.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
https://www.alz.org/help-support/caregiving/stages-behaviors/sleep-issues-sundowning?gclid=CjwKCAjw9LSSBhBsEiwAKtf0n_NwexzDwrQsfEEIVwGI2ekgMfDzhoM8Cftci4F5-DNIcLFDeGtivBoCnXcQAvD_BwE
I'd be careful with Melatonin which sometimes CAUSES bad dreams for elders and did nothing for my mother with advanced dementia to help with Sundowning. The only thing that did work was Ativan every 8 hours, which was increased to every 6 hours towards the end of her life when things got very bad.
Your profile says worrisome things; that your mother lives in her own home and refuses help? With advanced dementia, that's a very dangerous situation! You may need to get guardianship for her so you can have her placed in a Memory Care Assisted Living Facility for safety purposes. If you have POA, you can do that now w/o her agreement if she's been formally diagnosed with dementia by her doctor.
Here's a great 33 page article to read on the subject of dementia in general:
Understanding the Dementia Experience, by Jennifer Ghent-Fuller
https://www.smashwords.com/books/view/210580
Here is a list of useful tips from her e-book I found to be excellent:
The “Dont's”
· Do not reason and argue
· Do not demand that they reason or problem-solve
· Do not demand that they remember
· Do not demand that they get their facts straight
· Do not correct their ideas or scold them
· Do not reorient them
· Do not think that they are being uncooperative on purpose
· Do not think that they really do remember, but are pretending not to
· Do not use a “bossy” dictatorial attitude in care
· Do not act with impatience
The "Do's"
· Enter into their frame of reality, or their 'world'
· Be aware of their mood or state of mind
· Use few words and simple phrases
· OR use no words, just friendly gestures and simple motions
· Do everything slowly
· Approach from the front
· Wait for a slow response
· Constantly reassure them that everything is 'OK'
· Keep people with dementia comfortable 'in the moment' - every moment
· Maximize use of remaining abilities
· Limit TV or radio programs which they may feel are frighteningly real
· Maintain privacy
· Provide a safe physical environment
Language Needs
· Use short words
· Use clear and simple sentences
· Speak slowly and calmly
· Questions should ask for a “yes” or “no” answer
· Talk about one thing at a time
· Talk about concrete things; not abstract ideas
· Use common phrases
· Always say what you are doing
· If they repeat their question, repeat your answer as you did the first time · Give them a longer time to process information
· Wait patiently for a response
· Be accepting of inappropriate answers and nonsense words
· Speak softly, soothingly and gently
Care Needs
· Recognize that receiving personal care feels intrusive
· Reassure with your tone and manner
· Do one thing at a time
· Talk through the care “play-by- play”
· Be aware of your body language and use it to communicate relaxation and reassurance
· Be sincere
· Use a soft, soothing touch
· Be aware of the individual’s unique triggers
· Be aware that a person with dementia may not accurately judge whether a situation is threatening to them
· They may respond to fear, pain or anxiety by defending themselves with what we call “aggression”
· If they become distressed, stop immediately and allow them time to calm down – don’t try to restart the activity right away
You need to change your behaviour to adapt to the dementia because the person with the disease cannot.
Wishing you the best of luck with all you have on your plate.
Now, your Mom was much like my own Mom as per your profile. My Mom refused caregivers, refused to downsize, refused to use a walker as it would make her look old [she was in her 90's], and was under the impression that my Dad could catch her if she started to fall. No sundowning, but refused to believe everyone had aged around her. I was also a senior citizen.
It took a really bad fall in home in order for me to have my Mom placed in a nursing home, as she needed a village to help her. This is not uncommon, many of us here had to wait for such an event. Not long after that, Dad moved to senior living.
Just food for thought.
My mom does get agitated at night sometimes. Can sundowners come and go from day to day?
"Melatonin is a hormone in your body that plays a role in sleep. The production and release of melatonin in the brain is connected to time of day, increasing when it's dark and decreasing when it's light. Melatonin production declines with age."
Source: https://www.mayoclinic.org/drugs-supplements-melatonin/art-20363071
This Mayo Clinic page also includes a long list of possible prescription drug interactions with melatonin. Never give it without first consulting your doctor.
The first think I would do is talk to the person while they are lucid and explain the behavior they are showing and how it's not representative of who they are. They need to understand something is happening because most of the time they won't remember it or it will seems they feel their behavior is ok.
I would even put a camera in the room and record the next episode. It helps them understand more, when they are lucid that you are there to help them.
Part of it is helping them recognize when it's happening. And that's what you need to do...what triggers it, because sometimes there are triggers. With my mom it's loud noises and sounds at night.
Make sure at the end of the day, you turn DOWN the lights, turn off loud tv or music. Get their mind into a calm state.
So for us there is no treatment for sundowners as such, just managing the behavior as best we can to minimize the stress on both of us.